Global Public Bads

Public bads, which we can define as the opposite of GPG, are negative externalities that cause negative effects on people and societies. If these negative externalities spread across countries and/or generations, they are called global public bads.

Many international organizations (IMF, regional development banks, non­governmental organizations, the UN, the World Bank, the World Trade Organiza­tion, etc.) and governments around the world assume duties with the aim of adequate delivery of global public goods, which includes external aid and foreign military interventions to correct “global public bads.” If we take a brief look at the studies on global public bads, for instance, Cook and Sachs (1999) and Jayaraman and Kanbur (1999) investigated the impact of foreign aid on the prevention of global public bads. Similarly, Ferroni (2000) examined the issue of reforms in the provision of foreign aid for the prevention of global public bads. Again, Ferguson (2004) exam­ined the United States and its role in ensuring global stability. In his study, Mendez (1999) discussed the importance of the UN for peacekeeping. Collier (2008), in his study, investigated the effect of properly timed foreign military interventions on the prevention of military coups. Mitchener and Weidenmier (2005) and Ferguson and Schularick (2006) analyzed the historical foreign intervention cases of the United States and tried to reveal the necessary conditions for intervention and willingness to use the declared military force by emphasizing the GPGs produced by the UK and the army.

While the COVID-19 outbreak is considered a global public bad, the improve­ment of health care is considered a GPG.

As mentioned before, factors resulting in considerable environmental damage with negative consequences on health are public “bads” and reducing them is in the public interest. Important examples are the reduction of biodiversity, environmental and air pollution, global warming and depletion of the ozone layer. Air pollution in the big cities of countries typically occurs in a country and in a limited area such as Istanbul, New York and London. For this reason, governments intervene in the market through regulation, taxation or other means and provide the presentation of this public good in order to provide the public benefit (consuming fresh air) that citizens cannot buy for them individually. Where air pollution reaches country borders, such as the former East Germany, the Czech Republic and Poland, affected countries can act together to reduce a public bad to which they are collectively exposed (and collectively contributed) (Feachem and Medlin 2002).

Health is the major concern on the global agenda today. It is discussed at meet­ings of the G-8, and organizations and relevant actors establish worldwide health coalitions to overcome the global disease burden. Some of the mentioned orga­nizations include the Global Alliance for Vaccines and Immunization (GAVI); Medicines for Malaria Venture (MMV); Global Tuberculosis Drug Facility (GDF); Stop Smoking Campaign; and the Global Health Fund to fight acquired immun­odeficiency syndrome (AIDS) and other infectious diseases in Africa.

The problem of equity in accessing health care is also very important. Although public goods are defined as neither divisible nor excludable, they carry risks such as unequal access to public health services, biased priorities or negligence. The poor have different health priorities than the rich, and the rich can access preventive and protective healthcare services more than the poor. In addition, the spread of the global private market accelerates the privatization of healthcare services and the commer­cialization of health information. Private markets are naturally unequal because the poor, without purchasing power, are excluded from commercial services and health­care technologies. Another problem in this regard is whether new opportunities will be used to meet human health needs equally. For example, the average life expectancy in developed countries (about 80 years) is twice that of the most backward countries (about 40 years) in terms of health. There are equally large healthcare differences across countries. Even in the United States, the life expectancy of the healthiest men in the best county is twice that of the most unhealthy men in the worst county (Lopez and Murray 1998).

Control of many global diseases that concern the poor more can be considered a GPG. For example, successful elimination of smallpox, nearly eliminating polio and activities related to primary health care are global efforts for the public good. Global efforts are absolutely egalitarian. Different health problems offer to the rich popula­tion different priorities created by ready access to effective vaccines and antibiotics that are not accessible to many poor populations financially or logistically.

Currently, emergency interventions are carried out against increasing disease burden, as it is not sustainable in many developing countries. The main issue is what health policies are necessary to sustain such efforts and prevent similar future crises? Analyzing current health challenges from the perspective of a GPG, following a number of policy options is necessary for putting the current dispersed initiatives into a wider framework. These policies should offer a comprehensive rationale for inter­national cooperation on health issues and propose new arrangements for financing. Policies for more efficient delivery of health information and a new “matrix” approach to management of global health issues and initiatives are discussed nowadays. Glob­alization has currently created interdependencies dimming the difference between domestic and external relations. When the understanding of “the best way to ensure one’s own well-being is to be concerned about that of others” is acceptance all over the world, the parties will place more emphasis on cooperation for solution (Kaul and Faust 2001).

