In Zambia, a woman named Chileshe is dying of AIDS. She was infected by her now dead husband, who once worked in a textile plant along with thousands of others but lost his job when Zambia opened its borders to cheap, second-hand clothing. Resorting to work as a street vendor, he would get drunk and trade money for sex - often with women whose own husbands were somewhere else working, or dead, and who desperately needed money for their children. Desperation, she thought, is what makes this disease move so swiftly; she recalls that a woman from the former Zaire passing through her village once said that the true meaning of SIDA, the French acronym for AIDS, was "Salaire Insuffisant Depuis des Années" (Schoepf, 1998).
Chileshe's is one of four stories we used in a report that has just been published by Canada's Centre for Social Justice (Labonte, Schrecker & Sen Gupta, 2005b) to dramatize the health impacts of transnational economic integration ('globalization'). It is a composite, like the stories used in the World Bank's 1995 'World Development Report'. The Centre for Social Justice report, which grew out of a contribution to the first 'Global Health Watch Report' (forthcoming in July at http://www.ghwatch.org), directly challenges the elite religion of neoliberal, market-oriented economic policy, as promoted by agencies like the World Bank and the International Monetary Fund. Drawing on an extensive research base, we describe the causal pathways that link globalization to unequal and deteriorating health outcomes by way of increasing inequalities in access to the social determinants of health, and policies that tilt the economic playing field even more steeply toward the rich countries.
Health equity in economic and trade policies
Economic Partnership Agreements (EPAs) are likely to harm regional integration between developing countries, without achieving significant liberalisation of trade between the EU and ACP countries, according to new research by Christopher Stevens and Jane Kennan at the Institute of Development Studies. EPAs are new trade agreements being negotiated by the European Union to regulate trade between the EU and the ACP (Africa, Caribbean and Pacific) group of developing countries. Following the recent publication of the Commission for Africa report, the UK Government argued that EPAs should not be used to force open ACP markets. New IDS research indicates that it will be feasible to achieve this aim, without falling foul of the WTO, if the EU sticks to its recent practice in negotiations with other countries. The evidence from examining the detailed situation of ACP states suggests that most of them can avoid rapid or substantial liberalisation, thereby protecting fledgling domestic industries.
Health has gained importance on the global agenda. It has become recognized in forums where it was once not addressed. In this article three issues are considered: global health policy actors, global health priorities and the means of addressing the identified health priorities. The arenas for global health policy-making have shifted from the public spheres towards arenas that include the transnational for-profit sector. Global health policy has become increasingly fragmented and verticalized. Infectious diseases have gained ground as global health priorities, while non-communicable diseases and the broader issues of health systems development have been neglected. Approaches to tackling the health problems are increasingly influenced by trade and industrial interests with the emphasis on technological solutions.
The Indian Patents Act of 1970 has been amended to allow for the granting of pharmaceutical product patents. India was obliged to make these changes to comply with the WTO TRIPS Agreement as of January 1st 2005. The new Patents Act will mean that over time the source of affordable generics may dry up. The law will only affect medicines that have come onto the market since 1995. However, the amendments made by the Indian parliament have some very important provisions for access in the short term, says Medicines Sans Frontieres.
The health sector is to be excluded from draft European legislation designed to open up the market for services throughout the European Union’s 25 member states. The European Commission in Brussels has decided to radically overhaul its original proposal because of wide ranging opposition to the plans it tabled last year to abolish national restrictions on service providers.
Controversial legislation approved by the lower house of India's parliament on 22 March could drastically increase the cost of cheap HIV drugs and other medicines the country produces, according to international humanitarian organisations.The law threatens to affect the provision of healthcare to hundreds of thousands of patients, many of them in Africa, for whom low-cost Indian drugs are the only affordable means of treating AIDS. The new patents bill is intended to bring India's patent regime into line with the World Trade Organization's (WTO) agreement on Trade Related Aspects of Intellectual Property Rights (known as TRIPS), one of the conditions of India's membership of the WTO.
Negotiations to expand the availability of medicines under a World Trade Organisation agreement on intellectual property rights by 31 March broke down after informal consultations showed no compromise forthcoming, according to diplomatic sources in Geneva. At issue is an amendment of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) to allow countries producing generic pharmaceuticals under compulsory license to export those products to other countries in need.
Following the full implementation of the TRIPS Agreement in 2005 in India and the few other developing countries not yet granting pharmaceutical patents, access to new drugs may be expected to become more difficult, states this briefing paper from Doctors without Borders. "All new drugs may be subject to at least 20 years of patent protection in all but the least developed countries and the occasional non-WTO country such as Somalia, Palestine, and Macedonia. As this will affect producers in key manufacturing countries, such as India, and other countries that are dependent on India for raw materials, it will keep prices up and will likely make new medicines inaccessible for the majority of the population in developing and least developed countries. Generic producers will also be blocked from developing fixed-dose combinations until the relevant patents on the individual components of the combinations expire."
The emergence of an increasingly global economy suggests that the ability of individual countries to shape their own destinies is becoming more difficult. International trends and pressures now influence national, and even local, health care policy making. Researchers from the University of the Witwatersrand, South Africa, together with Oxford University, looked at the effect of globalisation on health issues in South Africa and assessed its influence compared to national and local forces. Political and economic developments in the international arena will inevitably influence health issues in South Africa. Institutions such as the WHO and the World Bank, together with international events such as the spread of AIDS, affect health care in the country. However local forces also play a large part in shaping the future of the South African health service.
"February 26, 2005 has been named a day of international protest against the actions of the Government of India. People around the world are calling to question the humaneness of a patent modification that permits the private sector to profit from public health. The Indian Patent Ordinance prescribes “TRIPS-PLUS” standards, which takes the country beyond the commitments agreed to under the TRIPS agreement. The Patent act has fostered the pharmaceutical industry in India, provided affordable medication to millions within India and the rest of the developing world. As of December 26, 2005, by Presidential Ordinance, the patent Act has been modified; we now face Product Patent protection for pharmaceuticals and agrochemicals in India."