Bioethics and Public Policy in the Next Millennium: Presidential Address

Alastair Campbell, President of the Fifth World Congress of Bioethics, has described our mission as that of confronting major opportunities and challenges to be faced in a global context in the next millennium. We are bioethicists ± philosophers, physicians, lawyers, nurses, theologians, social scientists, policy analysts, and other practitioners in our multidisciplinary field. To my knowledge, none of us is a fortuneteller, so we are unable to predict what fortunes or misfortunes the new millennium will bring. But we can look around us today and see what challenges face us here and now ± challenges that are urgent and will not disappear unless public policy on a global scale rises to meet them. I want to focus on two phenomena that are well described in the public health literature. The first is the gross inequalities in health and health care that exist between rich and poor classes within nations, as well as among industrialized countries and many developing countries. The second phenomenon that requires public policy remedies, most notably in developing countries, is the health status of women. Both of these are situations of grave injustice on a broad social scale. Global inequalities go beyond health status and health care. They exist, as well, in access to such prerequisites for good health as clean water and adequate nutrition. Add to that the demographic picture of the burden of diseases such as HIV in sub-Saharan Africa, and we see that the problem cannot be solved by policies developed solely within nation states. In South Africa and Zimbabwe, 20 to 25% of the adult population is infected with HIV. In Botswana, about one in three adults is infected. Peter Piot, the executive director of the Joint United Nations Programme on Bioethics ISSN 0269-9702 Volume 15 Number 5/6 2001