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entails a dual aspect. On the one hand, the promotion of health and social development for their people is understood as “a central purpose of governments” that is yet to be shared by “all sectors of society.” On the other hand, it is underlined that a broad range of initiatives is required, together with improving access to quality health care, in order to realize the right to the highest attainable standard of health. This responsibility can never be reduced to complying with legally binding rules and is now confronted with global challenges. The possibility to close or at least reduce the gap of inequality depends on our capacity to ﬁght against poverty and illiteracy, improve and share natural and human-made global commons, develop new forms of international cooperation, and strengthen the principle of universal justice through the motivation of cosmopolitan solidarity.
The notion of “social responsibility” was ﬁrst introduced in the ﬁeld of economics and rapidly became crucial to the development of “business ethics.” According to its more comprehensive deﬁnition, the notion entails both an enlargement of the actors to whom economic and entrepreneurial activity ought to be responsive and a widening of the goals that such an activity is called upon to include in its strategies. On the one hand, the enlargement of the actors builds on the new stakeholder approach launched by W. Evan and E. Freeman in their breakthrough article on Kantian capitalism published in 1998. The management of a corporation has to be considered responsible not only towards the property and the stockholders’ legitimate interest for proﬁt, but also the many individuals and organizations that are targeted or inﬂuenced by its decisions: customers, suppliers, advocates of special interest groups such as environmentalists, and others. On the other hand, the widening of the goals looks at the broader scope of the obligations that all those institutions whose activity has a signiﬁcant public impact are now supposed to meet. Needless to say, they have to comply with all the requirements and constraints that are legally binding. At the same time, however, they are called upon to take into due consideration other and more encompassing duties stemming from a commitment to boost the welfare and development of the societies they are rooted in as well as to prevent them from suffering the consequences of possible negative “externalities” on the environment, work and living conditions, urban crowding, etc. These “social” responsibilities correspond in many cases to moral rather than legal obligations, so that people who do not comply with them can certainly be blamed, but not put on trial. Yet, no one could ever say that the values involved and the effects that are produced are something “private” or less important. Not to mention the fact that the line to separate what is socially considered as morally advisable and what is legally binding is not ﬁxed once and for all: sufﬁce it to recall the examples of limits and obligations concerning pollution, juvenile work, and social security, which have been often introduced under public pressure.
Article 14 of the Universal Declaration on Bioethics and Human Rights, adopted by acclamation in 2005 by UNESCO’s General Conference, imposed itself as a benchmark for the application of the notion of social responsibility to the domain of health and health care. In this text, it is easy to recognize both the elements that characterize the concept. It is clearly stated that “all sectors of society” share the commitment of governments to promote health and social development for their people as “a central purpose.” At the same time, a holistic approach is proposed. To respect, protect, and fulﬁll the right of every human being to enjoy the highest attainable standard of health, access to quality health care and essential medicines is a fundamental yet insufﬁcient condition: social determinants of health play a role which is just as relevant, starting with access to adequate nutrition and water, improvement of living conditions and the environment, elimination of the marginalization and the exclusion of persons on the basis of any grounds, and reduction of poverty and illiteracy (UNESCO 2005, § 14). Society as a whole, with the deep faults of inequalities that impinge upon the right to attain even a decent standard of health, becomes a crucial issue for bioethics, going far beyond the limits of an approach mainly focused on questions of medical ethics. The global perspective is immediately focused on the fact that every human being is included, without any “distinction of race, religion, political belief, economic or social condition.” Therefore, the following article on the principle of Sharing of beneﬁts reafﬁrms that “beneﬁts resulting from any scientiﬁc research and its applications should be shared with society as a whole and within the international community, in particular with developing countries” (UNESCO 2005, § 15).
The decisive role of the social determinants of health has been long since acknowledged in the most inﬂuential international documents. Article 12 of the International Covenant on Economic, Social and Cultural Rights, adopted in 1966 by the General Assembly of the United Nations, together with the International Covenant on Civil and Political Rights, already mentioned, among the steps to be taken, the healthy development of the child, the improvement of the environment, and all the measures to boost the “prevention, treatment and control of epidemic, endemic, occupational and other diseases” (United Nations 1966b, § 12). In 2000, the United Nations Committee on Economic, Social and Cultural Rights further elaborated on this premise and expounded in greater detail the content of the right to the highest attainable standard of health: this right entails the right “to the enjoyment of a variety of facilities, goods, services and conditions,” which are necessary for its realization, “such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health related education and information, including on sexual and reproductive health.” A further important aspect – the text continues – “is the participation of the population in all health related decision-making at the community, national and international levels” (United Nations 2000, §§ 9 and 11).
In the same document, the States are explicitly referred to the Alma-Ata Declaration, “which proclaims that the existing gross inequality in the health status of the people, particularly between developed and developing countries, as well as within countries, is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.” A list of obligations is detailed accordingly: States parties “have to respect the enjoyment of the right to health in other countries, and to prevent third parties from violating it;” they should “facilitate access to essential health facilities, goods and services in other countries,” as well as “ensure that the right to health is given due attention in international agreements;” those States “which are members of international ﬁnancial institutions, notably the International Monetary Fund, the World Bank, and regional development banks, should pay greater attention to the protection of the right to health in inﬂuencing the lending policies, credit agreements and international measures of these institutions.” Cooperation “in providing disaster relief and humanitarian assistance in times of emergency,” provision “of international medical aid, distribution and management of resources,” and collective responsibility to address the problems stemming from easily transmissible diseases are also mentioned, and it is worth observing the overlap of this issue of international obligations with that of social responsibility in the sense of active participation: “all members of society – individuals, including health professionals, families, local communities, intergovernmental and non-governmental organizations, civil society organizations, as well as the private business sector – have responsibilities regarding the realization of the right to health” (United Nations 2000, §§ 38–42).
As an evidence of this growing awareness, beyond the many Bibliography : in the literature concerning the right to health, it is also to mention the decision of the World Health Organization to establish in 2005 a Commission on Social Determinants of Health, which produced its ﬁnal report in 2008. The report, vis-à-vis the huge inequalities between different peoples of the world, launched the ambitious commitment to “closing the gap in a generation” and proposed three overarching recommendations: (a) improve daily living conditions; (b) tackle the inequitable distribution of power, money, and resources; and (c) measure and understand the problem and assess the impact of action (WHO 2008, p. 10). The International Bioethics Committee of UNESCO has published in 2010 its report on the principle of social responsibility and health, reafﬁrming the importance of placing bioethics and scientiﬁc progress “within the context of reﬂection open to the political and social world” and underlining the responsibility to address “injustice, discrimination, intolerance, violence, accidents and conﬂicts” as the true test of our will “to minimize or eradicate avoidable risk of threats to health and well-being” (UNESCO 2010, §§ 1 and 100). The pivotal role of health within the scope of corporate social responsibility itself strengthens this link. In ISO 26000, the standard for social responsibility that has been worked out by the International Standard Organization, seven “core subjects” are identiﬁed: organizational governance, human rights, labor practices, the environment, fair operating practices, consumer issues, and community involvement and development (International Standard Organization 2010). Health is explicitly mentioned as one of the main issues directly related to the core subjects of labor practices, consumer issues, and community involvement and development, but its relevance for the others is also quite obvious, according to the simple observation that everyone’s health depends very much on the conditions in which people are born, live, work, and age. This observation holds at the global as well as the local level. Sufﬁce it to mention the case of multinational companies or other institutions whose strategies affect millions of people at a time.
The holistic approach to the right to the highest attainable standard of health (simply the right to health, once we clarify that no one, as is self-evident, can ensure an unconditioned right to be always healthy and free from diseases) and health as the cornerstone of the necessarily holistic dictionary and practice of human rights are the two sides of the same coin. This interconnectedness provides the conceptual weaving of the most challenging efforts of the international community to promote justice, equity, and development for every people and every human being. The eight Millennium Development Goals, whose adoption bound all the United Nations Member States to achieve by 2015 decisive improvements in the ﬁelds that had been indicated, may be considered the most illustrative example. The commitment to eradicate extreme poverty and hunger, to achieve universal primary education, to promote gender equality and empower women, to ensure environmental sustainability, and to develop a global partnership for development goes with the commitment to reduce child mortality, to improve maternal health, and to combat HIV/AIDS, malaria, and other diseases. The goal of “global partnership,” in particular, addresses not only the necessity to foster economic growth, but also – among others – the effort to “develop further an open, rule-based, predictable, non-discriminatory trading and ﬁnancial system” and, “in cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries.” Once again, a globalized corporate social responsibility and social responsibility for health appear to be strictly tied to each other.
