When surveying policy documents on global health one is often struck by a general lack of theorizing about why we have moral duties to promote equitable global health initiatives and in regards to what prioritized values should represent the satisfaction of these moral duties. Although there is general agreement that current inequalities in global health provision exist, and agreement that some form of response is necessary, there is little consensus about what should be done to rectify this situation. The purpose of this article is to explore four normative arguments about why we might have global health responsibilities and to examine their relationship with distributive principles for the alleviation of global health inequalities. Through this examination it will be argued that current theorizing about global health rests on opposing ontological perspectives about what global health should prioritize and that these presuppositions result in distinctively antagonistic normative demands about how we should distribute, who gets what and why.
Creating a more equitable distribution of global health requires policy makers to seriously rethink the key presuppositions, assumption and biases that underpin and perpetuate the inequalities involved with current global health policy.
In rethinking global health policy – and if we believe reaching some level of health equity to be a morally important endeavor – then greater commitments to the distributive and deliberative properties of cosmopolitan developmental partnerships will be required.
To this end, global health equity will require cosmopolitan commitments to individual health beyond state and civilizational boundaries, a renewed focus on the social determinants of health, key reforms to unjust global economic practices, and the reformation of global decision making toward more inclusive and deliberative governance formations.