From charity to rights: proposal for five action areas of global health.

I believe that we are at a turning point for public health—and that our choices are stark: either we reorient and strengthen public health within both modern and developing societies and institute a resilient system of global governance for health or we will face dire consequences in terms of human, social, and economic development. At present, it is the poorest countries that are paying the price for this negligence—but we have mounting signals that a new health divide is in the making as a large global underclass spreads out around the globe and defies the old definitions of vulnerable groups. Forceful action at nation state level will not be enough—we need nothing less than a new global social contract on health. I was delighted to see the use of that phrase also by Richard Smith, editor of the British Medical Journal in a recent excellent editorial. The drive for such a contract can only be established politically—developed through an ethical and political debate throughout society initiated by outspoken public health professionals, responsible politicians, and a concerned civil society at national and global levels of governance. And maybe this is the time for the respective journals to make this a joint wake up call to our professional community. We have reached a point where we need to make a choice of what kind of model of global public health we want to promote. It was one of the characteristics of modernity to take health out of the confines of religion and charity and make it a key element of the action of the state and the rights of citizenship. This process, initially within the context of the constitution of the nation state, today needs to go global as a key dimension of global justice. The International Labour Organization with its recent report on globalisation has presented some first steps in this direction. With such a perspective we can see that the present global drive for access to AIDS medicines for developing nations is not just about health, it is the spearhead of a global citizenship movement that has recognised that global health needs to move out of the charity mode of bilateral aid and philanthropy into the realm of rights, citizenship, and a global contract. With this in mind I would like to propose five key action areas for a global public health: