Health equity in economic and trade policies

The Impact of COVID-19 on SADC Economy
SADC Macroeconomic Subcommittee, SADC Secretariat: SADC, Gaborone, May, 2020

This report presents the impact of the COVID-19 Pandemic and implications for SADC Region as monitored by the SADC Macroeconomic Subcommittee, supported by the SADC Secretariat. It provides policy recommendations to Member States. The report recommends policy interventions in the face of the significant global economic downturn from COVID-19, including adding to the focus on health and humanitarian responses, strengthening early warning systems, response and mitigation of pandemics and disasters that have proved to be major threats to education, tourism, informal sector and other sectors; and developing Roadmaps and Action Plans that prioritize investments and channel scarce resources to identified economic sectors to resuscitate their economies, strengthen resilience and improve competitiveness, based on the SADC macroeconomic convergence programme.

'Alternative Mining Indaba': you should not only take oil and diamonds
Evans J: News 24, February 2020

A group of about 70 people from the Alternative Mining Indaba marched to the Mining Indaba 2020 held at Cape Town International Conference Centre to highlight their concerns over the problems extractive mining is causing for communities who live near mines. Rev. Martha Mutswakatira, from the Reformed Church in Zimbabwe, who had walked down Adderley Street with the civil society activists in her white collar on Wednesday, said communities are carrying the cost of damages caused by extractive mining. One man from Angola among the Alternative Mining Indaba picket said: "When you come to Africa you need to invest in people: You should not only take oil and diamonds, and leave people with their hands empty." They demanded legal reforms, responsible supply chains, and that mines that pollute be prosecuted. They also called for the legalisation of artisanal mining, with licences being granted to these miners, and that miners and mineworkers be entitled to health and social care. They recommend carbon taxing of mining companies, not allowing social initiatives by mines to be tax deductible, and a move away from fossil fuels. The group also called for the mining industry to provide compensation for former miners' whose health has been adversely affected. Their memorandum was accepted by a delegation which included the International Council on Mining and Minerals; the Department of Minerals and Energy and the Minerals Council South Africa.

Tackling injustices of occupational lung disease acquired in South African mines: recent developments and ongoing challenges
Kistnasamy B; Yassi A; Yu J; et al: Globalization and Health 14(60), doi: 10.1186/s12992-018-0376-3, 2018

This study aimed to assess developments over the last 5 years in providing compensation, quantify shortfalls and explore underlying challenges for ex mineworkers and their families. Using the database with compensable disease claims from over 200,000 miners, the medical assessment database of 400,000 health records and the employment database with 1.6 million miners, rates of claims, unpaid claims and shortfall in claim filing were calculated for each of the southern African countries with at least 25,000 miners who worked in South African mines, by disease type and gender. Interviews were also conducted in Johannesburg, Eastern Cape, Lesotho and a local service unit near a mine site, supplemented by document review and auto-reflection, adopting the lens of a critical rights-based approach. A myriad of diverse systemic barriers persist, especially for workers and their families outside South Africa. Calculating predicted burden of occupational lung disease compared to compensable claims paid suggests a major shortfall in filing claims in addition to the large burden of still unpaid claims. Despite progress made, our analysis reveals ongoing complex barriers and illustrates that the considerable underfunding of the systems required for sustained prevention and social protection (including compensation) needs urgent attention. With class action suits in the process of settlement, the globalized mining sector is now beginning to be held accountable.

WHO response to WTO member state challenges on tobacco, food and beverage policies
Barlow P; Labonte Rl McKee M; Stuckler D: Bulletin of the World Health Organisation 97(1) 846-848, 2019

In 2013, the World Health Assembly endorsed the World Health Organization’s (WHO) Global action plan for the prevention and control of noncommunicable diseases (NCDs) 2013–2020 to achieve a 25% reduction in mortality from NCDs by 2025. WHO’s Global Action Plan is ambitious. In the late 1990s, WHO used its treaty- making powers to address the issue of tobacco use, leading to the Frame-work Convention on Tobacco Control (FCTC). It enabled WHO to have a greater presence at World Trade Organization (WTO) meetings, supporting countries in their efforts to protect their populations against the harms from tobacco. While WHO was present when tobacco trade may conflict with public health concerns, this was not the case in WTO discussions concerning nutrition policy. Even though the Global action plan for the prevention and control of NCDs 2013–2020, fully recognizes the need for action on trade in certain foods and beverages, it was not possible to find any evidence of WHO participation in nutrition-related trade challenges, such as those related to unhealthy food high in salt, fat and sugar, alcohol, soft-drinks and infant milk formulae. The authors suggest that WHO can learn from its past successes in championing tobacco control at the WTO. The lack of a treaty similar to the FCTC for nutrition-related diseases may discourage WHO participation because such absence limits the perceived legitimacy of WHO input. Further investigations are necessary to understand why WHO has yet to comment on food and beverage regulations at WTO’s committee.

BAT faces landmark legal case over Malawi families' poverty wages
Boseley S: The Guardian, October 2019

Human rights lawyers are reported to be preparing to bring a landmark case against British American Tobacco on behalf of hundreds of children and their families forced by poverty wages to work in conditions of gruelling hard labour in the fields of Malawi. Leigh Day’s lawyers are seeking compensation for more than 350 child labourers and their parents in the high court in London, arguing that the British company is guilty of “unjust enrichment”. Leigh Day says it anticipates the number of child labourer claimants to rise as high as 15 000. While BAT claims it has told farmers not to use their children as unpaid labour, the lawyers say the families cannot afford to work their fields, because they receive so little money for their crop. Many of the families are from Phalombe, one of the poorest regions in the south of the country. Children as young as three are involved in tobacco farming, the letter of claim says, often during harvest when the work can be especially hazardous. Children are particularly vulnerable to the effects of toxic pesticides, fertiliser and green tobacco sickness, from nicotine absorption while handling the leaves. Symptoms include breathing difficulties, cramps and vomiting. BAT is one of the most profitable companies in the world, making an operating profit last year of £9.3bn on sales of £24.5bn. Like other big tobacco companies, it has distanced itself from the farmers by commissioning a separate company to buy a stipulated amount of tobacco leaf each year.

