From the United Nations Conference on Sustainable Development (Rio+20) "The Future We Want", the conference outcome document, agreed upon by member states attending the 20-22 June conference, highlights the fact that better health is a “precondition for, an outcome of, and an indicator of all three dimensions of sustainable development”. The outcome document emphasizes the importance of universal health coverage to enhancing health, social cohesion and sustainable human and economic development. It acknowledges that the global burden and threat of non-communicable diseases (NCDs) constitutes one of the major sustainable development challenges of the 21st century. The document states: “We are convinced that action on the social and environmental determinants of health, both for the poor and the vulnerable and the entire population, is important to create inclusive, equitable, economically productive and healthy societies. We call for the full realization of the right to the enjoyment of the highest attainable standard of physical and mental health”.
Health equity in economic and trade policies
In order to ensure their population's regular access to essential medicines, many countries are faced with the policy question of whether to import or manufacture drugs locally. For domestic manufacturing to be viable and cost-effective, the local industry must be able to compete with international suppliers of medicines. This paper considers the 'make-or-buy' dilemma by using Tanzania as a case study. Key informant interviews, event-driven observation, and purposive sampling of documents were used to evaluate the case study. The case study focused on Tanzania's imitation technology transfer agreement to locally manufacture a first-line ARV (3TC + d4T + NVP), reverse engineering the ARV. The study finds that Tanzania is limited by weak political support for the use of Trade-Related Aspects of Intellectual Property Rights (TRIPS) flexibilities, limited production capacity for ARVs and limited competitiveness in both domestic and regional markets. The Ministry of Health and Social Welfare encourages the use of flexibilities while others push for increased IP protection. Insufficient production capacity and lack of access to externally -financed tenders make it difficult to obtain economies of scale and provide competitive prices. Within the "make-or-buy" context, it was determined that there are significant limitations in domestic manufacturing for developing countries. The case study highlights the difficulty governments face to make use of economies of scale and produce low-cost medicines, attract technology transfer, and utilize the flexibilities of the WTO Agreement on TRIPS. The results demonstrate the importance of evaluating barriers to the use of TRIPS flexibilities and long-term planning across sectors in future technology transfer and manufacturing initiatives.
The report asserts that in South Africa, as in other jurisdictions, “Big Food” (large commercial entities that dominate the food and beverage environment) is becoming more widespread and is implicated in unhealthy eating. “Small food” remains significant in the food environment in South Africa, and it is both linked with, and threatened by, Big Food. Big Food in South Africa involves South African companies, some of which have invested in other (mainly, but not only, African) nations, as well as companies headquartered in North America and Europe. These companies have developed strategies to increase the availability, affordability, and acceptability of their foods in South Africa; they have also developed a range of “health and wellness” initiatives. Whether these initiatives have had a net positive or net negative impact is not clear. The authors argue that the South African government should act urgently to mitigate the adverse health effects in the food environment in South Africa through education about the health risks of unhealthy diets, regulation of Big Food, and support for healthy foods.
In this open letter from 13 African civil society organisations, they argue that sub-Saharan Africa is caught between the desire to regain control of its own development and excessive reliance on external sources of funding. In the past decade, African states have committed to dedicate more public resources to agriculture and to promote regional agricultural policy and trade through regional trade blocs like ECOWAS and NEPAD. These commitments testified to a real commitment to agriculture on the part of the African authorities, as well as to a new desire to assume control of African development in dialogue with local populations, and they were a sign to social movements and networks of peasants and producers that agriculture had regained its position at the heart of the political agenda. Unfortunately the methodology adopted for the formulation of the Comprehensive Africa Agriculture Development Programme, NEPAD’s initiative to boost agricultural productivity in Africa, rapidly degenerated, and the National Agricultural Development Programmes, promoted from above with insufficient dialogue with the concerned actors, appeared to be merely occasions for negotiating new aid. The letter argues that success in agricultural policies in Europe, the United States and in emerging countries like Brazil and India, have always been the product of sovereign will and of a partnership between the states and the economic actors, that is the producers, the processors, the traders. Therefore external funders and foreign investors are not the appropriate role players to drive agricultural policy in Africa.
This new book explores the development policies of Brazil, China, India, Mexico and South Africa. Using a case study approach, the author charts the evolution of South-South cooperation and elaborates on the lessons learnt from traditional forms of external funding. Against the background of the changes in the international system of development cooperation, she also discusses the possibility for convergence or conflict in this transitional phase of the architecture of development cooperation. The emergence of new development partners should be seen as the starting point for the gradual emergence of more comprehensive and balanced international development cooperation, bringing greater gains to aid-dependent economies, including key international development issues such as international tax cooperation, sovereign debt workouts and international economic governance. Emerging economies want to be rule makers, not just rule takers, and increasingly are making their voices heard in international forums. In so doing they are eroding the West's 'monopoly' on developmental issues.
