PoPulationand Public HealtH etHics

comprehensive response from others. However, more than a year later,
that comprehensive response has not come. From a public health ethics
standpoint, what obligation does the Ingo have to provide its services
indefinitely? Is it fair if these obligations are tied to the actions (or inactions)
of other organizations?
2 The lead poisoning epidemic attests to a de facto shift in public health
service provision from governments to Ingos. When governments
withdraw from essential service provision, Ingos expand to fill the
void. This may be mutually beneficial, since government officials are
able to delegate their responsibilities and Ingo workers are able to
benefit economically (and often professionally). Indeed, aid organizations
have been criticized as Trojan horses for global neoliberalism and
privatization. Yet the Preamble to the Constitution of the World Health
Organization (wHo, 1948) speaks of the moral and legal duty of states
to protect the health of their citizens as the foundation of public health
law. Consider public health crises that are costly and less publicized, like
the lead-poisoning epidemic: What are ethical arguments in support
of the role of the state in providing essential public health services? Do
these arguments preclude private organizations from taking over? Ingos
often compete for funding and publicity, and self-promotion may factor
into deciding whether or not an Ingo chooses to intervene in a public
health crisis. To what degree is this self-interest ethically objectionable,
or is it a practical necessity to ensure that the best Ingos survive?
3 Poverty, inequality and lack of essential public health services were root
causes of the lead-poisoning epidemic (Nigeria has some of the highest
mortality rates in the world for infants and child-bearing women).
Consider how such vulnerability reduces the likelihood of populations
protesting and demanding improvements to public services. By providing
‘band-aid’ solutions to public health problems, Ingos may make
grassroots movements even less likely, thereby getting in the way of
societal change. Given this consideration, what are situations where
it would be ethically justifiable for an Ingo not to intervene during a
public health crisis (even with lives at stake)?
acknowleDgeMents
International and Nigerian colleagues who participated
in the response to the epidemic.
Whose role is it to deal with societal determinants of health?
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