Many initiatives have been taken at the international level to effectively address the issue of “global” health, such as the Global Forum for Health Research, the Reaching the Poor Programme, and the Grand Challenges in Global Health, which involve both governmental and nongovernmental actors. Three priorities are becoming more and more transparent. The awareness of the many ways through which health is socially determined underpins a two-pronged strategy. Health in all policies, the Adelaide Statement adopted in 2010 by the participants at a meeting promoted by the government of South Australia together with WHO, points out both the necessity to promote health across all sectors of society and that of engaging the health sector in contributing to others: economy and employment; security and justice; education and early life; agriculture and food; infrastructure, planning, and transport; environment and sustainability; housing and community services; and land and culture. This is the way to trigger a fruitful circularity and eventually overturn the causal relationship between a poor social context and poor standards of health. In the second place and for analogous reasons, the “creation of a permanent global health underclass of poor and marginalized people” should be absolutely avoided, looking at “disadvantaged populations within better-off countries” as well as “the vast majority of people in worse-off countries” (Gostin and Friedman 2013, p. 19). In this perspective, the Joint Action and Learning Initiative on National and Global Responsibilities for Health (JALI), to whose Steering Committee Gostin and Friedman belong, has proposed to establish a Framework Convention on Global Health. Last but not least, a decisive shift is required from the beneﬁcence to the active participation approach. The goal of an adequate concept of solidarity cannot be achieved by a top-down charity. Article 15 of the Universal Declaration on Bioethics and Human Rights points at a different pathway, underlining capacity building as a pillar of the principle of beneﬁt sharing. The essential task to perform is that of giving all nations the concrete opportunity of being “producers of research as well as consumers” (WHO 2013, p. xi).
It comes as no surprise to observe that income (wealth) and education (culture) directly or indirectly affect most of the social determinants of health, inasmuch as they play a decisive role in shaping both the scope of opportunities and general living conditions. Availability, accessibility, acceptability, and quality are widely acknowledged as the four essential elements to be included in the commitment to respect, protect, and fulﬁll the right to health. It goes without saying that acceptability largely depends on education and culture, whereas the lack of resources can set up an insurmountable barrier as to the other elements. Life expectancy at birth, income, and educational attainments are indeed the variables that build up the Human Development Index, updated every year by the United Nations Development Programme and integrated through an “inequality adjusted” Index, which makes clear that these faults of inequalities exist even within and not just between the different States, so that poor people living in less developed countries appear to be doubly burdened. Nowadays, this is the way we have to understand the deﬁnition of bioethics as the multidisciplinary endeavor to address “ethical issues related to medicine, life sciences and associated technologies as applied to human beings, taking into account their social, legal and environmental dimensions” (UNESCO 2005, § 1). At the dawn of this century, Albert Jonsen complained about the “narrow philosophical focus” and the lack of attention for “the social dimensions of human decisions and actions” that had characterized bioethics “from the beginning.” “The time has come – he concluded – to move onto higher roads” (Jonsen 2001, p. 23). There is no doubt that bioethics is now treading these new roads.
The responsibility of States and governments for improving the social determinants of health is decisive, and their intervention is impossible to substitute. They are called on, also by international covenants and agreements, to take all the legislative and regulatory measures towards the full realization of the right to health and therefore the steady improvement of the many different conditions for development and well-being of their people. Hard law, which is by deﬁnition strictly binding, contributes to set and boost effective policies by imposing both negative and positive obligations, even though the realization of a social right necessarily requires consistency with the principle of progressivity, that is, the necessity to confront the limits of knowledge and resources with the aim of moving them forward as much as possible. Sufﬁce it to think, beyond health-care infrastructures and the measures to prevent epidemics, of “goods” such as safe food and drugs, clean air and water, urban planning, housing, energy, transport network, educational facilities, security from violence, and whatever kind of discrimination and stigmatization. The whole span of the competences entrusted to public institutions – regulation and standard setting, enforcement and coercion, ﬁnancing through taxation – is involved in producing converging goods, that is, goods that can be produced and maintained only through a shared effort, even though they are then enjoyed individually (Taylor 1989). A converging good may well be a one-off common good or belong to a collective yet still private sphere. However, all those converging goods whose lack or shortage affects the enjoyment of fundamental human rights ought to be conceived according to the concept of public goods in the strict meaning of the word: they should be to the utmost non-rivalrous (the consumption by one does not prevent others from doing the same) and non-excludable (it is impossible to exclude others from the beneﬁt). This is why the responsibility for these goods falls ﬁrst and foremost upon States and governments, as long as they control the most powerful means to orient and regulate collective priorities and actions as well as gather and allocate resources accordingly.
