Health equity in economic and trade policies

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.

SA just endorsed a draft resolution that could bring Big Pharma to its knees
Van Dyk J: Bhekisisa, April 2019

A World Health Assembly resolution this year proposed that drug prices could be reduced if countries forced pharmaceutical companies to be open about what it really costs to produce medicines. The plan is to give governments a way to enforce changes in the way medicine prices are set. In South Africa, cancer patients pay exorbitant prices to stay alive. Blood cancer patients are paying over R 800 000 for a year’s worth of one chemotherapy medicine, according to a report by the Cancer Alliance. Loopholes in South African patent laws are said to be one reason medicine prices are this high. Currently, companies that bring new drugs onto the market are awarded market monopolies through being awarded long-term patents that prevent anyone else from manufacturing a similar drug for many years. For example, the company that brought the blood cancer drug in question onto the market has had protection from competitors for 40 years, according to a briefing paper by the Initiative for Medicines, Access and Knowledge. In an overhauled system, it is proposed that market monopolies be capped at 15 years with small rewards offered when new, good drugs enter the market.

Smoke, spies and lies: Should you throw away your e-cigarette?
Van Dyk J: Bhekisisa Centre for Health Journalism, April 2019

E-cigarettes allow users to inhale solutions that usually contain nicotine in a colourless liquid such as propylene glycol – an additive typically found in food and cosmetics. This solution is heated in hand-held devices and produces a vapour, which is why smoking e-cigarettes is often called “vaping”. South Africa’s new tobacco control Bill, which was published in July last year, proposes the same harsh regulations for e-cigarettes as their traditional cigarette counterparts. These include advertising restrictions, plain packaging and the banning of smoking areas in restaurants and public buildings. After the Bill’s publication, the Vapour Products Association (VPA), which represents e-cigarette manufacturers and retailers, publicly asserted that e-cigarettes are 95% safer than conventional cigarettes and may even help traditional smokers to quit, quoting an expert review by Public Health England in 2015. The UK study has however been widely criticised with some scientists taking issue with its methodology, arguing the research was based on the opinions of experts, instead of clinical trials. Anthony Westwood, a pulmonologist at the School of Child and Adolescent Health at the University of Cape Town, explains: “Our children cannot afford to find out in 20 years that they’ve got cancer because of e-cigarettes. “We have a chance to defuse this ticking time bomb.”

Systematic looting robs Africa of billions of dollars
Centre for Natural Resource Governance, 31 May 2019

Natural resource governance activists have called on African leaders and corporates to stop the systematic looting of resources because it deprives the states of meaningful revenue needed for development. The call was made at a regional conference on the political economy of resource looting in the SADC region organized by Centre for Natural Resource Governance (CNRG) Southern Africa Political Economy Series (SAPES Trust) and regional watchdog Southern African Resource Watch (SARW) in Harare in May 2019. Southern Africa is said to be losing tens of billions of American dollars in potential natural resources revenue through systematic looting which includes trade mispricing, tax avoidance, corruption and transnational organized crime involving ruling elites and foreign actors, regional natural resource experts have said. SADC delegates present at the conference suggested that there is need to harmonise the laws in the region and adopt mineral resource governance and stronger contract negotiations to curb the leakages.

Tech firms to check suppliers after mining revelations in Tanzania
Watts J: The Guardian, June 2019

A network of journalists report that electronics companies, including Canon, Apple and Nokia, are re-evaluating their supply chains following reports they may be using gold extracted from a London listed Tanzanian gold mine that has been criticised for environmental failures. More recently, the Tanzanian government has imposed penalties on the mine and ordered the operators to build an alternative to its tailings reservoir, which is used to store potentially hazardous by-products of mining. Under Tanzanian law, no mine should operate within 200 metres of a home or 100 metres of a farm, but the mining company reported that it had not been able to meet this requirement. The company has built a wall in some areas, improved security training and introduced a grievance mechanism, which have led to a marked reduction in conflict over the past two years, but locals claimed there were still accidents and violence as a result of incursions, and toxic wastewater continued to seep from the mine into residential areas and waterways nearby. While there is scrutiny of the supply chain there is concern that this focuses on small-scale miners rather than multinationals, that there is not enough attention to environmental standards and local laws, and that responsibility gets diluted along the supply chain.