The World Is Fractured – Could Healthcare Save It?

Fighting HIV in South Africa, building hospitals in Syria, tackling Tuberculosis in Cambodia, stopping mpox outbreaks in the DRC, responding to Ebola in Uganda – these were all programs previously funded by USAID.1 However, on the 20th of January, the White House issued an executive order pausing all international aid by the US, thereby shutting down programs fighting disease in over fifty countries2 3. The US is not the only country categorically failing to support international health – around the world, wealthy countries are failing despite having both a moral imperative and an economic incentive to invest in global healthcare. Countries that claim to champion human rights or have benefitted from colonisation have obligations to do more. Even those who prioritize national self-interest should recognise that investing in global healthcare protects their own citizens, saves lives, and prevents economic disruption. In this essay we argue that wealthier nations have an evident responsibility to ensure equitable access to healthcare for developing countries, a responsibility derived from human rights, the duty of governments to protect their citizens and historical events.

In the words of the late US President Jimmy Carter, alleviating the suffering of people in other countries is a moral obligation, “an act of kindness, a recognition of our common humanity” 4. One of the easiest ways to do this is widening access to healthcare. The Twentieth Century saw revolutionary medical advances such as vaccines that dramatically increased life expectancy, reduced infant and maternal mortality and improved health equality in wealthy nations. Now, wealthier nations can share the benefits of this technological progress globally, recognising humanity’s inherent equality and improving the quality of life of billions. The absolute equality between all humans underpins the modern system of human rights, principles frequently championed by wealthier countries – yet they neglect widening access to healthcare – ignoring its place in the United Nations Declaration of Human Rights (UNDHR) which has been signed by every member of the OECD5 6. If wealthy nations wish to avoid the obvious hypocrisy, then they have a clear responsibility here to devote more spending to healthcare in developing countries. In the 1970s, a resolution asking developed countries to contribute at least 0.7% of their Gross National Income (GNI) to foreign aid was adopted by the UN General Assembly and accepted by almost all countries with the notable exception of the USA7 8. Yet by 2023, just five countries met this target, not even making up 10% of the OECD’s GDP 8 9. In fact, the OECD average contribution has never exceeded 0.4% of GNI and no country met the target by its original deadline8 9. This underscores how, for decades, wealthy countries have neglected their responsibility to support developing nations and have not met the targets they once accepted as reasonable. If over the past half century wealthy countries had met these targets, the global health landscape could have been radically improved, transforming billions of lives. Wealthy countries have a responsibility to improve health in developing countries not just because of the obvious moral arguments but also because it is a responsibility they have accepted but consistently failed to meet.

There is no denying that some wealthy nations amassed significant parts of their wealth through colonisation, with devastating consequences for global health. When colonial powers seized control, they were not focused on improving the lives of the colonised but rather focused on the ruthless extraction of resources. When colonial powers withdrew, they did not focus on establishing stable, democratic systems; instead, they rapidly disengaged to minimise their own losses. Enter autocratic regimes, civil wars and general chaos – not exactly a breeding ground for positive health outcomes. It has been claimed that in just forty years of British rule in India, one hundred million people were killed by famine and poverty while the damage still endures with life expectancy in India fifteen years lower than that in the United Kingdom10 11. Former colonial powers therefore bear a special responsibility to rectify the damage that they inflicted both in the past, and the enduring harm which has been perpetuated into the modern era.  All but two countries in Africa were colonised by European powers, and in 2023 there were 246 million malaria cases in this region12. Yet the R21 malaria vaccine costs an inconsequential $3.90 per dose13. A vaccine for each of those cases would have cost just under a billion dollars, a truly insignificant amount for countries with trillion-dollar economies built partly on colonial wealth, but lifesaving for millions. The aforementioned technological progress made by Western nations in the Twentieth Century would not have been possible without the riches taken unjustly from colonised nations, so countries that benefited from colonialism (which are now invariably wealthy) have a clear responsibility to repair the damage that they inflicted.

Wealthier nations also have a responsibility to protect their citizens, a duty that improving international health fulfils. The Covid-19 pandemic demonstrated that contagious diseases do not respect borders. Neglecting healthcare in poorer regions creates an incubator for diseases which will inevitably spread to wealthier nations, potentially devastating populations and crashing economies. Is supporting improved global health not a small price to pay to help prevent another global pandemic? The total cost of the Covid-19 pandemic to the USA has been estimated at $16 trillion while in 2023, the federal government spent just $71.9 billion in foreign aid (which is not all spent on healthcare)14 15. The impact on wealthier countries of diseases originating from developing countries will become even greater as populations in wealthy countries age and are therefore more vulnerable to disease. An example of this was an Ebola outbreak in West Africa in 2017 which killed more than 11,000 people.16 If the disease had spread to Nigeria, with its many travel links around the world, it could have become a much greater crisis but thanks partly to the intervention of a group of international health workers on an anti-polio campaign, the disease was contained before it could have an impact on wealthier countries. This example illustrates how foreign aid spent on healthcare protects citizens in wealthier nations, a responsibility of these countries. In 2017, eleven of the US’s top fifteen trade partners formerly received aid from the US17. Trade is mutually beneficial for both economies, so it has helped the US to meet its responsibility to its citizens to deliver economic growth. Moreover, in recent times the USA and China have been competing for influence in global affairs, particularly in key strategic regions such as the Asia-Pacific. As part of this competition, China has developed a “Health Silk Road” as part of its Belt and Road Initiative by which it seeks to invest in healthcare in Africa and central Asia to further its own interests18. To counter this, the USA and its allies should also be investing in healthcare in these regions as by doing so, the USA can simultaneously improve the lives of those in developing countries while also maintaining its authority and expanding its strategic interests. Saving and prolonging lives would be effective methods for building support for the US in developing countries, fostering stronger ties and regional stability. Healthcare spending would make local populations feel valued by the US, creating more popular support for its involvement in their countries. 

81% of German citizens think that immigration has been too high in the last 10 years; Donald Trump has bombastically declared that he will “deport 21 million illegal immigrants”; it seems that immigration from developing countries has become a defining challenge for politicians in wealthier countries.19 20 If, however, wealthy nations had spent the past fifty years investing in global health, it is plausible that immigration rates would be significantly lower than they currently are. By improving healthcare, migrants would have a higher quality of life in their home nations, so would be less likely to move to wealthier countries21. Thus, spending on healthcare aid helps politicians in wealthy countries to fulfil their responsibilities to their electorate.

Additional spending by wealthy economies on healthcare in developing countries is critical, morally, economically and politically but it is crucial that this is distributed correctly. Spending must focus on long-term treatment, not proverbial painkillers. Building effective, independent healthcare systems is key rather than systems which engender reliance on wealthier countries. If wealthy countries want their own citizens to be healthier, their own economies to be larger and to have increased global influence, investing in healthcare is a crucial method of achieving these objectives. Wealthy countries have a responsibility, because of treaties that they have signed, rights which they claim to uphold, and obligations to their citizens, to ensure equitable access to healthcare for developing countries, yet they frequently fail to. Critics warn of corruption and preach national self-interest, ignoring how easily the world could be transformed into a healthier, happier, and more prosperous place for all. The benefits are undeniable – wealthier nations have an opportunity to choose action over apathy by accepting their responsibility to invest in healthcare in developing countries. It is not too late.

Works cited

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