Health equity in economic and trade policies

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.

Climate costs South Africa 10% of its GDP
Kings S: Mail and Guardian, South Africa, April 2019

Research suggests that poor countries in the south would have 24% larger economies if it wasn’t for global warming. This is because the world is 1°C hotter than it was a century ago. That warming means crops fail, economic productivity goes down and people get sick or die because of the heat. South Africa is argued to be between 10% and 20% poorer than it would have been without that warming in the last six decades. Nigeria is 29% poorer and India is 30% poorer. The research, titled “Global warming has increased global inequality' reports that rich countries have benefited from this warming. By calculating temperature and economic growth between 1961 and 2010, the researchers found that already rich countries, mostly in colder climates, have growth spurts during an unusually hot year. This is because hotter weather moves them closer to what is known as the “empirical optimum” — the closer a country’s average temperature is to 13°C, the more its economy thrives. South Africa’s average is around 17°C and is only increasing with global warming. The researchers concluded that global warming has meant countries are also more unequal. Richer people can insulate themselves from extreme events — by buying food when the price goes up or by being able to claim from insurance — and keep functioning. Those with few resources to start with do not have such a buffer. This local and global inequality in the impact of global warming is the topic of fierce international negotiation. While China and India are massively growing their emissions, the authors note that they still represent a fraction of total emissions in the last two centuries, with China has emitted half of what the United States has and India a seventh.

'You often get sick': the deadly toll of illegal gold mining in South Africa
Clark C: The Guardian, April 2019

According to a 2015 report by the South African Human Rights Commission, South Africa’s burgeoning illicit gold trade has been fuelled by the formal mining industry’s decline combined with the failure of government to regulate the informal mining sector. The report estimated 30,000 illegal miners were operating across South Africa; about 75% are believed to be undocumented migrants, primarily from Zimbabwe, Mozambique and Lesotho. The authors indicate that hundreds have died due to collapsing mine shafts, gas explosions and turf wars between the criminal syndicates that have seized control of the illegal industry. On Johannesburg’s outskirts, cut off from support networks and services, women are bearing the brunt of the violence and lawlessness associated with illicit mining. With the vast majority of people in the area living off the proceeds of illicit mining, fear of arrest or deportation prevents many women from going to the police or seeking help at overstretched local medical clinics.

Commercial determinants of health: advertising of alcohol and unhealthy foods during sporting events
Ireland R; Bunn C; Reith G; Philpott M; et al: Bulletin of the World Health Organisation 97(4), 290-295, 2019

Tobacco, alcohol and foods that are high in fat, salt and sugar generate much of the global burden of noncommunicable diseases. A better understanding is needed of how these products are promoted. The promotion of tobacco products through sporting events has largely disappeared over the last two decades, but advertising and sponsorship continues by companies selling alcohol, unhealthy food and sugar-sweetened beverage. The sponsorship of sporting events such as the Olympic Games, the men’s FIFA World Cup and the men’s European Football Championships in 2016, has received some attention in recent years in the public health literature, as have global football events with which transnational companies are keen to be associated, to promote their brands to international markets. Despite this the marketing and sponsorship portfolio of these events have received very little scrutiny from public health advocates. The authors call for policy-makers and the public health community to formulate an approach to the sponsorship of sporting events, one that accounts for public health concerns.

Local solutions can boost healthier food choices in South Africa
Ndlovu N: The Conversation, March 2019

