A Global Social Contract for a Healthy Global Society?

The world was appalled when HIV/AIDS was ravaging sub-Saharan Africa but lifesaving treatment was priced out of reach of 99% of the population in 2001. It was heartbroken when an earthquake brought unprecedented devastation to Haiti in 2010 and to Japan in 2011. It was outraged when 15-year old Malala Yousafzai was shot in the head for advocating that girls be educated in 2012. And it was shocked when thousands of civilians in Syria were attacked with chemical weapons in 2013.

We live in an increasingly global society. This global society is one that is marked – like all societies – with diverse and often conflicting values, views and interests, and by societal arrangements that can be grossly unjust. But it is also marked by new possibilities for solidarity. Globalization has decreased the social distance between individuals and communities worldwide. To each of the events mentioned above – and innumerable more – there has been a social response marked by empathy and collective action, however imperfect.

However, unlike at national level, this global society is not yet underpinned by a global social contract. If we consider all members of the human race to belong to a global society, what kind of global social contract of rights and responsibilities could be constructed to promote its overall welfare?

Protecting the well-being of a population has been a central objective of the national social contract, and primary responsibility for the health of a population lies with the nation-state. However, the factors that affect health are increasingly beyond the control of any single government. National health systems are struggling for money, staff, and medicines, and they are struggling to regulate powerful actors.
How can we expect them to function when globally we are not training enough healthcare workers to meet societal needs, and failing to stem the braindrain of highly-educated health personnel from poorer to richer countries? When international intellectual property rules allow drug prices to be set at unaffordable levels, while failing to stimulate research into the diseases primarily affecting the poor? When the global threat of pandemic influenza is not matched by an adequate system of vaccine production and global access? When the rapid movement of capital across borders undermines the national tax base required to finance health systems? When health budgets are slashed by austerity policies and financial crisis? When international investment treaties tie the hands of governments to regulate the marketing of tobacco, for example, or to ban dangerous chemicals? When global media make it easy to evade national regulations on the marketing of alcohol or other restricted products to minors?  

In other words, in a globalized and interdependent world, nation-states acting alone cannot fulfill their national social contracts.  But in the absence of a robust global social contract, how can social welfare be protected and promoted?

The paper that the ISGlobal Think Tank is presenting this week -A Global Social Contract for a Healthy Global Society: Why, What and How- argues that health is a compelling theme around which a global social contract could begin to take shape. The contract should encompass four elements: resource pooling for social protection, regulation, provision of global public goods, and legitimate processes of global governance. A global social “contract” does not have to mean a written document, but rather could be a set of formal and informal norms and rules that lay out expectations of the rights and obligations of the members of a society. While there is not yet a set of institutions that could reasonably be called a global social contract, its contours can be glimpsed in evolving norms around minimum standards of a decent life, universal human rights as well as cross-border obligations, and rules that aspire to create a better-governed world. A more concrete, operational global social contract may very well lie within reach.

Related Event

Seminar: Building a Global Health Social Contract for the 21st Century