However, some public bads—such as global warming and ozone depletion— affect large regions or even the entire world. For this reason, it is difficult to establish fast collaborations. For the public goods corresponding to such public bads, the properties of non-excludability and non-rivalry apply, this time, to countries instead of individual consumers. Ideally, the global or regional reach of these properties will inspire countries to act collectively to encourage (or discourage) global public goods (or bads) delivery. If global warming could be slowed down by means of collective action, a country having made no contribution cannot be prevented from benefiting, and the cost of that benefit to the dissenting country would be zero.

The concept of GPG suggests a possible framework to consider these issues (Kaul 2000). In this statement, “goods” encompass a range of physical products (such as bread, books and shoes), but also include services (such as security, information and travel) that distinguish between private and public goods. Most of the goods are “private” as their consumption can be stored until a payment is made in return and cannot be reconsumed once consumed. On the contrary, when “public” goods are provided, no one can consume (non- excludable) and the consumption by one person does not prevent anyone else (non-rivalry in consumption) from consuming it (Kaul et al. 1999a, b). For example, all individuals in one country benefit from reducing the risk of epidemics, and one who benefits from this reduction in risk does not prevent anyone else from taking advantage of it.

The fact that international travel is now easy, changes in technology and the rapid liberalization of trade also bring different features to healthcare GPG. Today, infec­tious diseases (often drug-resistant) are spreading faster (Smith and Coast 2002), with our environmental damage, access to fresh air and clean water is reduced world­wide, and new information about traditional and modern medical technologies is increasingly patented. These new changes coming with globalization disrupt the non-excludability characteristic of the GPG goods, making them artificially exclud­able (Thorsteinsdottir et al. 2003). It also allows GPG to worsen existing inequities. Some healthcare services are open to the public, yet some may not be accessible to the poor. Practices such as the free trade regime in an unequal world can cause the rich to have all the resources. If these exclusion concerns are not taken into account, people’s and states’ willingness to cooperate will suffer and so will the presenta­tion of GPGs.

Equity is very important in effective presentation of GPGs, but equity is itself a GPG. GPGs are non-rival, such that treating a person equitably does not reduce the chance of another person to be treated the same, and if equity in access to health care is accepted as a norm-like other global norms and principles such as human rights, no one can be excluded from accessing the health care. Hence, equity in accessing the health care should be ensured globally, as a universal principle, in the best and most predictable way (Kaul 2000).

The COVID-19 outbreak brought to mind a new question about GPG. Why a new class of global public goods emerge? Based on other studies on global trends (Hirst and Thompson 1999; Rodrik 1997; Kaul et al. 2003), it is clear that a variety of factors contributed to the emergence of new GPGs. Countries have become more vulnerable to risks by reducing cross-border controls, as well as increasing political pluralism and democracy. Considered along with technological developments, this has promoted more international economic activity, more foreign trade, more foreign investment and more international travel and communication. Lincoln et al. (1999) stated in their study that even non-communicable diseases are a global health problem with the integration of markets and internationalization of marketing. The authors, among other things, refer to the fact that ads around the world do not contain healthy information and the spread of unhealthy consumption patterns such as smoking.

When defending their own interests, countries should never build conservative obstacles, or they should work to maximize the welfare of the country by combining national interests with international imperatives, not to defend the country against external influences. In other words, it is necessary to address the interrelated, internal and external issues posed by the new global public goods class (Kaul et al. 1999a, b).

International cooperation is an active area. As Young (2012) stated, “we live in the world of international regimes.” In some regions, international cooperation, infor­mation exchange and consultation activities on common concerns work very well. However, actors must cooperate fully to transform intentions into policy actions. There are many obstacles to the implementation and follow-up of international agree­ments. The first one is the uncertainty about the feasibility of possible policy practices. Therefore, international organizations are very important for providing information and reducing the uncertainties of the governments in the negotiation process (Haas 1992). The second one is, despite the emergence of new GPGs and the activities of non-state actors related to these new goods, countries do not want to present GPGs at an adequate international level. This causes problems to deepen in areas that are not operated and are idle (Kaul et al. 1999a, b).

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