Yet the principle of social responsibility does not only entail the awareness that health depends on social determinants. It is also, if not essentially, about sharing this responsibility with other public and private organizations and associations and ﬁnally with the individuals themselves. The best designed institutional and legal system will not sufﬁce without the active participation of all the actors involved, and this observation becomes even more compelling at the international level. Within this context, some ethical and political priorities need addressing.
The lack of justiciability and that of attainability are the two major ﬂaws that are usually challenged in the commitment to realize social rights, including the right to health. As to justiciability, the difference with civil and political rights appears conspicuous even in the two Covenants of 1966. The instruments to respect, protect, and fulﬁll the rights enshrined in the two documents are quite divergent. In the case of civil and political rights, each State Party is called upon to adopt “such laws or other measures” as may be necessary to ensure “that any person whose rights or freedoms as herein recognized are violated shall have an effective remedy” and that such a remedy be guaranteed by “competent judicial, administrative or legislative authorities” (United Nations 1966a, § 2). In the case of economic, social, and cultural rights, each State Party has to take steps “to the maximum of its available resources,” in order “to achieving progressively the full realization of the rights” (United Nations 1966b, § 2). The judicial remedy is a very strong one, while progressive realization, even though “by all appropriate means, including particularly the adoption of legislative measures” (ibidem), is a much weaker provision. As to attainability, it is ﬁrst and foremost the issue of resources that makes the difference, bearing out the conclusion that the counterpart of social rights can only be imperfect duties: everyone, starting with States and governments, ought to do their best; everyone, in the end, retains the freedom to choose what to do and water down goals that appear to be either too ambitious or too demanding.
This is exactly where social responsibility steps in: collective action and personal commitment help anticipate or implement what is legally binding. Campaigns to make the public aware of pivotal issues and serious inequities, networks of cooperation, and a rigorous control of the actions of the administrative machinery are among the most effective tools to fuel both the will to urge political institutions to not fail in their responsibility as to the social determinants of health and the disposition to raise valid complaint against them whenever necessary. Changes in social behaviors can be as important as changes in policies and institutions and are in any case their premise and support. At the same time, lifestyles and personal attitudes play a decisive role to make good practices more pervasive and effective. Individuals cannot claim to be without responsibilities. It is up to them, for example, once they get informed about the causes of many diseases, like lung cancer or cardiovascular problems owed to binge eating, to steer their everyday life accordingly. In this perspective, social responsibility for health entails a dual commitment: to integrate the human rights framework more and more with the law and to increase by all means available the effectiveness of the principles that can neither be realized overnight nor through the law alone.
At the international level, two different kinds of problems are key. First, there is the unacceptable inequality as to the standard of health that is effectively attainable for different peoples, epitomized by the life expectancy index: more than 80 years in many of the most developed countries of the world, less than 50 at the bottom of the ranking. At the same time, through the experience of the growing interconnectedness triggered by the many streams of globalization, the global dimension itself of some social determinants of health becomes a crucial issue. In this perspective, some scholars have elaborated the notion of global public goods, whose beneﬁts (or disadvantages, when there is a shortage of them) rebound upon a great deal of countries, if not all of them, without discriminating against any group or set of generations. Building on this definition, it is possible to distinguish (1) natural global commons (such as the climate stability), (2) human-made global commons (such as scientiﬁc knowledge and cultural heritage), and (3) global policy outcomes (such as peace or global trade agreement) (Kaul et al. 1999, p. 453). All of them depend on successful international cooperation, and all of them have an impact on life conditions and health.
Even when the deterioration of a global good poses an immediate global risk (as happened in the case of the ozone layer), it is not easy to attain a global agreement on how to address the problem. The never-ending controversies on climate change or the limits of the protection of intellectual property when life itself is at stake, depending on the non-affordability of essential medicines, are just examples of a fundamental difﬁculty: international obligations, including those set by legally binding instruments, tend to suffer from and to increase the “imperfection” encapsulated in social rights. This is why, for example, it is often accepted that the principle of progressive realization itself be applied at a different pace, opening a breach that has sometimes been used even to turn the goal of the highest attainable standard for every human being into the practice of different standards for the rich and the poor.
