Health equity in economic and trade policies

Mine Tailings Storage: Safety is No Accident
United Nations Environment Programme: UNEP, December 2017

This report was prompted by tailings dams disasters and rising global concerns about the safety, management and impacts of storing and managing large volumes of mine tailings. The report laments that although the number of dam failures has declined over many years, the number of serious failures has increased, despite advances in the engineering knowledge that can prevent them. The report makes two recommendations that can help the industry to eliminate tailing dam failures. Firstly, it calls for a “safety-first” approach to tailings storage that should be reflected in both management actions and on-the-ground operations. The report also recommends establishing a UN Environment stakeholder forum to facilitate international strengthening of tailings dam regulation. These approaches could include establishing a database of mine sites, identifying best practice and developing technical solutions to the main causes of failure. The assessment also discusses how mining firms can adopt cleaner processes, new technologies and re-use materials in order to reduce waste.

Strengthening expertise for health technology assessment and priority-setting in Africa
Doherty J; Wilkinson T; Edoka I; et al: Global Health Action 10(1),, 2017

This study aimed to identify how research organisations and partnerships could contribute to capacity strengthening for health technology assessment and priority-setting in Africa. A rapid scan was conducted of international formal and grey literature and lessons extracted from the deliberations of two international and regional workshops relating to capacity-building for health technology assessment. ‘Capacity’ was defined in broad terms, including a conducive political environment, strong public institutional capacity to drive priority-setting, effective networking between experts, strong research organisations and skilled researchers. Effective priority-setting requires more than high quality economic research. Researchers have to engage with an array of stakeholders, network closely other research organisations, build partnerships with different levels of government and train the future generation of researchers and policy-makers. In low- and middle-income countries where there are seldom government units or agencies dedicated to health technology assessment, they also have to support the development of an effective priority-setting process that is sensitive to societal and government needs and priorities. Research organisations were found to have an important role to play in contributing to the development of health technology assessment and priority-setting capacity. In Africa, where there are resource and capacity challenges, effective partnerships between local and international researchers, and with key government stakeholders, can leverage existing skills and knowledge to generate a critical mass of individuals and institutions. It is proposed that these would help to meet the priority-setting needs of African countries.

Access to medicines and hepatitis C in Africa: can tiered pricing and voluntary licencing assure universal access, health equity and fairness?
Assefa Y; Hill PS; Ulikpan A; et al,: Globalization and Health 13(73)1-11, 2017

This paper analyses the implications of a tiered pricing and voluntary licensing strategy for access to Direct Acting Antivirals (DAAs) for treating Hepatitis C Virus (HCV). Seven countries in Africa were examined (Egypt, Ethiopia, Nigeria, Democratic Republic of Congo, Cameroon, Rwanda and South Africa) to assess their financial capacity to provide DAAs for treating HCV under present voluntary licensing and tiered-pricing arrangements. The cost of 12-weeks of generic DAA varied from $684 per patient treated in Egypt to $750 per patient treated in other countries. The current prices of DAAs are much higher than the median annual income per capita and the annual health budget of most of these countries. If governments alone were to bear the costs of universal treatment coverage, then the required additional health expenditure from present rates would range from a 4% increase in South Africa to a staggering 403% in Cameroon. The current arrangements for increasing access to DAAs, to eliminate HCV would require increases in expenditure that are too burdensome for governments, individuals and families. The authors argue that countries need to implement the flexibilities in the Doha Declaration on Trade Related Intellectual Property Rights agreement, including compulsory licensing and patent opposition to address this, and this requires political commitment, financial will, global solidarity and civil society activism.

Disentangling regional trade agreements, trade flows and tobacco affordability in sub-Saharan Africa
Appau A; Drope J; Labonté R; et al: Globalisation and Health 13(81) doi:, 2017

In principle, trade and investment agreements are meant to boost economic growth. However, the removal of trade barriers and the provision of investment incentives to attract foreign direct investments may facilitate increased trade in and/or more efficient production of commodities considered harmful to health such as tobacco. The authors analyze existing evidence on trade and investment liberalization and its relationship to tobacco trade in Sub-Saharan African countries. Comparisons are made between tobacco trading patterns and foreign direct investments made by tobacco companies. The authors estimate and compare changes in the Konjunkturforschungsstelle (KOF) Economic Globalization measure, relative price measure and cigarette prices. Preferential regional trade agreements appear to have encouraged the consolidation of cigarette production, which has shaped trading patterns of tobacco leaf. Since 2002, British American Tobacco has invested in tobacco manufacturing facilities in Nigeria, Kenya and South Africa strategically located to serve different regions in Africa. Following this, British America Tobacco closed factories in Ghana, Rwanda, Uganda, Mauritius and Angola. At the same time, Malawi and Tanzania exported a large percentage of tobacco leaf to European countries. After 2010, there was an increase in tobacco exports from Malawi and Zambia to China, which may be a result of preferential trade agreements the EU and China have with these countries. Economic liberalization has been accompanied by greater cigarette affordability for the countries included in the analysis. Only excise taxes and income are reported by the authors to have an effect on cigarette prices within the region. The results suggest that the changing economic structures of international trade and investment are likely heightening the efficiency and effectiveness of the tobacco industry. As tobacco control advocates consider supply-side tobacco control interventions, the authors suggest that they consider carefully the effects of these economic agreements and whether there are ways to mitigate them.

