[Equity in global health as a challenge for applied ethics. The case of child mortality]

Socioeconomic inequalities within German society affect the health and thereby the lives of the population: those who are least well-off have the highest risk of illness and premature death. However, the dimension of socioeconomic and health inequalities in Germany is small when compared to that between low- and high-income countries. I here use the example of child mortality, which varies by a factor of almost 100 (Sierra Leone vs. Iceland), to illustrate global inequalities in health. Low-income countries tend to be more affected by child mortality, but not all such countries have equally high rates. Effective interventions to reduce child mortality exist and many are affordable, but they are not being implemented at a sufficient scale. Global inequality in child mortality thus constitutes an inequity. Ethical considerations play a central role when decisions are taken on what control measures are legitimate, and whether the high-income societies have an obligation to intervene. Do the citizens of rich nations carry a moral responsibility for the global inequality in child mortality and for taking appropriate action? Or is it primarily a responsibility of the families and the governments in countries with high child mortality? Should a reduction of the (comparatively small) inequalities in Germany be given priority over reducing global inequalities? I approach these questions from an intuitive, moral position and move towards a critically-reflexive position.