Health equity in economic and trade policies

This report, written for Oxfam, examines the impact of the global financial crisis on the budgets of low-income countries, especially their spending to reach the Millennium Development Goals (MDGs). It points out that the current global economic crisis has created a huge budget revenue hole of US$65 billion, of which aid has filled only one-third. As a result, after some fiscal stimulus to combat the crisis in 2009, most low-income countries (LICs) – including those with International Monetary Fund (IMF) programmes – are cutting MDG spending, especially on education and social protection. They have also had to borrow expensive domestic loans, and increase anti-poor sales taxes. The report argues that almost all LICs could absorb much more aid without negative economic consequences (whereas they have much less space to borrow or to raise taxes). It urges the international community to make strong new aid commitments at the Millennium Summit in September 2010, funded by financial transaction taxes or other innovative financing. The IMF should encourage LICs to spend more on MDG goals and on combating climate change and to report regularly on such spending, and LIC governments should increase spending on social protection and education, and bolster efforts to fight tax avoidance.

Are counterfeit products first and foremost a threat to human health and safety or is provoking anxiety just a clever way for wealthy nations to create sympathy for increased protection of their intellectual property rights? This article indicates that coverage of this issue in the world’s news media varies greatly. Some argue that attempts to fight fake drugs are as much a risk to access to the real medicines as the fakes themselves. Legitimate, low-cost generics – often the only medicines the poor can afford – can get caught in the crossfire of anticounterfeiting enforcement measures. In addition, they say, there is need to combat not only medicines that violate trademarks (as counterfeit is often defined) but also medicines of general low quality (harder to spot and often, some say, a greater problem). The article examines a variety of news items that have recently appeared in the international media. Sources in American media have focused on organised crime in drug counterfeiting without considering the problems of access to medicines in developing countries. On the other hand, India’s newspapers are concerned with the impact of new legislation on the production of generics and the United Kingdom’s BBC has acknowledged the problems of access to medicine.

Most of the estimated 5.2 million people worldwide on antiretroviral (ARV) treatment are taking generic versions manufactured primarily in India, but tighter global intellectual property rights and trade rules could shut down this trade. While the patents on many older, first-line ARVs have expired, leaving generic manufacturers free to produce them, newer, less toxic and more effective drugs are patented and priced out of reach of less developed nations. The main way generics manufacturers can produce newer drugs is to obtain a ‘voluntary licence’ from the patent holder. This usually sets quality requirements and defines the markets in which the licensee can sell the product. For example, pharmaceutical giant Gilead has allowed the South African firm, Aspen Pharmacare, to manufacture and distribute branded and generic versions of tenofovir, one of the newer first-line ARV drugs. However, civil society activists say voluntary licences skew the balance of power too far in favour of patent-holders and present a way to control generic competition by creating dependency on the innovator companies, according to this article. The United States and the European Union have been accused of pressuring developing countries by using trade threats to coerce these countries into adopting intellectual property laws that will increase the cost of medicines. By jeopardising generics, especially those from India, this article argues that they are effectively putting millions of lives at risk.

This study’s objective was to assess the effect of food taxes and subsidies on diet, body weight and health through a systematic review of the literature. Researchers searched the English-language published and grey literature for empirical and modelling studies on the effects of monetary subsidies or taxes levied on specific food products on consumption habits, body weight and chronic conditions. Twenty-four studies met the inclusion criteria. The study found that, in general, taxes and subsidies influenced consumption in the desired direction, with larger taxes being associated with more significant changes in consumption, body weight and disease incidence. However, studies that focused on a single target food or nutrient may have overestimated the impact of taxes by failing to take into account shifts in consumption to other foods. The quality of the evidence was generally low. The study concludes that food taxes and subsidies have the potential to contribute to healthy consumption patterns at the population level. However, the empirical evaluation of existing taxes should become a research priority, along with research into the effectiveness and differential impact of food taxes in developing countries.