Health equity in economic and trade policies

The continent of Africa contains more than 50 countries, but, as Visual Capitalist details, just five countries account for more than half of total wealth on the continent: South Africa, Egypt, Nigeria, Morocco, and Kenya. Despite recent setbacks in Africa’s largest economies, wealth creation has been strong in a number of areas, and total private wealth is now estimated to be US$2.1 trillion. There are an estimated 21 billionaires in Africa today. Drawing from the latest Africa Wealth Report, this article looks at where all that wealth is concentrated around the continent.

While not always labelled commercial determinants of health (CDOH), some policy attention has been given in sub-Saharan Africa (SSA) to both harms and benefits of commercial impacts on health, particularly from harmful products and processes, and noting rising non-communicable diseases. This discourse analysis highlights differing interests and lenses among the multiple policy actors involved; the forms of narrative, agential and structural power used to advance and contest commercial policy interests in the health sector; and how this has been intensified by COVID-19. The evidence is used to propose actions to advance public health interests. Public health actors and ‘one health’ actions need to build on current efforts to strengthen own discursive power, challenging narratives with evidence; to strengthen their agential power through institutionalising health impact assessment, regulation and control measures; and to deepen initiatives to engage with structural power through support for local producers, harmonised regional standards and engagement on global rules that constrain health promoting activity, as was done in the Trade Related Aspect of Intellectual Property Rights (TRIPS) Waiver. Subregional and continental level organisations play a key role in enabling such actions, as does investment in SSA leadership in locally relevant innovation and production, and in links between state, academic and civil society actors to support evidence and to ensure public interests, transparency and accountability in policy decisions on CDOH.

More than a 1,000 Kenyan tea pickers who say that harsh and exploitative working conditions on a Scottish-run tea farm have caused them crippling health complaints can now pursue their class action in an Edinburgh court. Prolonged bending to gather tea for James Finlay Kenya is argued to accelerate ageing of pickers’ backs by up to 20 years. Lawyers acting for the tea pickers have won an order from the court of session, Scotland’s highest civil court, telling James Finlay Kenya Ltd (JFK) to abandon attempts to block the suit through the Kenyan courts. Finlays, an Aberdeen-registered multinational whose estates in Kericho, Kenya, stretch across 10,117 hectares (25,000 acres), is one of the largest suppliers of tea and coffee in the world. The company has defended its health and safety record, and carries the Fairtrade mark on its products, as well as certifications from the Soil Association and the Rainforest Alliance. But in previous testimony, the article reports that workers claimed that oppressive working conditions caused them significant and permanent musculoskeletal damage. They said they had to work up to 12 hours a day in a six-day week, carry up to 26lb of the tea leaf pickings on their back over rough slopes, and in some cases meet a weight target of 66lb of tea a day or not get paid. The article reports that the lawyers hope that the case will impact more broadly on practices in the industry.

While the supporters of the original TRIPS waiver are still coming to terms with the remains of the 20 month saga that yielded a ministerial decision clarifying the rules of compulsory licensing for the production of vaccines, they are back at the WTO to stomach another fight, this time, to discuss the way forward to boost the production of therapeutics and diagnostics by seeking to extend the applicability of the June decision to these medical products. This puts the co-sponsors, again, directly in opposition to industry interests where companies alone are projected to make billions off a single drug to treat COVID-19. The co-sponsors point out that there are four times as many patent filings related to therapeutics compared to vaccines. Already, more than 5,200 patent applications related to COVID-19 were published across 49 patent offices between 2020-21, according to the World Intellectual Property Organization Patent Landscape Report, the co-sponsors cite. They argue that granting of patents could delay the entry of generic drugs, and in turn lead to price increases affecting access. They seek an extension of the policy tools provided in the June ministerial decision to therapeutics and diagnostics. This, they say, “will help developing countries to address IP barriers to the expansion and diversification of production”.