Countries have reached universal health coverage by different paths and with varying health systems. Nonetheless, the trajectory toward universal health coverage regularly has three common features, identified in this paper. The first is a political process driven by a variety of social forces to create public programmes or regulations that expand access to care, improve equity, and pool financial risks. The second is a growth in incomes and a concomitant rise in health spending, which buys more health services for more people. The third is an increase in the share of health spending that is pooled rather than paid out-of-pocket by households. This pooled share is sometimes mobilised as taxes and channelled through governments that provide or subsidise care – in other cases it is mobilised in the form of contributions to mandatory insurance schemes. The predominance of pooled spending is a necessary condition (but not sufficient) for achieving universal health coverage. The authors describe common patterns in countries that have successfully provided universal access to health care and consider how economic growth, demographics, technology, politics, and health spending have intersected to bring about this major development in public health.
Health equity in economic and trade policies
Much has changed in the world since economic partnership agreements (EPAs) negotiations between the European Union (EU) and African, Caribbean and Pacific (ACP) countries started 10 years ago. Emerging developing countries have increased their share of the world market and China has become one of the largest trading nations, while ACP countries have diversified trading partners and external funders. Today both the EU and the ACP countries struggle with the mess that the extended and deadlocked EPA negotiations have created. The interim EPAs have complicated the negotiations even further, causing rifts in the regions, and the refusal of the EU to swiftly amend them left the negotiations stuck with protracted discussions on contentious issues. The author of this article calls on the EU not to force ACP countries to accept agreements simply to avoid losing trade preferences. And he argues further that it is a problem when trade negotiations are held behind closed doors and policies are based on secret (unless leaked) mandates, with hardly any parliamentary involvement. Economic reform is too important to all layers of society to be left to behind closed door negotiations.
In this report, the authors consider the four biggest global agricultural commodity traders: Archer Daniels Midland, Bunge, Cargill, and Louis Dreyfus, often collectively referred to as ‘the ABCD companies’. The ABCD companies are often invisible in policy debates about farmers and consumers, and they are careful about where and when they get involved in such debates, rarely seeking the limelight. The report looks at critical issues in agriculture and food security, such as the ‘financialisation’ of agricultural products, the emergence of Asian competitors to the ABCDs and the impact of the large-scale biofuel industry on food security. The authors argue that food price volatility is a problem and commodity speculation and biofuels, alongside other factors such as export bans, are helping to drive volatility. The role played by the ABCD trading firms is important, but that how to address them and limit their power is not obvious, and regulations and changes will probably need to target broader reforms. But understanding the economic and political power of the ABCDs is essential to developing policies that will protect the interests of smallholder farmers and poor consumers in developing countries, the authors conclude.
Although technology transfer and innovation feature in the final outcome of the Rio+20 United Nations Conference on Sustainable Development (UNCSD), held 20-22 June 2012, intellectual property rights (IPRs) - which are closely related to them - are barely mentioned, according to this brief. While the mention of IPRs in the Rio+20 outcome document signals their relevance for efforts to achieve sustainable development, no consensus was reached on how to ensure they are equitable and relevant to green technology. However, the stalemate may be addressed in several ways, the author proposes. Clear parameters are needed to foster a more constructive and pragmatic dialogue. Intellectual property should be seen in a broader context of appropriate policies, adequate institutions and human resources to both encourage green innovation and to ensure that its benefits are widely diffused. Other recommendations include improving access to technological information on green technologies, facilitating licensing of green technologies, fast-tracking green patents and ensuring open innovation for sustainability.
According to this study, the rate of increase in consumption of ‘unhealthy commodities’ - namely soft drinks, processed foods, tobacco and alcohol - is fastest in low- and middle-income countries (LMICs), with little or no further growth expected in high-income countries (HICs). The pace at which consumption is rising in LMICs is even faster than has occurred historically in HICs thanks to multinational companies, which have now achieved a level of penetration of food markets in middle-income countries similar to what they have achieved in HICs. Higher intake of unhealthy foods correlates strongly with higher tobacco and alcohol sales, suggesting a set of common tactics by industries producing unhealthy commodities, the authors argue. Contrary to findings from studies undertaken several decades ago, urbanisation no longer seems to be a strong risk factor for greater consumption of risky commodities at the population level, with the exception of soft drinks. Rising income has been strongly associated with higher consumption of unhealthy commodities within countries and over time, but mainly when there are high foreign direct investment and free-trade agreements. Economic growth does not inevitably lead to higher unhealthy-commodity consumption.