Global social responsibility for global health needs requires a more complex institutional framework, starting with the forms of ﬁnancing research and health care and setting the agenda of priorities. Many of the aforementioned initiatives took a promising pathway, bridging governmental and nongovernmental organizations and turning beneﬁcence and charity into capacity building and social development. The international community as a whole should be considered responsible for a rigorous and consistent consideration of the fallout of different and alternative policies on the health of the population affected, especially when they concern the environment, exploitation of natural resources, delocalization of industrial activity, migration ﬂows, trade, and ﬁnance. In the international arena, no country and no public opinion should tolerate policies and actions by subjects under their control or even by their governments that are at least dubious in terms of consistency with the respect of the right to health to which every human being, regardless of his or her nationality and condition, is entitled.
The common sense observation that a longer and better life relies on greater and comprehensive human development underlines the importance of the outcomes of economic activity, including its positive as well as negative externalities. The notion of corporate social responsibility is indeed strictly interwoven with that of responsibility for health: “Work conditions can be harmful for people. Pollution can damage the environment and jeopardize the well-being of the population. Marketing strategies are often used to boost unhealthy behavior related to food and lifestyles. Research itself may serve proﬁt-oriented activities more than interests and needs of individuals and society” (UNESCO 2010, § 64). At the global level, the corresponding obligation to not pursue strategies and avoid actions that could be causal factors in harms to health ought to be integrated through the obligation “not to support governments engaged in unjust activities that are harmful to the health of their citizens or others” and the obligation “not to impede the health-promoting efforts of states, labor organizations, and legitimate international and trans-national organizations” (Buchanan and Decamp 2006, p. 110). The incentive to elude these obligations and make the most of differences as to legislation, when they allow a greater proﬁt through the means of social dumping, can be countered either by the decision to share and apply legally binding instruments at the international level or by introducing other incentives and disincentives that make non-proﬁtable what is yet – at least somewhere – legal.
Naming and shaming campaigns in some very striking cases of discrimination and exploitation, but also a growing awareness of the many ethical issues incorporated in the products of everyday life, can exert a strong inﬂuence on reshaping the strategies of proﬁt-oriented companies and corporations, starting with those, such as pharmaceutical industries, whose activity is immediately related to health. Fair trade, ethical ﬁnance, sustainability indexes, and voting with the wallet converge on the goal to reconcile the creation of economic value with social responsibility (Becchetti 2012), underscoring the importance of bottom-up initiatives not only as a stimulus for government action but also as a powerful driver of change in themselves.
Given this context, it is true that socially responsible behaviors may easily become instrumental. By improving their own reputation, companies could aim at the very same purposes of more traditional marketing actions: approval by consumers and consequently trust, readiness to buy, and loyalty. In this sense, the concepts of “cause-related” marketing and “strategic philanthropy” have been introduced. Even though such initiatives can ameliorate situations of suffering and produce positive effects, it goes without saying that true social responsibility is about something else. It requires a deeper change in the cultural background of our way of producing, trading, and consuming goods. It requires always applying the golden standard set by the best practices and the most advanced legislations and international codes and agreements.
Education is one of the most powerful drivers to raise the standard of health. There are two main lines of argument, which bear out this conclusion and refer, respectively, to the individual and public sphere. On the one hand, education increases health-related knowledge and awareness and helps people therefore adopt healthier lifestyles, avoid risks such as exposure to hazardous substances, and comply with prevention programs. Illiteracy as such, together with poverty, is the factor that most undermines everyone’s possibility to cope with the natural and social conditions of vulnerability to which human beings are exposed. The notion of “health literacy” entails exactly this responsibility to endow people with the capacity to obtain, understand, and make use of at least the basic information that may be relevant for their health. This is also the precondition for making decisions according to the principle of free, informed consent, which replaced paternalism as the cornerstone of medical ethics. On the other end, a high level of education boosts the quality and number of professionals, facilitates the application of the most advanced results of scientiﬁc research, and sets the premise of a strong and effective public control on those policies which are most likely to affect health. Accountability of governments and institutions relies obviously on the transparency, thoroughness, and reliability of information, which is the speciﬁc social responsibility that media are entrusted with, but also on educational infrastructure that teaches citizens to claim their fundamental rights, watch over their respect, and criticize the lack of it. It is not by chance that poor educational systems, weak institutions, deep social inequalities, and poor health tend to overlap.
