Global health and moral values.

Soon after assuming office on July 21, 2003, the new Director-General of WHO, Jong-Wook Lee, announced plans to launch several global health initiatives: reenergising primary health care to achieve the Millennium Development Goals (MDGs), launching the ambitious 3 by 5 initiative to expand access to antiretroviral drug treatment to 3 million HIV-positive people by 2005, and accelerating country-based action through strengthening human resources. A similar pattern of new global initiatives characterised the opening phase of the previous WHO administration led by Gro Harlem Brundtland, launching programmes such as Roll Back Malaria, Stop TB, tobacco control, polio eradication, and partnerships such as GAVI (Global Alliance for Vaccines and Immunization). Ethics and moral values are invariably invoked to mobilise support for these global initiatives. Earlier on in May, 2003, Lee used the terms social justice and security in his address to the World Health Assembly. On assuming office, he underscored that “global health work must be guided by an ethical vision”. Recently, he wrote: “Both technical excellence and political commitment have no value . . . unless they have an ethically sound purpose.” If ethics are the foundation for global health initiatives, how should moral philosophy guide policy choices and shape the way such programmes are undertaken? In this essay we argue that clarity regarding morality underlying global health initiatives is important, both for why and how programmes should be undertaken. Common moral values might be used to justify new global programmes, suggesting that the programmes might be Lancet 2004; 364: 1069–74