World running out of antibiotics, says WHO in new reports
Third World Network: TWN Info Service on Health Issues, Oct17/02, 2017

On 19 September, the World Health Organization released a new report that reaffirms the world is running out of antibiotics to fight key and deadly infections due to the fast pace of resistance by bacteria and the lack of new antibiotics to replace or supplement the existing antibiotics. Most new drugs in the pipeline are only modifications of existing classes of antibiotics and are short term solutions, says the WHO. And there are very few potential treatment options for antibiotic resistant infections causing the greatest health threats including resistant TB. This article by TWN explore the issue and the level of (under)investment in new treatments. It argues further for improved infection prevention and control and for fostering appropriate use of existing and future antibiotics.

Africa Is Not Poor, We Are Stealing Its Wealth
Dearden N: Sangonet, NGO Pulse, August 2017

The report Honest Accounts 2017: how the world profits from Africa’s wealth explores how Africa’s wealth is effectively “stolen” from the continent and “calculates the movement of financial resources into and out of Africa and some key costs imposed on Africa by the rest of the world”. Nick Dearden, director of Global Justice Now, writes that although there is money coming into the continent in the form of remittances, there is a larger amount leaving the continent in the form of taxes, “repatriate[d]” profits and illegal trade. A 2014 estimate suggests that rich Africans were holding a massive $500-billion in tax havens. Africa’s people are effectively robbed of wealth by an economy that enables a tiny minority of Africans to get rich by allowing wealth to flow out of Africa. With few exceptions, countries with abundant mineral wealth experience poorer democracy, weaker economic growth, and worse development. The author raises that to prevent tax dodging, governments must stop prevaricating on action to address tax havens.

In which developing countries are patents on essential medicines being filed?
Beall R; Blanchett R; Attaran A: Globalisation and Health 13(38) 2017

This article is based upon data gathered during a study conducted in partnership with the World Intellectual Property Organisation on the patent status of products appearing on the World Health Organisation’s 2013 Model List of Essential Medicines (MLEM). It is a statistical analysis aimed at answering: in which developing countries are patents on essential medicines being filed? Patent data were collected by linking those listed in the United States and Canada’s medicine patent registers to corresponding patents in developing countries using two international patent databases (INPADOC and Derwent) via a commercial-grade patent search platform (Thomson Innovation). The respective supplier companies were then contacted to correct and verify their data. The authors tallied the number of MLEM patents per developing country. A subset of 20 of the 375 (5%) products on the 2013 MLEM fit the inclusion criteria. The number of MLEM patents per country was positively associated with human development index (HDI), gross domestic income (GDI) per capita, total healthcare expenditure per capita, population size, the Rule of Law Index, and average education level of the country. Population was a powerful predictor of the number of patent filings in developing countries along with GDI and healthcare expenditure. Broad surveillance and benchmarking of the global medicine patent landscape is valuable for detecting significant shifts that may occur over time. With improved international medicine patent transparency by companies and data available through third parties, the authors suggest that studies such as this will be increasingly feasible.

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.’

Magufuli: Barrick ready to pay what it owes Tanzania
Mtulya A: The Citizens, 14 June 2017

President of the United Republic of Tanzania, John Magufuli has met with Prof John Thornton, Chairman of Barrick Gold Canada, parent company of Acacia Mining to discuss the issue of mineral sand exportation in Tanzania. The new development came after Dr Magufuli received two reports on the exportation of mineral concentrates abroad for smelting. The first committee probed at the technical aspects of the concentrate and the second committee examined the economic and legal frameworks around the export. Both reports damned Acacia for foul play and suggested that Tanzania lost over Sh100 trillion since it started exporting concentrates in the late 1990s. Dr Magufuli who was accompanied by the Minister for Legal and Constitutional Affairs Prof Palamagamba Kabuki said the meeting was successful and Barrick have “repented” for what has happened and they are ready to compensate Tanzania for the loss that has been incurred over the years. Dr Magufuli announced on a video clip tweeted on the official government spokesperson account that Barrick have “repented” and are ready to compensate Tanzania for the loss incurred over the years. Garrick Gold Canada is the largest shareholder of the Acacia Mining Company. On March 2017, the export of mineral concentrates by Barrick from Tanzania was stopped by Presidential directive.

Open letter to WHO on industrial animal farming
Weathers S; Hermanns S; and 270 expert signatories: Open Letter Animal Farming, 2017

In this letter over 200 scientists, policy experts and others concerned persons are urging the new World Health Organisation Director-General to recognise and address factory farming as a growing public health challenge. The authors suggest that WHO negotiate country-level standards for antibiotic use in animal husbandry, in coordination with the Food and Agricultural Organisation. Member states should be encouraged to articulate specific, verifiable standards for what constitutes legal antibiotic use in animal farms. Further, meat producers should dispose of antibiotics and waste residue properly to prevent environmental contamination and excess greenhouse gas emissions and work with all relevant ministries, including those outside of health, to reduce the size and number of factory farms to better balance dietary need and ecological capacity. WHO should discourage member states from subsidising factory farming and its inputs, which can cause significant harm to the public and consider the application of relevant fiscal policies in member states that would help to reduce meat demand and consumption, especially where consumption exceeds health recommendations. WHO should encourage member states to adopt nutrition standards and implement health education campaigns which inform citizens of the health risks of meat consumption and work closely with ministers of health and agriculture to formulate policies that advocate for a greater proportion of plant-based foods in the diets of member states. Lastly, they recommend that the WHO should consider funding the scientific development of plant-based and other meat alternatives, which have the potential to eliminate or reduce the harms of factory farming.