Corporations’ use and misuse of evidence to influence health policy: a case study of sugar-sweetened beverage taxation
Fooks G, Williams S, Box G, Sacks G: BMC Globalization and Health, 15, 56, doi:10.1186/s12992-019-0495-5, 2019.

Sugar sweetened beverages (SSB) are a major source of sugar in the diet. Although trends in consumption vary across regions, in many countries, particularly LMICs, their consumption continues to increase. In response, a growing number of governments have introduced a tax on SSBs. SSB manufacturers have opposed such taxes, disputing the role that SSBs play in diet-related diseases and the effectiveness of SSB taxation, and alleging major economic impacts. Given the importance of evidence to effective regulation of products harmful to human health, the authors scrutinised industry submissions to the South African government’s consultation on a proposed SSB tax and examined their use of evidence. The findings not only highlight the value of improving the transparency and scrutiny of regulatory impact assessments and consultations in health policy-making, but also other modes of industry political activity. The authors argue that. efforts need to be made to enhance appraisal of industry use of evidence. Ideally, there should be a presumption in favour of in-depth critical appraisal, organised and financially supported by national governments. Beyond this, there is a strong case for closer transnational collaboration between civil society actors and academics that centres on producing real-time appraisals of companies’ use of evidence in both public consultations and other contexts in which they provide information to policy actors and the public.

Huawei's pitch to African mayors: ‘Our cameras will make you safe’
Allison S: Mail and Guardian, November 2019

A conference organised by the Brenthurst Foundation, a Johannesburg-based think-tank and lobby group gave Huawei a slot to pitch its vision for the future of African cities. It is a vision that revolves around surveillance, artificial intelligence and 5G communication networks, creating a world where your every movement is tracked, recorded and searchable. Human Rights Watch describes this technology, however, as “algorithms of repression”, given a potential for abuse of people’s rights.

Potential Health Impact of the African Continental Free Trade Area Agreement (AfCTA)
Awosusi A: International Health Policies, 2019

Nearly all African countries have endorsed the continental free trade agreement. Trading is scheduled to commence in 2020 after key negotiations are concluded. Implementation of the agreement is likely to impact health in at least five areas: human capital investments, health innovations, trade for social impact, health security and universal health coverage. The author reccommends that health and development stakeholders take proactive measures to ensure health is protected in policies, programs and negotiations. While the five proposed areas are not exhaustive, they are argued to represent a basic foundation for rigorous research and informed engagement by health and development leaders in AfCFTA and trade-related processes. Other issues such as research and development, biopharmaceutical innovation and intellectual property rights also need to be considered.

Urban Health Initiative in Accra: Workshop on planning for climate action, improved air quality and health
Accra Metropolitan Assembly: Ghana, May 2019

The World Health Organisation, Accra Metropolitan Assembly, Ghana Health Service, Environmental Protection Agency, UN-Habitat and ICLEI hosted a two-day workshop with the Accra Metropolitan Assembly in May 2019 to support action towards healthier urban environments and to engage other municipalities to jointly act on air quality, public health and the reduction of short-lived climate pollutants. With representatives from several assemblies and municipalities, ministries and other relevant institutions, the workshop took participants through working sessions to discuss the health and economic impacts of sectoral policies, to inform the development of Accra’s Climate Action Plan and control of air pollution.

WHO: Member States adopt resolution on transparency in medicine pricing
Third World Network: TWN Information Service on IP and Health, May 2019

The 72nd World Health Assembly (WHA) of health ministers in May 2019 adopted the resolution on “Improving the transparency of markets for medicines, vaccines, and other health products” in what is considered as a first step to improve the transparency on medicine pricing and other factors impacting prices such as clinical trial costs. The resolution urges the WHO Member States in accordance with their national and regional legal frameworks and contexts to take appropriate measures to publicly share information on the net prices of health products. Further, the resolution urges Member States to take measures to disclose the net price i.e. the price received by the manufacturer instead of the price paid by the government or customers. The resolution requires that costs from human subject clinical trials, regardless of outcomes, be made publicly available or be voluntarily provided. Further, the resolution provides a clear mandate to the WHO Secretariat to “analyse the availability of data on inputs throughout the value chain, including on clinical trial data and price information”. Unlike the initial draft, first proposed by Italy and then supported by a group of countries, the resolution does not create any responsibility on the part of Member States to ensure transparency on R&D cost and clinical trial cost. TWN report that the debate on the resolution brought out out the division within Europe between the countries with pharmaceutical industry such as Germany, France, the United Kingdom, Switzerland, Sweden and Denmark on the one hand, and countries that do not have strong pharmaceutical industry such as Spain, Portugal, the Netherlands, Austria and Norway. The USA supported the resolution, stating the commitment of the Trump Administration’s initiative to legislate to ensure competition in the pharmaceutical market through transparency in pricing. Though the resolution was adopted by consensus i.e. without any objection from the Member States, Germany, Hungary and the UK stated their disassociation from the resolution at the WHA plenary.