The global health community has struggled to answer a pivotal question involving social justice: What do rich countries owe to the world's least healthy people? (1) In my last column, for example, I examined the responsibility of the world's rich to equitably share influenza A (H1N1) vaccines with developing countries. (2) But there is another important question that is rarely asked: What duties do low-income countries have for the health of their own populations? In many ways, this is the more important question because the state must owe the primary obligation to serve the needs of its population. This places clear responsibilities on public officials in low- and middle-income countries. But it also requires the United States to adopt policies and programs that empower, rather than emasculate, poor countries. President Obama's Global Health Initiative views global health investment as a national security "smart power" strategy that engages all U.S. government agencies--an "all-of-government" approach. It provides an opportunity to change direction, using global health diplomacy to strengthen the autonomy and capacity of poor countries to steer their own course.
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