B. Who Has the Responsibility to Ameliorate the Vast Disparities in Global Health?

A core insight about health disparities is that there are multiple causal pathways to numerous dimensions of disadvantage. The causal pathways to disadvantage include poverty, poor education, unhygienic and polluted environments, and social disintegration. These, and many other causal agents, lead to systematic disadvantage not only in health, but also in nearly every aspect of social, economic, and political life. Inequalities of one kind beget other inequalities, and existing inequalities compound, sustain, and reproduce a multitude of deprivations in well-being.

Human instinct tells us that it is unjust for large populations to have such poor prospects for good health and long life simply by happenstance of where they live. Although almost everyone believes it is unfair that the poor live miserable and short lives, there is little consensus about whether there is an ethical, let alone legal, obligation to help the downtrodden. When are health inequalities between different societies unjust, and what do wealthier societies owe as a matter of justice to the poor in other parts of the world? Even if reasonable people believed that health disparities were morally wrong, they would be hard pressed to answer the difficult questions: Why are inequalities unfair? Who is responsible for ameliorating the high rates of illness and death? And what level of assistance is ethically warranted?