The health of peoples: predicaments facing a reasoned utopia

How might nations cooperate to improve the health of their most vulnerable peoples? There is, presently, no coherent political, social, or ethical framework to answer this question. What progress there is remains piecemeal. Despite a long-term strategy to 2015 enshrining health as part of the process of human development--the Millennium Development Goals--existing institutions are struggling to meet these challenges. The WHO is underfunded and its work in countries is weak. The World Bank is rich but remains unable to free itself from a neoliberal Washington consensus. New institutions--such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria--distort efforts to build a coordinated international strategy for global health. And major policy initiatives (e.g., the Commission on Macroeconomics and Health) lack political commitment to invest in health. In this article, the author traces the beginnings of an answer to the question of what might constitute a political (specifically, foreign policy) approach to improving the health of peoples. A normative model for defining a just health system is urgently required. The author uses the framework of international relations provided by John Rawls to devise a series of policy principles for the health of peoples.