As the nineteenth International AIDS Conference took place in Washington DC, thousands of protesters marched on the White House with a set of demands to end the epidemic. The march consisted of a coalition of AIDS advocacy and activist groups organised under the mantra ‘We Can End AIDS’. At the forefront were calls for an end to free trade deals that protesters argue make vital AIDS medicines unaffordable. They pointed out that free trade deals with the Barack Obama administration contain excessively stringent protections for pharmaceutical patents on AIDS drugs. A spokesperson for the demonstration urged governments to accept recommendations related to intellectual property rights in a July 2012 report issued by the Global Commission on HIV and The Law (included in last month's newsletter), an independent high-level legal commission made up of former heads of state and leading legal, human rights and HIV experts. The Commission recommended a moratorium on TRIPS patent enforcement on pharmaceutical products, which they argue will allow developing countries to manufacture low-cost generic medicines urgently needed for their populations.
Local users are now the main source of electronic waste in Africa, but illegal imports of old computers, televisions, and other electronics devices from Europe, Asia, and North America still make their way there. That’s the finding of Where Are WEEE in Africa?, a new United Nations Environment Programme (UNEP) report about waste electronic and electrical equipment—also known as WEEE, or e-waste—in Benin, Côte d’Ivoire, Ghana, Liberia, and Nigeria.1 A large portion of these imports are of good quality, have a decent life expectancy, and bring many socioeconomic benefits, according to the report, but the rest is hazardous junk that is often resold and recycled under unsafe conditions. This article discusses the findings from the Where Are WEEE in Africa? report and the problems of its safe recycling and disposal.
Traditional long-established food systems and dietary patterns are being displaced in Brazil and in other countries in the South (Africa, Asia, and Latin America) by ultra-processed products made by transnational food corporations (‘Big Food’). This displacement, the authors of this paper argue, is increasing the incidence of obesity and of major chronic diseases and affects public health and public goods by undermining culture, meals, the family, community life, local economies, and national identity. In Brazil, the penetration of transnational companies has been rapid, but the tradition of shared and family meals remains strong and is likely to provide protection to national and regional food systems. The Brazilian government, under pressure from civil society organisations, has introduced legislation to protect and improve its traditional food system - by contrast, the governments of many industrialised countries have partly ceded their prime duty to protect public health to transnational companies. The authors recommend that the experiences of countries like Brazil in the South that still retain traditional food systems should be used as a basis for policies that protect public health.
Information Communication Technology (ICT) has revolutionized modern living, international business, global governance, communication, entertainment, transport, education, and health care. This has been driven by unprecedented high volumes of production and usage of consumer electronic products, in particular, personal computers, mobile phones, and television sets. Access to ICT has been identified as an indicator of a country’s economic and social development. The difference in access to ICT between developed and developing countries is commonly referred to as the “digital divide”. Africa has been undergoing rapid ICT transformation in recent years, attempting to bridge this divide by importing second-hand or used computers, mobile phones, and TV sets from developed countries. The countries of the region, however, lack the infrastructure and resources for the environmentally sound management (ESM) of electrical and electronic waste (e-waste) arising when such imports reach their end-of-life. The report analyses the flows of electrical and electronic equipment and e-waste and makes recommendations for African countries to prevent the import of e-waste and near-end-of-life equipment without hampering the socio-economically valuable trade of EEE of good quality.
In South Africa, as elsewhere in the world, large commercial entities that dominate the food and beverage environment (‘Big Food’) are becoming more widespread and are implicated in unhealthy eating. Interestingly, the authors of this study found that small independent producers (‘Small Food’) remain significant in the food environment in South Africa, and are 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, as well as having 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 recommend that the South African government act urgently to mitigate the adverse health effects in the food environment in South Africa through education about the health risks of unhealthy diets and regulation of Big Food, including support for healthy foods.