Ethical Foundations of Critical International Health

Recently, I attended the 10th annual Western Region International Health Conference at Oregon Health Science University, April 5-7, 2013 in Portland, OR. There, Dr. Chunhuei Chi of Oregon State University delivered the morning plenary talk: Against the Golden Rule- Ethical Foundations of Critical International Health. Chi described the “golden rule” as the ethical framework and political/economic structure that informs the current landscape of global health and development. Essentially, resource rich governments, organizations, and foundations hold the “gold” and therefore set priorities and make the “rules.”

Chi deconstructed traditional and neoliberal motivations behind participation in global heath, which are prominently dictated by compassion and human rights. Compassion, he argues, involves self-interest; ones own values; and a need for “similar possibility.” Priority setters tend to show greater compassion when the possibility for a problem is easy to conceptualized through the lens of their own lives and experiences. To illustrate this concept, Chi described how paranoia for the spread of the H1N1 in 2008-09 eclipsed the suicide epidemic of Indian farmers during that same time period. Although controversial, many believe this suicide spike was correlated with the World Bank’s policies that forced India to open its seed sector to terminal seeds from global corporations such as Monsanto, Syngenta, and others.1 Because the threat of flu felt more relevant and more likely to affect so called gold-holders, global resources flooded to the relatively tame H1N1 outbreak, while mental health and suicide remain sidelined.

While Dr. Chi certainly was not advocating for less benevolence in health policy, he did challenge the audience to critically examine how compassion from personal experience influences ones perception of a problem. Instead of emotion-based decision making, Chi advocates for a framework of ethical principles he calls “Critical International Health” which encompass human dignity, solidarity, and self-determinism. To further breakdown the golden rule, Chi suggests putting golden rule makers on the defense; holding developers, workers, and researcher accountable to the community they intend to serve; and reducing the need for “gold” by creating partnerships and building capacity.

This reimagined framework reminds us that as public health workers, clinicians, policymakers, educators, and citizens of the planet, we have a responsibility to act intentionally because the potential to do more harm than good is always looming.


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