This study reviewed evidence on the impact of reproductive, maternal, newborn, and child health (RMNCH) on economic growth and development. The authors performed a systematic search of the published literature in electronic databases and consulted grey literature such as working papers and reference lists of selected articles. They found that GDP loss attributable to maternal mortality varies from US$0 per year in Botswana to US$504 per year in Ethiopia. If maternal mortality increases by one death, GDP per capita decreases by US$0.36 per year on average in 45 sub-Saharan countries. AIDS was found to have a negative effect on economic growth, especially in sub-Saharan Africa, although the magnitude varies among studies from 0.05% to 1% decline in GDP per capita. The intergenerational effect of HIV and AIDS is much higher, at 30-50% reduction of GDP per capita over four generations at a 15-20% HIV prevalence rate. The review revealed inadequate evidence on the impact of RMNCH on economic growth and development, which may, in part, be due to difficulties in measuring economic impact over extended time periods, and may also be due to the breadth of health states that fall within the RMNCH continuum. The authors argue that future research should focus on identifying the most cost-effective policy, programmes and interventions to prevent, reduce, delay or eliminate the complications of RMNCH.
Health equity in economic and trade policies
The authors of this paper argue that there is scope to balance current fiscal consolidation efforts in favour of more equity with only limited adverse impact on potential growth. In particular, relatively little weight has been given to reducing tax expenditures and raising taxes on immovable property. A number of consolidation instruments are consistent with equity goals while doing little or no harm to potential growth: increases in the effective retirement age, raising efficiency in the education and health care systems, cutting certain tax expenditures, hiking taxes on immovable property and broadly-based consumption taxes. Increases in capital income taxes would also be equitable but need to be well designed to avoid being distortive. Calculations based on simplifying assumptions indicate that increasing household direct taxes would reduce income inequality, while cutting transfers by the same amount would have a larger and opposite effect on inequality. However, raising progressive labour income taxes could have adverse effects on long-run growth. Cuts in government wages and employment can yield fast consolidation gains but the authors warn that this needs to be accompanied by increases in efficiency of service delivery to avoid that reductions in public services mainly hit poor people.
In this article, the authors discuss the issue of how medicines may be eligible for patents and how this affects evergreening practices, whereby pharmaceutical companies extend the patent on their medicines by making slight modifications. However, evergreening of pharmaceutical patent protection, also includes patent monopolies over manufacturing processes, formulations, dosages, uses and methods of treatment. The authors present data that shows that evergreening patents have extended patent protection to nearly 50 years in some cases, well beyond the 20 year period provided in TRIPS. They argue that the net cost for society of evergreening patents is substantial and they have been proven to interfere and hinder fair competition in the pharmaceutical market, with the result that pharmaceutical companies can charge high monopoly prices for far longer than is justified. Because of its critical implications for competition and public health, India’s s.3(d) is becoming a model criteria for patent eligible subject matter in other countries. For instance, Brazil’s patent reform proposes to adopt such a provision. The invention threshold plays a critical role in the patent system. Setting the bar too low makes it easier for the patent system to be improperly exploited by those that use extended patent monopolies to extract economic rents. This behaviour should not be facilitated, the authors argue, as it unreasonably restricts society’s ability to benefit from the technology transfer trade-off.
According to this book, governments across the globe are being persuaded by economists that government spending on services like education and health is unnecessary and can only worsen the global economic crisis. To this effect they have advanced a policy of draconian budget cuts – austerity - to solve the financial crisis. However, the author of this book argues that the source of the financial crisis is not in government spending but the direct result of bailing out, recapitalising and adding liquidity to the broken banking system. Through these actions private debt was reclassified as government debt, which now is the responsibility of taxpayers to pay off, hence the proposed cuts in government spending. Blyth argues that historical evidence shows that austerity doesn't work when all states try it simultaneously: all they do is shrink the economy. He shows how austerity policies aggravated the Great Depression of the 1930s and created the conditions for seizures of power by the forces responsible for the Second World War: the Nazis and the Japanese military establishment. He concludes that the arguments for austerity are tenuous and the evidence thin. Rather than expanding growth and opportunity, the repeated revival of this dead economic idea has almost always led to low growth along with increases in wealth and income inequality.
For too long Africans have been dependent on aid and medicines from the West, argues the author of this article, but Brazil, India, China and South Africa (BRICS) are emerging as dominant players in Africa’s health markets. In the late-1990s, Brazil played an instrumental role in shifting the paradigm of healthcare and human rights when it challenged the World Trade Organisation (WTO) and its intellectual property regime. Brazil violated a WTO clause to provide antiretroviral drugs and to lower their price. This reaffirmed medicine as a fundamental human right. While many drugs continue to be developed in the West, India has stepped in to manufacture generic medicines for the world's poorest countries. Through low-cost support and commodities, India has filled a gap in the global market. China has an increasing role to play in the global health arena. It invested $36.1 billion in 2011 in research and development, placing the country in a position to become a major player in healthcare innovation. Additionally, given the sheer scale of industry and financial resources available, China has the capacity to develop and supply HIV drugs and technologies to meet the needs of the African epidemic. The departure of traditional international funders like the United Kingdom and the United States presents an opportunity for new sources of engagement with the growing BRICS economies. Investing in the health of Africa will fuel development, enhance diplomacy and build South-South solidarity, the author argues.
