Health equity in economic and trade policies

6th Anniversary of the Marikana Massacre
Marikana Solidarity Collective; Review of African Political Economy, August 2018

This paper presents a case that six years after the Marikana Massacre, the London-based mining corporation involved (Lonmin) has decided to leave its platinum mining operation in South Africa by preparing to sell to Sibanye-Stillwater. The authors support the demands of women’s organisation Sikhala Sonke and victims’ representatives that Lonmin must fulfil a social covenant with the community, rather than to the banks. The paper reports the demands of social movements that Lonmin apologise to the South African nation and to the victims of the massacre and pay reparations to the affected parties. The authors also report the call that Lonmin join calls to release the miners in prison as a result of the massacre and to prosecute the police officers and authors of the massacre, take responsibility for the environmental destruction at Marikana and comply with the obligations of its social and labour plan and add its voice to those calling to review the Farlam Commission and finance the legal process. They reject the excuse that the company is now insolvent.

BRICS-Johannesburg simultaneously disappoints and threatens
Bond P: Pambazuka News, August 2018

The author asks whether the Brazil-Russia-India-China-South Africa (BRICS) bloc can rise to the talk in Johannesburg about counter-hegemonic prospects during the BRICS summit held in the last week of July. However he also notes that their ideological diversity means that an excellent opportunity for this was lost and that the unity came rather from a support for mercantilist-neoliberalism. This he notes points to progressive international reform being practically impossible at present. He noted that the BRICS further distorted the International Monetary Fund (IMF) during its 2015 vote restructuring. Four of the five countries took much greater shares for themselves (aside from South Africa which lost 21 percent of its vote) at the expense mainly of poorer countries. He argues that the main site to consider antidote analysis and news is “brics from below,” a tradition of counter-summit critique begun in Durban five years ago, and also witnessed in Fortaleza in 2014, Goa in 2016 and Hong Kong in 2017. and as found in a protest led by four Goldman Environmental Prize winners and their organisations and allies: Makoma Lekalakala of Earthlife Africa, Bobby Peek of groundWork, Thuli Makama of OilChange International and Des D’Sa of the South Durban Community Environmental Alliance. As one outcome the largest proposed mega-project made at prior BRICS summits in 2014 and 2015 on US $100 billion worth of nuclear energy reactors as a deal between former South African president Jacob Zuma and Putin, is now on indefinite hold.

Countries Pressured to Drop Language on Protecting Access to Affordable Meds from TB Summit Declaration Negotiations
Medicins Sans Frontieres; Doctors Without Borders: July 2018

Countries negotiating the final declaration text for the first-ever UN High-level Meeting on Tuberculosis in September were put under significant pressure to drop references to protecting countries’ rights to take fully-legal actions to access affordable medicines for their people, Médecins Sans Frontières reports. One of the final sticking points in the negotiations in New York was language on public health safeguards enshrined in the World Trade Organization’s (WTO) Agreement on Trade-related Aspects of Intellectual Property Rights (TRIPS). This allows governments, among other things, to issue ‘compulsory licenses’ to override patents in the interest of public health, so that they can allow generic versions to be produced or imported and more people can receive needed treatment. The ‘Group of 77’ bloc of developing countries has been under pressure to drop all references to the WTO’s 2001 Doha Declaration that enshrined public health flexibilities and safeguards in the TRIPS agreement. This led to a call by Leena Menghaney, South Asia Head for MSF’s Access Campaign for all countries, including those in the Group of 77, and Brazil, Russia, India, China and South Africa, that have a high burden of TB, to urgently stand up right now against what they refer to as 'bullying', that aims to keep medicines out of the hands of people who need treatment.

Social support under siege: An analysis of forced migration among women from the Democratic Republic of Congo
Wachter K; Gulbas L: Social Science & Medicine (208) 107-116, 2018

The authors aimed to develop theory to explain how women who migrated from the Democratic Republic of the Congo recreate social support post-resettlement in the United States. An interpretive approach informed by postcolonial feminist perspectives guided the grounded theory methodology. Upon arrival to the United States, women experienced partitioned lives through changing relationships in space and time, which contributed to women being alone and impacted on their well-being. Converging processes propelled women towards learning to stand alone, through which they developed a sense self-reliance, but not without consequences for themselves and their relationships. The analysis contributes to the knowledge of how resettlement is a life altering event that sets into motion psychosocial processes with implications for well-being and health.