On 18 May 2012, a few days before the 2012 World Health Assembly, the permanent mission of Brazil organised an informal meeting on sanitary regulation and how to improve global cooperation among drug regulatory agencies. Margaret Chan, Secretary-General of the World Health Organisation (WHO), discussed the WHO drug prequalification programme, which she said was intended to give the opportunity for manufacturers from low- and middle-income countries to enter the market with straight quality and safety standards, and to enter into fair competition with other manufacturers. Many countries lacked capacity to pre-qualify their medical products, such as vaccines, as they did not have a functional national drug regulatory authority. These authorities often lacked resources and support from government and other stakeholders. Medicins sans Frontiers voiced its support for regional cooperation between regulatory agencies, adding that WHO should continue the development of norms and standards for phamacovigilence and support their implementation at country level. The Indian delegation identified lack of harmonisation of regulatory systems as a challenge and argued for the exchange and sharing of information among drug regulatory agencies.
This report contends that Africa should not follow the same ‘grow now, clean up later’ approach that was adopted by currently industrialised countries. The continent should instead pursue a different path that reconciles economic growth with environmental sustainability. The report urges African governments to shift from traditional to modern, less-polluting energy sources, wherever these energy sources are economically and environmentally viable, and to promote a shift to organic agriculture to ensure environmentally sustainable increases in harvests, to bring higher prices to farmers and to keep rural populations engaged in farming rather than migrating to the cities. The report calls for developed countries to increase financial assistance to Africa, but emphasises that equally important will be greater technology transfer from developed and emerging countries to Africa, increased South-South cooperation in green technology use and adaptation, and more flexibilities in the design of the global intellectual property rights regime. More "policy space" will be needed for African governments so that they have the ability to use incoming funds and technology in the most efficient way for their specific circumstances. Each African country will have to design strategies and policies based on its own sectoral and resource priorities, environmental challenges, initial conditions and domestic capabilities. Countries that are already embarked on that path in Africa include Kenya, Mauritius and South Africa.
Developed countries have traditionally been the source of most biopharmaceutical innovations as well as the destination for the resulting economic and health benefits. As a result, most prior research on this sector has focused on developed countries. This paper seeks to fill the gap in research on emerging markets by analysing factors that influence innovative activity in the indigenous biopharmaceutical sectors of China, India, Brazil and South Africa. Using qualitative research methodologies, the authors show how biopharmaceutical innovation is taking place within the entrepreneurial sectors of these emerging markets, identify common challenges that indigenous entrepreneurs face and highlight the key role played by the state. Their findings reveal that the transition to innovation by companies in the emerging markets is characterised by increased global integration. Further findings suggest that biopharmaceutical innovators in emerging markets are capitalising on opportunities to participate in the drug development value chain. In this way, they are developing capabilities and relationships for competing globally both with and against established companies headquartered in developed countries.
The culture of secrecy that surrounds agricultural land deals raises concerns about government misconduct in relation to issues of public interest, according to this article. There is a growing global consensus in favour of contract transparency and a few governments have started publishing contracts or improving legislation on transparency, with Liberia leading the way. After a review and renegotiation of all extractive industry concessions and contracts, President Sirleaf introduced the Liberia Extractive Industry Transparency Initiative Act (the LEITI Act), which requires all payments by individual companies and operating contracts and licenses to be published and reviewed on the LEITI website. This bold step has not deterred investors, as initially feared. Other countries are following suit. Ghana has also started publishing contracts in the oil sector, and Ethiopia has started making certain contracts public, the article notes. Some countries, including Sierra Leone, Ghana and Liberia, require large investment projects to be ratified in parliament, ensuring a layer of public scrutiny.
Sub-Saharan Africa continues to record strong economic growth, despite the weaker global economic environment. Regional output rose by 5% in 2011, with growth set to increase slightly in 2012, helped by still-strong commodity prices, new resource exploitation, and the improved domestic conditions that have underpinned several years of solid trend growth in the region’s low-income countries. But there is variation in performance across the region, with output in middle-income countries tracking more closely the global slowdown and with some sub-regions adversely affected, at least temporarily, by drought. Threats to the outlook include the risk of intensified financial stresses in the euro area spilling over into a further slowing of the global economy and the possibility of an oil price surge triggered by rising geopolitical tensions.