Health equity in economic and trade policies

A decade of tobacco control: The South African case of politics, health policy, health promotion and behaviour change
Reddy PD, James S, Sewpaul R, Yach D, Resnicow K, Sifunda S, Mthembu Z, Mbewu A: South African Medical Journal, 103 (11):835-840, November 2013

The South African (SA) government has implemented comprehensive tobacco control measures in line with the requirements of the Framework Convention on Tobacco Control. The effect of these measures on smoking prevalence and smoking-related attitudes, particularly among young people, is largely unknown. This paper describes the impact of a comprehensive health promotion approach to tobacco control amongst SA school learners with evidence from four successive cross-sectional Global Youth Tobacco Surveys (GYTSs) in 1999, 2002, 2008 and 2011 among nationally representative samples of SA grades 8 - 10 school learners. Smoking-related attitudes and behaviours showed favourable changes over the survey period. The surveys demonstrated that the comprehensive and inter-sectorial tobacco control health promotion strategies implemented in SA have led to a gradual reduction in cigarette use amongst school learners. Of concern, however, are the smaller reductions in smoking prevalence amongst girls and black learners and an increase in smoking prevalence from 2008 to 2011. Additional efforts, especially for girls, are needed to ensure continued reduction in smoking prevalence amongst SA youth.

A lifeline to treatment: The role of Indian generic manufacturers in supplying antiretroviral medicines to developing countries
Waning B, Diedrichsen E and Moon S: Journal of the International AIDS Society 13(35), 14 September 2010

This study set out to produce quantitative estimates of the Indian role in generic global anti-retroviral (ARV) supply to help understand potential impacts of such measures on HIV and AIDS treatment in developing countries. It utilised transactional data containing 17,646 donor-funded purchases of ARV tablets made by 115 low- and middle-income countries from 2003 to 2008 to measure market share, purchase trends and prices of Indian-produced generic ARVs compared with those of non-Indian generic and brand ARVs. The study found that Indian generic manufacturers dominate the ARV market, accounting for more than 80% of annual purchase volumes. From 2003 to 2008, the number of Indian generic manufactures supplying ARVs increased from four to 10 while the number of Indian-manufactured generic products increased from 14 to 53. Indian-produced generic ARVs used in first-line regimens were consistently and considerably less expensive than non-Indian generic and innovator ARVs. The study warns that future scale up using newly recommended ARVs will likely be hampered until Indian generic producers can provide the dramatic price reductions and improved formulations observed in the past. Rather than agreeing to inappropriate intellectual property obligations through free trade agreements, India and its trade partners - plus international organisations, donors, civil society and pharmaceutical manufacturers - should ensure that there is sufficient policy space for Indian pharmaceutical manufacturers to continue their central role in supplying developing countries with low-priced, quality-assured generic medicines.

A new debt crisis? Assessing the impact of the financial crisis on developing countries
Edwards S: Jubilee Debt Campaign, 2009

This paper details the extent of what it sees as a burgeoning ‘debt crisis’. With traditional sources of finance drying up, export markets collapsing and a range of other economic impacts, the threat of a renewed debt crisis is very real. Out of the 43 most vulnerable countries, 38 needed at least some debt cancellation to meet their people’s basic needs. Governments with large debt burdens, which are usually denominated in foreign currencies such as the dollar, may struggle to meet the repayment requirements and even default on their debts. Private capital flows to developing countries could fall to around US$165 billion in 2009. The paper recommends canceling more debts, responsible finance and a debt tribunal. Current debt relief initiatives are inflexible, entirely creditor-controlled and wholly inadequate to meet the challenge of the continuing debt crisis.

A new low in the Pharma Drug Wars - Abbott withdraws seven medicines in Thailand
Baker BK: Health GAP, 14 March 2007

Abbott's abrupt decision to withdraw seven pending registration applications, including one for a new heat-stable form of Kaletra, and its threat to make Thailand a no-drug zone for all new Abbott medicines is a truly appalling example of corporate hubris. After touting itself to the be the engine of new life-saving discoveries, Abbott is now willing to withhold medicines altogether in order to extract even greater intellectual property concessions from developing countries.

Further details: /newsletter/id/32159
A paradigm shift for socioeconomic justice and health: from focusing on inequalities to aiming at sustainable equity
Garay J; Chiriboga D: Public Health 149, doi:, 2017

This study measured the ‘best possible health for all’, incorporating sustainability, to establish the magnitude of global health inequity. The authors identified countries with three criteria: firstly, a healthy population—life expectancy above world average; secondly, living conditions feasible to replicate worldwide—per-capita gross domestic product (GDP-pc) below the world average; and thirdly, sustainability—per-capita carbon dioxide emissions lower than the planetary pollution boundary. Using these healthy, feasible, and sustainable (HFS) countries as the gold standard, the authors estimated the burden of global health inequity (BGHiE) in terms of excess deaths, analysing time-trends (1950–2012) by age, sex, and geographic location. Finally, the authors defined a global income ‘equity zone’ and quantified the economic gap needed to achieve global sustainable health equity. A total of 14 countries worldwide met the HFS criteria. Since 1970, there has been a BGHiE of about 17 million avoidable deaths per year (about 40% of all deaths), with 36 life-years-lost per excess death. Young children and women bore a higher BGHiE, and, in recent years, the highest proportion of avoidable deaths occurred in Africa, India, and the Russian Federation. By 2012, the most efficient HFS countries had a GDP-per capita/ year of US$2165, which the authors proposed as the lower equity zone threshold. The estimated US$2.58 trillion economic gap represents 3.6% of the world's GDP—twenty times larger than current total global foreign aid. Sustainable health equity metrics provide a benchmark tool to guide efforts toward transforming overall living conditions, as a means to achieve the ‘best possible health for all.’