In this article, Ndlovu asks, how should countries like South Africa go about making sure that people – particularly poor people where the burden of non-communicable diseases is highest – have access to healthy food? Recent research from the Wits School of Public Health, the Health Systems Trust and the University of KwaZulu-Natal sheds fresh light on the problem, showing a proliferation of unhealthy food, particularly in poorer communities. The research set out to assess differences in food environment based on socio-economic status. It focused on grocery stores and fast-food restaurants only, with full service restaurants excluded. The analysis used a tool called the “modified retail food environment index” and show the proportion of food retailers in Gauteng that were “healthy” and what proportion were “unhealthy”. The results showed how fast-food outlets and the unhealthy foods they serve, vastly outnumbered formal grocery stores. In November 2016, there were 1559 unhealthy food outlets in Gauteng compared to only 709 healthy food outlets. Strikingly, the distribution of these outlets are income-based. Most of the poorer wards had only fast-food retailers with no healthy food outlets. Conversely, grocery stores are concentrated in wealthy areas. The research shows that many wards in Gauteng have high concentrations of unhealthy food – in other words, they have “obesogenic” food environments. This means the type of food available in this environment promote obesity, leaving their residents little choice. Local as well as national government structures have the authority to license and control food retailers. Alternatively, national level policies can better guide implementation at a local level. This would require governments to adapt existing business licensing and planning frameworks to take into account the lack of healthy food retailers in a particular area. Additionally, municipalities could streamline the process for licensing healthy food retailers, making it easier and faster for them to open in areas most in need. The authors indicate that there is a plethora of options to select from if municipalities want to improve their food environments and can facilitate the right to access to healthy foods for the poorest and most vulnerable.

The health impacts of extractive industry transnational corporations: a study of Rio Tinto in Australia and Southern Africa
Anaf J; Baum F; Fisher M; London L: Globalization and Health 15(13) 1-20, 2019

This research on extractive industries examined Rio Tinto in Australia and Southern Africa to test methods for assessing the health impacts of corporates in high and middle income jurisdictions with different regulatory frameworks. The authors adapted existing Health Impact Assessment methods. Data identifying potential impacts were sourced through media analysis, document analysis, company literature and semi-structured interviews. The data were mapped against a corporate health impact assessment framework which included Rio Tinto’s political and business practices, productions and workforce, social, environmental and economic conditions. Both positive and detrimental aspects of Rio Tinto’s operations were identified. Positive impacts include provision of direct employment under decent working conditions, but countered by an increase in precariousness of employment. Commitments to upholding sustainable development principles are undermined by limited site remediation and other environmental impacts. Positive contributions are made to national and local economies but then undermined by business strategies that include tax minimisation. This study confirmed that it is possible to undertake a corporate health impact assessment on an extractive industry transnational corporation. The different methods provided sufficient information to understand the need to strengthen regulations that are conducive to health; the opportunity for Rio Tinto to extend corporate responsibility initiatives and support their social licence to operate; and for civil society actors to inform their advocacy towards improving health and equity outcomes from transnational corporations operations.

Reflections of an Engaged Economist: An Interview with Thandika Mkandawire
Meagher K: Development and Change 0(0), doi:, 2019

This article reports an interview with Professor Thandika Mkandawire, a leading development economist of Malawian origin specializing in the comparative study of Africa. The interview explores how growing up under colonialism in Zimbabwe meant that huge decisions were being made that had profound effect on one's life, that he saw in the experience of his father as a unionised worker on a mine and a tailor at home. He recounts the conversations on politics and working conditions on the mines that took place while people waited for their garments, as people tried to make sense of policies they had no contribution to. As a school student in Malawi doing is 'O levels' at a time of anti-colonial struggles, he was involved in demonstrations that exposed the brutality of the police. After school and working on a weekly paper his experience of being arrested exposed the facade of rule of law in a trial that he called a farce. His study of economics was initially to be a better journalist. Studying in Latin America he saw the hostility of Latin Americans to the USA as a 'more naked' form of the 'new imperialist order'. The interview traces him to his life in exile from Malawi, living in Sweden, where the thinking of Amartya Sen and others exposed the deeply social and political nature of economics, while the writing of African nationalists exposed the tension between class and nation as the overriding concern, a debate he posits as continuing until today. Living in Sweden at that time provided an experience of a democratic state that could "tame the structural power of capital", reinforcing but also moderating his "leftist inclinations". The interview continues to track how his life experiences and work at institutions such as CODESRIA and UNRISD influenced his thinking on developmental states, his views on strategic responses to the structural adjustment programmes in Africa, of the role of intelligent, capable and democratic states as the only viable instrument for development, and of social investment as a developmental tool. The interview explores his views on the implications for the current African political economy and for African scholarship.