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? 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.
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