In their recent article Values in Global Health Governance, Professors Benatar, Lister and Thacker call into question the values that direct our actions today in global health. The argument they put forward is that current approaches based on individualism and the respect of human rights, economic liberalism, corporatism and managerialism, a focus on biomedical science rather than social solutions, and a simplistic linear approach to health problems have failed. The origin of these failures, they suggest, stems not from our actions themselves but the overarching values and ideologies which have determined our actions. As such, they bring into question the very fabric of modern civilisation. In solution they suggest that the academic field of bioethics be transformed into a forum to promote a public discourse on new values and the development of a framework that combines understanding of global interdependencies with enlightened long-term self-interest.

The world described by the authors is bleak indeed. The foundations of modern society have failed us evidenced in the disparities in health and wealth that remain persistent and have even expanded despite tremendous economic growth and global frameworks such that the Universal Declaration of Human Rights. The main problem, they claim, is that human rights, and in particular, second generation rights like the right to health, have been subsumed within a hierarchy of values subservient to free market ideology. This is a world in which profit driven incentives for trade and investment protect the rights and freedoms of corporations over those of communities-thereby undermining democratic processes and accountability. Unethical business practices have in turn fuelled poor governance, war and devastation. Efficiency motives and cost containment practices have led to public institutions which behave like commercial businesses-the public increasingly seen more as customers than as citizens. Furthermore, those values of profit and efficiency have pinned humanity's blinkered hopes on new technologies such as vaccine and medicine production while would-be gains from the wiser use of existing knowledge, resources and preventive measures are overlooked.

Benatar, Lister and Thacker, argue clearly that what is needed is a new paradigm centred on sustainability and global distributive justice. The authors are to be lauded for boldy making the leap from describing what needs to be done to describing how it might be achieved. We believe the authors are right to suggest that a new world order-a re-writing of the institutions of global economic and social governance, and furthermore that a shift in human mentality from the international mode to the global-is desperately needed. A new public discourse that can shake the values on which we base our actions may indeed be what is needed. However, will a re-conceptualisation of bioethics provide a space for discussion sufficient to rival the dominate discourse? It's true that there may now be a window of opportunity to shift the dominant value base presented by the transition from a G8 to a G20 world order. Perhaps the question now is can we develop new values from which to shape our actions? Or are our values rather demonstrated as a consequence of the actions we take as a global community, and thereby restricted in scope by the gravitational pull of path dependency?

These comments may at first come across as sensational or overdramatic, but let's not forget that this article is calling for a revision of nothing less than the very pillars of modern society. In today's day and age ideological revolution is perhaps a concept left only for the historians. It surely won't hurt to call for more dialogue, more deliberations on how the world is run-with issues such as climate change at the top of the international agenda it appears that humanity is finally gaining a view of its condition that is approaching "global", but I fear we have yet to find that Archimedean point from which the forces of change can actually be rooted.

Values in global health governance
S. R. Benatar ; G. Lister ;S. C. Thacker
Global Public Health: An International Journal for Research, Policy and Practice, 1744-1706, First published on 05 January 2010
http://www.informaworld.com/smpp/title~db=all~content=g909933751