In order to promote social responsibility for health at the global level, education to solidarity is also key. Solidarity is often interpreted as a group concept, which is based on a shared experience of life and events. It includes therefore only some people in a special bond of responsibility and obligations and leaves out others. This is why justice does not converge exactly with solidarity, especially within the framework of universal human rights: the former cannot be predicated on the latter, because of the asymmetries of commitment that it seems to entail. However, asymmetries are what people bump against when they cross the border (and sometimes even within the border), not only in most practices but also in most normative statements, which reafﬁrm that the States’ ﬁrst and primary obligation is to their own people and loosen consequently the obligation to the others. A cosmopolitan justice will remain difﬁcult to attain as long as we lack a cosmopolitan solidarity, which would turn social responsibility itself into “a principle that deﬁnes and celebrates our common humanity.” This is the crucial educational challenge, for States and governments and for everyone who is really committed to upholding the idea that neither the limits of attainability nor the lack of legally binding instruments allows to dismiss the principle that “the maximum of equality remains the ultimate goal when everyone’s right to life is at stake” (UNESCO 2010, §§ 101 and 40).
Health-related research and professional and economic activities entail special duties. Legislation and the codes of conduct of physicians determine – even though in different ways depending on different cultural contexts – the balancing of the so-called internal goods (healing and well-being of patients) with the external ones (success, power, income), setting limits to the freedom to pursue the latter at the expense of the former. The relationships with proﬁt-oriented bodies such as pharmaceutical industries and medical equipment ﬁrms, decision-making procedures on priority setting, the focus on the actual needs of people, and the consequent prohibition to take advantage of the asymmetry of competence to realize other and “external” ends correspond to as many social responsibilities and are among the issues more commonly dealt with.
When the issue of health and health care is addressed, the principle of social responsibility overlaps the commitment to sharing: sharing of beneﬁts, in the most immediate sense of the term. It is difﬁcult, if not impossible, to avoid scientiﬁc development being driven also by interest in potential ﬁnancial gain. Maybe, this is even not desirable. What is unacceptable, however, is that price becomes an insurmountable barrier for need. Many promising initiatives have been taken to address this crucial issue, both at governmental and nongovernmental levels, but the outcomes are still absolutely insufﬁcient. The task to perform should be in any case that of progressively giving up the top-down philanthropic approach. Sharing of responsibilities implies sharing of capacities and therefore – among others – of knowledge as a “global common,” of standards and programs of education, and of policies oriented to improving the social determinants of health. Asymmetries and inequalities are not a kind of natural and therefore insurmountable curse, but the product of historical dynamics that can be addressed and reshaped. Sharing of knowledge and education, in particular, is made possible by establishing networks based on the principle of open access and promoting exchange programs of students and teaching staff. In this perspective, the determination to turn the so-called brain drain of highly skilled professionals from low-income countries to the richest ones into a “brain circulation” fruitful for all can play a decisive role. The global health labor market is a telling example of the necessity to not leave the global labor market as a whole to the rude rule that might is right. Article 5.1 of the WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted in 2010, points out that “the health systems of both source and destination countries should derive beneﬁts from the international migration of health personnel” and goes on encouraging collaboration with source countries to “promote health human resource development and training” and calling on Member States to “discourage active recruitment of health personnel from developing countries facing critical shortages of health workers” (WHO 2010). Networking is one of the keywords of social responsibility.
Universal justice will remain wishful thinking as long as the health gap between and within countries remains open. The poor functioning of the health-care system and the lack of access to quality health care are almost always associated with a background of poor social conditions, starting with food and water, housing, employment, environment, income, and illiteracy and including persisting forms of marginalization, discrimination, and stigmatization. The right to enjoy the highest attainable standard of health is a social right, and most of the laws concerning social rights, depending on the issue of attainability and progressivity, can only be formulated in a program-type manner, even when they entail some binding obligation or prohibition, depending precisely on the issue of attainability. This is why all individuals and sectors of society, together with governments, are called upon to do their best to improve the different factors that contribute to raise the standard for everyone. This is all the more important at the international level, where the faults of inequalities are deeper and the legal coercion looser. A greater availability and affordability of the most effective means to prevent diseases and to ﬁght against them presupposes a holistic approach to the different determinants of human ﬂourishing. Global bioethics can therefore be interpreted as a possible epitome of the commitment to human rights in the twentyﬁrst century.
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