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Instruments of health and harm: how the procurement of healthcare goods contributes to global health inequality
  1. Mei L Trueba1,
  2. Mahmood F Bhutta2,
  3. Arianne Shahvisi3
  1. 1Global Health and Infection, Brighton and Sussex Medical School, Falmer, Brighton, UK
  2. 2Department of Ear, Nose and Throat (ENT), Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  3. 3Ethics, Brighton and Sussex Medical School, Falmer, Brighton, UK
  1. Correspondence to Dr Mei L Trueba, Global Health and Infection, Brighton and Sussex Medical School, Falmer Brighton BN1 9PX, UK; m.trueba{at}


Many healthcare goods, such as surgical instruments, textiles and gloves, are manufactured in unregulated factories and sweatshops where, amongst other labour rights violations, workers are subject to considerable occupational health risks. In this paper we undertake an ethical analysis of the supply of sweatshop-produced surgical goods to healthcare providers, with a specific focus on the National Health Service of the United Kingdom. We contend that while labour abuses and occupational health deficiencies are morally unacceptable in the production of any commodity, an additional wrong is incurred when the health of certain populations is secured in ways that endanger the health and well-being of people working and living elsewhere. While some measures have been taken to better regulate the supply chain to healthcare providers in the UK, further action is needed to ensure that surgical goods are sourced from suppliers who protect the labour and occupational health rights of their workers.

  • rights
  • public health ethics
  • resource allocation
  • occupational health
  • health care economics
  • surgical equipment
  • healthcare supply chains
  • occupational health and safety
  • global health inequality
  • NHS
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  • Correction notice The paper has been updated since first published to amend heading levels.

  • Contributors AS conceptualised the project and led the theoretical design of the work. All authors conducted the research, helped draft the initial manuscript, made revisions and prepared the manuscript for submission. All three authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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