Trade challenges at the World Trade Organization to national noncommunicable disease prevention policies: A thematic document analysis of trade and health policy space
Barlow P; Labonte R; McKee M; et al.: PLOS Medicine, doi:, 2018

It has long been contested that trade rules and agreements are used to dispute regulations aimed at preventing noncommunicable diseases (NCDs). Yet most analyses of trade rules and agreements focus on trade disputes, potentially overlooking how a challenge to a regulation’s consistency with trade rules may lead to ‘policy or regulatory chill’ effects, whereby countries delay, alter, or repeal regulations in order to avoid the costs of a dispute. Systematic empirical analysis of this pathway to impact was previously prevented by a dearth of systematically coded data. In this paper, the authors report analysis of a newly created dataset of trade challenges about food, beverage, and tobacco regulations among 122 World Trade Organization (WTO) members from January 1, 1995 to December 31, 2016. The scope and frequency of trade challenges are thematically described, and economic asymmetries between countries are analysed, raising and defending them, and summarised through four cases of their possible influence. Between 1995 and 2016, 93 food, beverage, and tobacco regulations were challenged at the WTO. ‘Unnecessary’ trade costs were the focus of 16.4% of the challenges. Only one (1.1%) challenge remained unresolved and escalated to a trade dispute. Thirty-nine (41.9%) challenges focussed on labelling regulations, and 18 (19.4%) focussed on quality standards and restrictions on certain products like processed meats and cigarette flavourings. High-income countries raised 77.4% of all challenges raised against low- and lower-middle–income countries. The authors further identified four cases in Indonesia, Chile, Colombia, and Saudi Arabia in which challenges were associated with changes to food and beverage regulations. Data limitations precluded a comprehensive evaluation of policy impact and challenge validity. The authors observe that policy makers appear to face significant pressure to design food, beverage, and tobacco regulations that other countries will deem consistent with trade rules. They note that trade-related influence on public health policy is likely to be understated by analyses limited to formal trade disputes.

Chronic respiratory disease among the elderly in South Africa: any association with proximity to mine dumps?
Nkosi V: The Conversation, May 2018

There is increasing evidence that environmental factors such as air pollution from mine dumps increase the risk of chronic respiratory symptoms and diseases. This study investigated the association between proximity to mine dumps and prevalence of chronic respiratory disease in people aged 55 years and older. Elderly persons in communities 1-2 km (exposed) and 5 km (unexposed), from five pre-selected mine dumps in Gauteng and North West Province, in South Africa were included in a cross-sectional study. Structured interviews were conducted with 2397 elderly people, using a previously validated ATS-DLD-78 questionnaire from the British Medical Research Council. Exposed elderly persons had a significantly higher prevalence of chronic respiratory symptoms and diseases than those who were unexposed., Results from the multiple logistic regression analysis indicated that living close to mine dumps was significantly associated with asthma, chronic bronchitis, chronic cough, emphysema, pneumonia and wheeze. Residing in exposed communities, current smoking, ex-smoking, use of paraffin as main residential cooking/heating fuel and low level of education emerged as independent significant risk factors for chronic respiratory symptoms and diseases. The study suggests that there is a high level of chronic respiratory symptoms and diseases among elderly people in communities located near to mine dumps in South Africa and that new long term effective dust control measures should be researched and implemented. One possible intervention could be to put buffer zones in place between mining dumps and where people come to settle as a start to what needs to be concerted government efforts to address the problem.