In this article, the author discusses the ramifications of a 2013 legal battle in the United States that ended with the court ruling unanimously that human genes cannot be patented. He argues that the implications of this ruling are far-reaching in terms of public health and equity. He views the case as an example of how societal inequality is a result not just of the laws of economics, but also of how we shape the economy through politics, including through almost every aspect of our legal system, in this instance intellectual property regimes. The right to life and right to health should not be contingent on the ability to pay. He also argues that some of the most iniquitous aspects of inequality creation within our economic system are a result of ‘rent-seeking’, namely profits, and inequality, generated by manipulating social or political conditions to get a larger share of the economic pie, rather than increasing the size of that pie. The world’s poorly designed intellectual property system encourages pharmaceuticals to pursue such rent seeking. And while advocates of intellectual property rights emphasise their role in promoting innovation, the author counters that most key innovations in history were motivated by the quest for knowledge, not financial gain. He provides evidence that the patent actually prevented the development of better tests, and so interfered with innovation.
After an impressive acceleration in growth and poverty reduction since the mid-1990s, many African countries continue to register robust growth in the aftermath of the global financial crisis. Will this growth persist, given the tepid recovery in developed countries, numerous weather shocks, and civil conflicts in Africa? This paper "stress tests" African economies. The findings indicate that Africa's long-term growth is fairly impervious to a prolonged recession in high-income countries. Growth is, however, much more sensitive to a disruption of capital flows to the region, and to internal shocks, such as civil conflict and drought, even if the latter follow historical patterns. The broad policy implication is that with proper domestic production conditions African countries can sustain robust long-term growth. Because of the economic dominance of the agriculture sector and the share of food in household budgets, countries will need to increase the resilience of agriculture and protect it from unfavorable climate change impacts, to prevent food insecurity.
According to the latest edition of MSF’s report on HIV treatment price and access issues, the price of first- and second-line anti-retrovirals have declined due to increased generic competition, while third-line regimens remain “exorbitantly priced”. For newer HIV medicines, including integrase inhibitors, generic competition is mostly blocked because of patents, and these drugs are more expensive as a result. MSF finds that patents remain a barrier on newer drugs and in middle-income countries, but some countries are using World Trade Organisation-sanctioned flexibilities to issue compulsory licences to increase access to the medicines. Flexibilities are built in to the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). MSF has proposed patent opposition (when applications do not meet a country’s patentability requirements) and the issue of compulsory licences in the interest of public health, as ways to bring prices down further. Additionally, MSF claims that free trade agreements continue to pose a threat to access, pointing to the European Union-India Free Trade Agreement and the Trans-Pacific Partnership Agreement as examples of agreements with “harmful provisions”.
Much has been written about Africa’s so-called ‘resource curse’, whereby natural resources disrupt an economy and create incentives for wide-scale corruption and even conflict. The effects of the resource curse need not, however, be viewed as inevitable, the author of this article argues. Political choice is key. Botswana has used its mineral wealth to develop into a stable, middle-income country. More recent producers such as Ghana, Liberia and Sierra Leone appear to be making good governance decisions so far. Emerging markets, especially China, continue to ramp up demand for the continent’s commodities, offering a once in a millennium opportunity for African governments to lift millions of people out of poverty. African leaders and the international community, big business and civil society must assume responsibility, the author argues. The most practical and credible form of becoming ‘transparent’, she says, is the Extractive Industries Transparency Initiative (EITI), which requires governments to explain clearly and openly the revenues flowing from its extractive sector so that any party can see how much the country in question receives from oil, gas and mining companies. So far, ten African governments have been judged compliant.
Africa is lacking a clear and unified policy in terms of how it relates to China, argue the authors of this opinion piece. He points to China’s lack of respect for human rights and the problem of China issuing loans without conditions. The cooperation between Africa and its economic development partners (EU, China and US) are strategically different, and each is driven by economic self-interests. It is of vital importance therefore, that Africa approves on an equal footing, strategic and most consistent partner (business or otherwise) who recognises, shares and respects its difficult but critical needs be it political, economic or social as well as sovereignty. Africa must necessarily develop a coherent and structured plan in successfully asserting its political, economic and social ties with China, the authors argue. It must avoid repeating some of the mistakes committed in its past relations with its traditional development partners. In the meantime, African leaders must be able to define and formulate strategic and comprehensive policies, individually, for the influx of Chinese investments. For instance, they must exert pressure on China and together, differentiate and separate investments and loans clearly from interest free loans, grants and aid projects.