A Proposal for a Framework Convention on Global Health

This article searches for solutions to the most perplexing problemsin global health—problems so important that they affectthe fate of millions of people, with economic, political, andsecurity ramifications for the world's population. No State,acting alone, can insulate itself from major health hazards.It is for this reason that safeguarding the world's populationrequires cooperation and global governance. What is truly needed,and what richer countries instinctively do for their own citizens,is to meet what I call ‘basic survival needs.’ Byfocusing on the major determinants of health, the internationalcommunity could dramatically improve prospects for good health.A vehicle such as a Framework Convention on Global Health (FCGH)could powerfully improve global health governance. Such a FrameworkConvention would commit States to a set of targets, both economicand logistic, and dismantle barriers to constructive engagementby the private and charitable sectors. It would stimulate creativepublic/private partnerships and actively engage civil societystakeholders. A FCGH could set achievable goals for global healthspending; define areas of cost effective investment to meetbasic survival needs; build sustainable health systems; andcreate incentives for scientific innovation for affordable vaccinesand essential medicines.     

The Great Unraveling: Federal Budgeting, 1998–2006

Since 1998, budgeting reforms at the federal level have unraveled extensively. The budget process has become ad hoc, fragmented, and opaque, balance has been elusive, and the failure to prioritize has become endemic. One cause was the mismatch between the budget process in 1998, which was designed to eliminate deficits, and the emerging budgetary surpluses of that time. A second contributing factor was the desire to reduce taxes while expenditures were increasing as a result of wars and natural disasters. The consequences of this great unraveling include the failure to fund Medicare and Social Security adequately when the opportunity was presented, as well as threats to constitutional and democratic governance. Renewed reform may require greater transparency and a willingness to embarrass elected officials with iconic stories.     

Clinical Ethics and the Road Less Taken Mapping the Future by Tracking the Past

Although various aspects of clinical ethics consultation have been discussed in the literature, there has yet to be sustained systematic debate about the fundamental philosophical and methodological issues at stake in doing clinical ethics. Arguing that the field of clinical ethics is at ta critical crossroads, the author of this article outline the core issues that need to be addressed, debated, and resolved in order for the field to secure a meaningful future.