A Primer to the Emerging Extractive Sector in Kenya: Resource Bliss, Dilemma or Curse
Oiro Omolo MW, Mwabu G: Institute of Economic Affairs, November 2014

In any economy, the extractive sector consists mainly of oil, gas and mining activities. Experience in countries such as Norway, Canada, Botswana and Ghana suggests that extractives can be effectively managed to contribute to sustainable economic growth. Experience, however, in other parts of the world including Nigeria, the Democratic Republic of Congo, South Sudan, and the Central African Republic suggest that extractives if not well managed can lead to conflict. Extractives in Kenya contribute approximately one per cent to gross domestic product. The sector is however emerging. In the recent past, there have been oil and more mining discoveries in Kenya. For instance, oil has been discovered in Turkana County, and there are new discoveries in the mining sectors for minerals such as titanium in Kilifi County and coal in Kitui County. In addition, Kenya is actively undertaking off shore explorations with the aim of making gas discoveries. The growing extractive sector in Kenya means that there is need to give more attention to the social and economic dynamics of the sector. For instance, when Kenya discovered oil in Turkana County in March 2012, the Government was faced with emergent issues such as environmental implications, community obligations and rights, a suitable governance framework, and effective utilisation of resources generated from the sector.

A Recovery for All: Rethinking Socio-Economic Policies for Children and Poor Households
Ortiz I and Cummins M (Editors): UNRISD, October 2012

The world’s financial and economic crisis has taken a toll on children and poor households. High food and commodity prices, unemployment and austerity measures have aggravated persistent inequalities and contributed to a substantial rise in hunger and social tensions. Now, more than ever, investments for the world’s poor are needed to recover lost ground in pursuit of development objectives. People everywhere are demanding change. This book describes the social impacts of the crisis, policy responses to date and United Nations alternative proposals for ‘A Recovery for All.' The book guides us through the effects of the multiple crises on the poor, but it also demonstrates convincingly that the fiscal space for a basic floor of social protection that would provide effective protection from the worst social fall-out of such crises can be found. The book reminds that fiscal space is not a question of economic performance or state of development, it is first and foremost a question of political will. It is the lack of political will, i.e., cruel indifference vis-à-vis avoidable ill health, hunger, destitution and deaths, that prevents us from reducing vulnerability of those who have no means to fend for themselves.

A rethink is needed on Africa’s EPAs with the EU
Khor M: South Bulletin 52, 25 November 2010

African countries have stalled on signing economic partnership agreements (EPAs) with the European Commission because they fear negative consequences for their smaller economies, this article reports. To avoid the pitfalls of signing the EPAs in their current form, the article suggests African countries should negotiate trade preferences. The author notes that the 33 least-developed countries (LDCs) in the African Union do not have to sign the EPAs since their trade preferences will continue under the ‘Everything But Arms’ scheme. They should not have to sign EPAs in order to maintain the common external tariffs they have or would like to have with the non-LDCs in their regional economic groupings. Instead, the 14 non-LDCs can request that the EU provide them also with the ‘Everything But Arms’ scheme, without their having to give preferences to the EU in return. He argues that there is a good case for this, as these 14 countries are also poor and vulnerable, and have similar characteristics as the LDCs. Moreover, they belong to regional economic groupings in which LDCs are the majority of the membership, and there is thus also a good case that they be given a similar status as the LDCs so that these groupings can continue with their common tariffs, without the LDCs having to be sacrificed. There are a number of cases in the WTO in which waivers have been given for non-reciprocal agreements between a developed country member and a developing country or region. The article concludes that the best option to resolve the EPA impasse is for Europe to give a non-reciprocal preferential package for Africa as a region, or for the 14 African non-LDCs, in a treatment similar to ‘Everything But Arms’.

A review of co-morbidity between infectious and chronic disease in sub-Saharan Africa: TB and diabetes mellitus, HIV and metabolic syndrome, and the impact of globalization
Young F, Critchley JA, Johnstone LK and Unwin NC: Globalization and Health 5(9), 14 September 2009

This review found that globalisation was clearly related to an increased risk of diabetes and cardiovascular disease in sub-Saharan Africa. It may be exerting other negative and positive impacts upon infectious and chronic non-communicable disease associations but current reporting on these is sparse. The predicted impact of these co-morbidities in the region is likely to be large. An increasing prevalence of diabetes may hinder efforts at tuberculosis control, increasing the number of susceptible individuals in populations where tuberculosis is endemic, and making successful treatment harder. Roll out of anti-retroviral treatment within sub-Saharan Africa is an essential response to the HIV epidemic however it is likely to lead to a growing number of individuals suffering adverse metabolic consequences. One of the impacts of globalisation is to create environments that increase both diabetes and cardiovascular risk but further work is needed to elucidate other potential impacts. Research is also needed to develop effective approaches to reducing the frequency and health impact of the co-morbidities described here.

A Row to Hoe: The Gender Impact of Trade Liberalization on our Food System, Agricultural Markets and Women‘s Human Rights
Spieldoch A: IATP and the International Gender and Trade Network, 2007

This research paper draws together analysis of recent trends in food and agriculture from a gender perspective within an analysis of how trade and investment have affected food security and agricultural development. Although a number of case studies exist exploring how women have been affected by changes in global and local food systems, few have situated these case studies and their findings in the more global context of international trade and investment. This paper explores these linkages, pointing to the connections as well as to the need for further research to deepen our understanding of why women, who aremore than half the world’s population and overwhelmingly responsible for child nutrition, must be involved in policy decisions that affect agriculture and food security.