Health equity in economic and trade policies

A cross-sectional survey on knowledge and perceptions of health risks associated with arsenic and mercury contamination from artisanal gold mining in Tanzania
Charles E, Thomas DS, Dewey D, Davey M, Ngallaba SE and Konje E: BMC Public Health 13(74), 25 January 2013

An estimated 0.5 to 1.5 million informal miners, of whom 30-50% are women, rely on artisanal mining for their livelihood in Tanzania, and are exposed daily to mercury and arsenic. The primary objective of this study was to assess community risk knowledge and perception of potential mercury and arsenic toxicity in Rwamagasa in northwestern Tanzania, an area with a long history of artisanal gold mining. A total of 160 individuals over 18 years of age completed a structured interview. These interviews revealed wide variations in knowledge and risk perceptions concerning mercury and arsenic exposure, with 40.6% and 89.4% not aware of the health effects of mercury and arsenic exposure respectively. Males were significantly more knowledgeable (36.9%) than females (22.5%) with regard to mercury poisoning. An individual’s occupation category was associated with level of knowledge, and individuals involved in mining (73.2%) were more knowledgeable about the negative health effects of mercury than individuals in other occupations. Of the few individuals (10.6%) who knew about arsenic toxicity, most (58.8%) were miners. Overall lack of knowledge, combined with minimal environmental monitoring and controlled waste management practices, highlights the need for health education, surveillance, and policy changes, the authors conclude.

African Union to Proceed With controversial Pan-African IP Office
New W: Intellectual Property Watch, 6 February 2013

The African Union (AU) has announced it will proceed with the establishment of a Pan-African Intellectual Property Office (PAIPO), despite misgivings from civil society and development economists about the potential impact on local economies. There is currently no intellectual property (IP) office for Africa. The AU has requested a meeting of all stakeholders dealing with intellectual property before the May 2013 AU Summit. According to the author of this article, public information is difficult to obtain from the African Union, and nothing further is known at this time. He argues that signing up to the global IP system, in which nearly all of the IP rights are owned by non-African entities, clashes with the development objectives of the African Union, which are to promote African sovereignty and equitable development.

Aid for trade: An opportunity to increase fruit and vegetable supply
Thow AM: Bulletin of the World Health Organisation (early online version), 16 November 2012

Low fruit and vegetable consumption is an important contributor to the global burden of disease. In the wake of the United Nations High-level Meeting on Non-Communicable Diseases (NCDs), held in September 2011, a rise in the consumption of fruits and vegetables is foreseeable and this increased demand will have to be met through improved supply. The World Health Organisation, the Food and Agriculture Organisation and the World Bank have highlighted the potential for developing countries to benefit nutritionally and economically from the increased production and export of fruit and vegetables. Aid for Trade, launched in 2005 as an initiative designed to link development aid and trade holistically, offers an opportunity for the health and trade sectors to work jointly to enhance health and development. It is one of the few sources of aid for development that is stable and experiencing growth, according to this paper. At present the health sector has very little input into how Aid for Trade funds are allocated. This is an opportune moment to investigate opportunities for collaboration, since more than half of the reporting external funders are planning to revise their Aid for Trade strategies in 2013. Health departments should make central planning and finance departments aware of the potential health and economic benefits, for both developed and developing countries, of directing Aid for Trade to fresh produce markets.

Global Wage Report 2012/13: Wages and Equitable Growth
International Labour Organisation: 7 December 2012

The 2012/13 edition of the Global Wage Report looks at the macroeconomic effects of wages, and in particular at how current trends are linked to equitable growth. Among the major findings of the report are that the gap between wage growth and labour productivity growth is widening, the difference between the top and bottom earners is increasing, and the labour income share is declining. Workers are receiving a smaller slice of the economic pie than before. These worrying changes affect the key components of aggregate demand – particularly consumption, investment and net exports – that are necessary for recovery and growth. The report looks at the reasons for these trends, which range from the increasing financial and trade globalization to advances in technology and the decline in the power of trade unions and reduced union density. Raising average labour productivity remains a key challenge which must involve efforts to raise the level of education and the capabilities that are required for productive transformation and economic development. The development of well-designed social protection systems would allow workers and their families to reduce the amounts of precautionary savings, to invest in the education of their children, and to contribute towards stronger domestic consumption demand and raise living standards. The report calls for internal and external “rebalancing” to achieve more socially and economically sustainable outcomes within and across countries, proposing policy actions beyond labour markets and national borders.

LDCs seek indefinite extension of transition period under TRIPS
Raja K: Third World Network, 9 November 2012

The Least Developed Countries (LDCs) have submitted a "duly motivated" request to the WTO TRIPS Council for an extension of the transition period for them to comply with the TRIPS Agreement "for as long as the WTO Member remains a least developed country". The request was submitted by Haiti, on behalf of the LDCs, at a meeting of the TRIPS Council on 6-7 November 2012. The exemption will continue to allow LDCs to access affordable medicines without the risk of violating patents on the medicines. Haiti argued that because of their extreme poverty, LDCs need the policy space to access various technologies, educational resources, and other tools necessary for development. Furthermore, LDCs have such small economies that they do not represent a significant loss of profits for pharmaceutical patent owners. Most intellectual property-protected commodities are simply priced beyond the purchasing power of these countries’ governments and their nationals, the spokesperson for Haiti added. Haiti has asked for this issue to be put on the agenda of the next TRIPS Council meeting, scheduled to take place in March 2013.