A Bitter Harvest Child Labour and Human Rights Abuses on Tobacco Farms in Zimbabwe
Wurth M; Buchanan J: Human Rights Watch, 2018

Tobacco farming is a pillar of Zimbabwe’s economy. Tobacco is the country’s most valuable export commodity—generating US$933.7 million in 2016—and the crop is particularly significant to Zimbabwean authorities’ efforts to revive the economy. However, Human Rights Watch research in 2016 and 2017 into conditions on tobacco farms in Zimbabwe revealed an industry tainted by child labour and confronted by other serious human rights problems as well. This report—based on extensive field research and interviews with 64 small-scale tobacco farmers, as well as 61 hired workers on tobacco farms in the largest tobacco-growing provinces in Zimbabwe—found several human rights problems in the tobacco sector. Children under 18 were found to work in hazardous conditions on tobacco farms in Zimbabwe, some performing tasks that threaten their health and safety or interfere with their education. Adults involved in tobacco production—both small-scale farmers and hired workers— were reported to face serious health and safety risks, with insufficient information, training, and equipment to protect themselves. Hired workers on some large-scale tobacco farms said they were pushed to work excessive hours without overtime compensation, denied their wages, and forced to go weeks or months without pay. The authors call on companies and government to prohibit children from any work involving contact with tobacco, as a policy that is both protective and straightforward for companies to communicate, implement, and monitor throughout the supply chain.

The burden of tobacco smoking on public health
Specioza A: Centre for Health, Human Rights and Development, 2018

The tobacco industry has for a long time affected innocent lives world over through several ways including; advertising and encouraging direct smoking of cigarettes, secondhand smoke exposure, smoking of other combustible tobacco products , smokeless tobacco and electronic nicotine delivery systems (ENDS) among others. The WHO report on Global Tobacco Epidemic 2008, confirms that the global tobacco epidemic is one of the greatest public health threats of modern times as smoking causes so many deleterious health effects. Some of these health effects include; diminished health status, susceptibility to acute illnesses and respiratory symptoms, death, coronary heart disease, cancers of any organ of the body, chronic obstructive pulmonary disease or COPD, pre-mature births, among others. Uganda has taken a great leap in tobacco control interventions through ratification of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and consequently the enactment of the Tobacco Control Act of 2016.

Africa is not poor, we are stealing its wealth
Dearden N: Al Jazeera, May 2017

"Africa is rich, but we steal its wealth". That's the essence of a report from several campaign groups released in May 2017. Based on a set of new figures, it finds that sub-Saharan Africa is a net creditor to the rest of the world to the tune of more than $41bn. It reports that there is money going in to sub-Saharan Africa the tune of around $161bn a year in the form of loans, remittances from those working outside Africa and sending money back home, and from development aid. There's also $203bn leaving the continent. Some of this is direct, such as $68bn from taxes foregone, such as when multinational corporations legally organise flows to indicate that they are generating their wealth in tax havens. These flows are asserted by the author to amount to around 6% percent of the continent's entire gross domestic product and three times what Africa receives in aid. The report estimates that $29bn a year is being lost from Africa through illegal logging, fishing and trade in wildlife. Given these and other sources of loss the author asserts that if African countries are to benefit from foreign investment, they must be allowed to - even helped to - legally regulate that investment and the corporations that often bring it.

Flexibilities provided by the Agreement on Trade-Related Aspects of Intellectual Property Rights
Correa C: Bulletin of the World Health Organisation 96(3) 148, 2018

To minimize the problems caused by the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), academics, governments of low-income countries, many nongovernmental organizations, the World Health Organization (WHO) and other United Nations organizations pay special attention to the Agreement’s so-called flexibilities. The extent to which such flexibilities have already been incorporated into national laws and practice shows substantial variation. Several compulsory licenses – allowing a company to produce a patented product or process without the consent of the patent owner – have been issued for medicines, mainly to treat infections with human immunodeficiency virus. Most of these licenses have led to substantial reductions in the costs of treatment. The use of such licenses is not limited to low- and middle-income countries. Another important flexibility is provided by the definition of the standards of patentability, and the rigour with which they are applied in determining whether a claimed invention is patentable. Weaknesses or gaps in such standards can allow ever-greening by the pharmaceutical industry. Research has shown that the TRIPS flexibilities are poorly exploited and that much more could be done to align intellectual property protection with public health policies. To support the more extensive exploitation of the flexibilities provided by the Agreement on TRIPS, the author argues that a continuous effort from academics, governments, international and nongovernmental organizations is needed, observing that the health of a large part of the world’s population depends on timely and effective action.