Pragmatism, Structural Reform and the Politics of Inequality in Global Public Health

Despite broad international agreement on the importance of addressing global health inequalities on grounds of both social justice and health security, there is little accord on how this should be done. The Debate that follows interrogates the role that capital and corporate institutions have assumed in defining and implementing global healthcare reforms. The contributors to the Debate do not agree on the legitimacy of the classic oppositions in design of healthcare state vs market or public vs private. Nor do they concur on the (in)compatibility between pragmatic collaboration with corporate institutions and realization of norms of social justice in health. Yet all do agree that unequal access to healthcare is only one of the structural determinants of inequalities in global health. Global capital is implicated in structural patterns of investment that have made jobs, wages and land-based livelihoods insecure and unhealthy, fouled air and water and profited from spiralling costs of drugs and treatment. On such an economically and politically conflictual terrain, it is unlikely that collaboration with corporate institutions is consistent with structural assault on the social determinants of global inequalities in health.