Economics, health and development: some ethical dilemmas facing the World Bank and the international community

The World Bank is committed to work[ing] with countries to improve the health, nutrition and population outcomes of the world's poor, and to protect[ing] the population from the impoverishing effects of illness, malnutrition and high fertility.(1) Ethical issues arise in the interpretation of these objectives and in helping countries formulate strategies and policies. It is these ethical issues-which are often not acknowledged by commentators-that are the subject of this paper. It asks why there should be a focus on the poor, and explores the link between improving the health of the poor, and reducing health inequalities between the poor and better-off. It discusses difficult ethical issues at both the global level (including debt relief and the link between country ownership and donor commitment) and the country level (including user fees and whether providing assistance to the non poor may in the long run be a way of helping the poor).