Regulation of the Global Marketplace for the Sake of Health

Abstract

Mounting evidence suggests that socioeconomic status is a determinant of health. As nations around the globe increasingly rely on market-based economies, the corporate sector has come to have a powerful influence on the socioeconomic gradient in most nations and hence upon the health status of their populations. At the same time, it has become more difficult for any one nation to influence corporate activities, given the increasing ease with which corporations relocate their operations from country to country. As a result of all of these factors, nations wishing to assure the health of their populations will need to both involve the corporate sector and cooperate with other nations. Mounting evidence suggests that socioeconomic status is a determinant of health. As nations around the globe increasingly rely on market-based economies, the corporate sector has come to have a powerful influence on the socioeconomic gradient in most nations and hence upon the health status of their populations. At the same time, it has become more difficult for any one nation to influence corporate activities, given the increasing ease with which corporations relocate their operations from country to country. As a result of all of these factors, nations wishing to assure the health of their populations will need to both involve the corporate sector and cooperate with other nations.In this article, we review the business ethics literature and consider what justification it might provide for requiring multinational corporations to attend to concerns about population health. We adopt Thomas Donaldson and Thomas Dunfee's Integrative Social Contracts Theory and Donaldson's ethics of international business to provide a basis for arguing that norms derived from a hypothetical social contract impose some ethical obligations on corporations. We modify their theories to suggest the possibility that emerging recognition of the relationship of economic gradient to health status may provide both new grounds for a duty of corporations to avoid depriving health, as well as a mechanism for having groups of nations as the parties to the contract with the corporation. This ethical analysis justifies the regulation of corporations that operate in the global marketplace and lends grounds for a global economy that aims to promote not only free trade, but population health as well.To be healthy is an interest of all individuals and it is an interest that individuals cannot address entirely on their own. The usual strategies for maintaining health have been found in the domains of public health and medical care. But those with a commitment to assuring population health will have to contend with a surprising finding --one that defies the usual strategies of these traditional domains: A growing body of scientific evidence indicates that socioeconomic factors are powerful determinants of health. Specifically, both economic status and socioeconomic gradient influence health status, a circumstance that is true even when health care is universally avail...

A Critical Perspective of Integrative Social Contracts Theory: Recurring Criticisms and Next Generation Research Topics

“…Application of ISCT to specific ethical issues ISCT has been applied to a wide variety of ethical issues, including gender discrimination where cross cultural norms conflict (Mayer and Cava, 1995); computer ethics (Conger and Loch, 2001); downsizing (Van Buren III, 2000); bribery ; the role of corporations concerning the impact of relative wealth distribution on human health (Danis and Sepinwall, 2002); privacy and direct marketing (Culnan, 1995); consumer privacy issues in South Africa (Higgs-Kleyn et al, 2000); the marketing of family planning in Bangladesh (Smith, 2000); brownfield development (Poindexter, 1995); sweatshop labor standards (Hartman et al, 2003); costing issues involved with distributing life-saving pharmaceuticals in developing countries Sama, 2003, 2004); banks' marketing of credit cards to college students (Lucas, 2001(Lucas, , 2004; employee whistle-blowing and deviance (Warren, 2003); the influence of location between Russia and the United States on ethical attitudes ; a comparison of norms between entrepreneurs and managers in a cross-cultural context ; the globalization debate (Mayer, 2001;Madsen, 2003); the effect of national identity and degree of integration of expatriates into host country environments on ethical attitudes ; identifying norms associated with urban prosperity initiatives (Cava and Mayer, 2004); corporate drug testing programs (Strong and Ringer, 2000); and understanding corporate governance in Russia (McCarthy and Puffer, 2004). Beyond these, TD2 have given many examples in their writings about ISCT.…”

A review of management of infertility in Nigeria: framing the ethics of a national health policy

“…In effect, only clients covered by some third party arrangements such as retainership can afford PME services.”28 Thus, it will often be the case that the goals of medicine as expressed by physicians practicing in the private sector will necessarily (thus, with defensible ethical warrant) be subordinated to those of public health, given the country’s pattern of disease and the resources available in the public sector and under the purview of a ministry of public health. This is all the more so in a case such as Nigeria, which has a national health system per capita expenditure of US$9.44 29. Infertility as a problem faces stiff competition for available resources in this context.…”

“…Health policy scholar Larry Churchill29 commented, “ethical problem solving without the benefit of theoretical reflection is like digging a garden with one’s bare hands rather than using the appropriate tools,” even as one may reasonably say, in balance, “theoretical reflection that is untested by involvement in the concrete particulars of life is like reading about gardens without ever planting and tending one.” The foregoing question – “ Who is entitled to what services within the available resource constraints and restraints on performance?” – attests to the problem of identifying standards of assessment. This is a problem of ethics, given asserted claims of entitlement to specified services.…”

“…Let us consider this question in terms of the debate within an ethical theory between those who advocate a utilitarian approach to the allocative decision and those who advocate a justice as fairness (“contractarian”) approach – the ethical decision then being gauged in terms of a commitment to either a principle of utility (or principle of “average” utility, as argued by Harsanyi58) or the difference principle (as articulated by John Rawls). Here it is instructive to consider the arguments presented for the Rawlsian approach to ethics and health policy, presented by Danis and Sepinwall29 and then assess that position in relation to the criticisms of Rawls’s theory as presented by Harsanyi 58. Presumably, arguments in favor of “justice as fairness” as applied to health sector decision-making generally could be articulated more specifically relative to the problem of infertility in a developing country setting of decision, even as the utilitarian argument can be likewise developed for the purpose of comparative instruction.…”

“…Danis and Sepinwall29 consider a series of evidence claims about social determinants of health, making it clear on empirical grounds that income/health gradients (eg, life expectancy in relation to gross domestic product per capita) are not the result of some fixed or determinate laws of economic development but instead are influenced by policy choices. Further, they argue, income/health gradients are not merely the result of deprivation of the poorest groups but operate across the whole socioeconomic spectrum within societies – and this would hold true for a developing economy as well.…”