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Hastings Center News

Cofounder Daniel Callahan Organizes Global Health Meeting

Daniel Callahan, cofounder and president emeritus of The Hastings Center, organized a daylong meeting to explore urgent issues in global health and discuss ways that bioethics can help address them. The meeting, which took place at the Center on November 1, focused on the stark disparities in access to health care, inequities and human rights concerns in women’s and reproductive health, and the rise of chronic illness around the world.

His reason for holding the meeting was to stimulate a greater interest within the field of bioethics in global health care. “Much too often over the decades its importance was pushed aside by issues facing developed countries,” said Callahan (middle photo, right). “There is a gap to be filled, and we hope the Hastings Center can help close it.”

Presentations were made by leaders in global bioethics. Solomon Benatar (middle photo, center), a Hastings Center Fellow who is an emeritus professor of medicine at the University of Cape Town and a visiting scholar in bioethics at the University of Toronto, began with a discussion of global disparities in economics and health. “Seventy-percent of the world population lives on less than $10 a day,” he said. “The challenge is to create a dialogue that doesn’t exist. We need to change the paradigm about health and economics.” The paradigm he would like to see is centered less on individual freedoms and more on social strength – as he put it, “from the anthropocene to the symbiocene.”

Ruth Macklin, also a Hastings Center Fellow and professor emerita of Albert Einstein College of Medicine, discussed health disparities for women around the world, noting that they are deeply rooted in cultural norms, including religious teachings and ideological and political factors. She said that these disparities are likely to be exacerbated by policies of the Trump administration. It has reduced funding for the United Nations Population Fund, which supports contraception and reproductive health and HIV prevention and treatment in more than 150 countries. And it reinstated and expanded the “Mexico City Policy,” also known as the “global gag rule,” which requires any overseas organization receiving U.S. aid not to have anything to do with abortion. “The global gag rule violates the ethical principles of autonomy, beneficence, and justice,” said Macklin, a recipient of The Hastings Center’s Henry Knowles Beecher Award for lifetime achievement in bioethics.

Michael Gusmano, a Hastings Center research scholar, presented findings from the World Cities Project, which he codirects, and which compares the performance of health, social, and long-term care systems in large cities in wealthy countries around the world. He and his colleagues are looking at the degree to which these cities are addressing disparities in health care and health care access. Gusmano focused on India and China, the two countries with the largest populations in the world. Both have aging populations, inadequate public health infrastructures, and significant social inequalities. A key difference, he said, is that China has been investing in public health and health care, which might help its aging population remain healthy and productive.

Callahan ended the meeting by discussing the burden of chronic conditions, long a scourge in the developed world and now rising in resource-poor countries. He said that chronic diseases, including cardiovascular disease, diabetes, and cancer, emerge about 10 years earlier in poor countries than in wealthy countries. These diseases are extremely expensive to treat, straining the health care systems of wealthy countries and likely to overwhelm the capacity of poor countries.

To reckon with the challenges posed by chronic disease, Callahan called for a new model for medicine, applicable for both rich and poor countries. He called it “sustainable medicine,” meaning that it is affordable for a country in the long term, not open-ended in its aspiration to extend individual lives, able to keep health care costs below a country’s annual gross domestic product growth, and able to be equitably distributed.