Pharmaceutical industry targets Africa's growing middle class
Berton E: Mail and Guardian, 12 February 2013

Pharmaceutical spending in Africa is expected to reach US$30 billion by 2016, driven by increases in incomes and the shifting nature of its disease burden, according to this article. Non-communicable diseases (NCDs) are expected to account for 46% of all deaths in sub-Saharan Africa by 2030, up from 28% in 2008. As a result, big pharmaceutical companies are now expressing interest in new opportunities opening up for treating chronic, non-communicable diseases (NCDs), particularly in African middle classes. The author projects that the pharmaceutical market in Africa will grow in the next decade.

Protection of populations from exposure to second-hand smoke in Africa: Policy Implementation challenges
Piotie PN: Consultancy Africa Intelligence, 22 January 2013

Economists have predicted that tobacco consumption will double in the next 12 to 13 years in Sub-Saharan Africa unless anti-smoking policies are adopted. Besides impoverishing families, an increase in the consumption rate will result in an increase in disease burden that will generate unaffordable health costs. Implementing smoke-free policies in Africa remains a problem, however, largely due to tobacco industry interference, insufficient financial and human resources, lack of support from government officials and legislators and poor involvement of civil society. However, the author argues that poor compliance, as well as poor, often non-existent enforcement and monitoring and surveillance systems are the real threats to smoke-free laws in Africa. Therefore, there is a crucial need for efficient implementation strategies, along with proper monitoring and surveillance systems on the one hand; and on the other, a need for scientific research in order to evaluate the effectiveness of smoke-free policies in Africa.

The Slate is Clean: What’s Next? An evaluation of debt relief in the Democratic Republic of Congo, 2003-2010
De Crombrugghe D, de Looringhe D and Ruben R: GREAT Insights 2(1), January 2013

In this report, the authors provide an in-depth evaluation of debt cancellation measures the Democratic Republic of Congo (DRC) that took place at the beginning of the 21st century. As a proxy for the effect of debt relief, the authors of this report looked into the education sector for evidence of improvements following the debt cancellation. Some positive changes, notably in the payment of wages, were found that correlated with the debt relief, but these changes did not reach further than the headquarters of the ministry of education in Kinshasa. They identified two new issues: the growing need to question the legitimacy of ‘odious debt’ incurred during a dictatorship without the population ever having received any benefits from it; and the ongoing fight against vulture funds and other rogue creditors, which buy up the debt of poor developing countries at very low prices and then sue them to enforce payment of the nominal value, including arrears of interest. Legislation outlawing the seizure of Overseas Development Assistance (ODA) funds and state-to-state loans would be an important step in that direction, the authors argue. Belgium has already passed a law to protect its ODA grants against seizure and also intends to audit the ethical basis of all sovereign credits on developing countries. (Please note that this report has only been issued in French – the English version is forthcoming.)

Contagion, liberalisation, and the optimal structure of globalisation
Stiglitz JE: Journal of Globalization and Development 1(2): Article 2, 2010

Advocates of capital market liberalisation argue that it leads to greater stability, as countries faced with a negative shock borrow from the rest of the world, allowing cross-country smoothing. However, the author of this paper argues that there is considerable evidence against this conclusion. He explores in detail the ways in which market integration can exacerbate contagion, whereby a failure in one country can more easily spread to others. The author examines the conditions under which such adverse effects overwhelm the putative positive effects, illustrating how capital controls can be welfare enhancing, reducing the risk of adverse effects from contagion. This paper is intended to provide an analytic framework within which policy makers can begin to address broader questions of optimal economic architectures.

Health at the G20: A small but significant step in Seoul
Gubert J and Lennox R: Health Diplomacy Monitor 1(5): 9–11, January 2011

The G20, a group of wealthy, industrialised nations, met for their fifth summit on 11–12 November 2010, in Seoul, Korea. On par with previous summits, the leaders’ primary focus was on economic and financial issues. While the leaders did not discuss health in a major way, it was specifically referenced in their final summit documents. Most notably, non-communicable diseases and the importance of health issues were highlighted in both the Seoul Development Consensus and the Multi-Year Action Plan for Shared Growth. The related issue of development was a prominent theme, culminating in the Seoul Development Consensus for Shared Growth. Other health-related issues, including climate change, food security, and poverty reduction, were also discussed. At the Seoul Summit, while still very limited, the G20 referenced health – directly and indirectly – more than it had at any previous meeting. According to this article, health is likely to continually increase in importance on the G20 agenda. If so, the G20 could have a major impact on global health.

Pages