Only the alt solves global health by making healthcare a public good. The aff ensures inequitable access and the recreation of disease.

Economists have long debated the concept of public goods, which broadly refers to those goods (or services) that are commonly available to everyone in society because they are considered essential to the smooth functioning of society. Examples commonly provided include national defence, education, security, infrastructure and environmental protection. They are required to be both non-rivalrous (that is, an individual’s consumption of the good does not diminish another’s ability to do so) and non-excludable (that is, it is not possible to exclude others from using it).9

These criteria would exclude medicines and other health technologies which are viewed as private commodities, partly because reigning bioethical models emphasise the individual aspects of healthcare (such as patient autonomy and private consumption of medicines), and also because the market targets consumers who can afford highly priced medicines to the exclusion of those unable to afford them. While medicines may not satisfy the criteria of non-rivalry and non-excludability, viewed from the perspective of welfare economics, they are – at least partially – public goods as they have significant implications for public health, are also global in their development and impact, and are prone to regulation in their development, manufacture, allocation and use.10 The public nature of medicines is well known, both from their role in public health vaccination measures, and in the treatment of epidemic and endemic diseases. The public dimension also extends to the public consequences of choices made in research and development of new medicines, and the profiteering around lifestyle drugs which draws resources away from research into so-called ‘neglected’ diseases. Public goods also have positive externalities, in that their accessibility and use benefit the public at large, not merely those who use them. This public benefit is most obvious in the case of vaccination, where herd immunity develops through widespread diffusion.11

Health inequity is not confined to the developing world. In the USA, for example, the needs of marginalised groups – low-income individuals, or historically disadvantaged people of colour – are frequently ignored. Parthasarathy12 asserts that this is in large part due to the heavy reliance of government policy on the expertise of scientists and market players. IP policies fail to consider issues of affordability and accessibility; limit the range of innovators to those evincing a particular notion of expertise; distort innovation incentives by prioritising research which follows market imperatives rather than health needs; and tolerate harmful or biased innovation – as in the case of pulse oximeters which provided distorted blood oxygen level readings in dark-skinned individ- uals, yet were zealously defended by their proprietary rightholders.13