Globalisation and Health

Global health and globalisation

what are they, and how are they relevant

Session overview• What is global health?• Is it different to international health?

– Theoretical/practical• What is it not?• What is globalisation?• What is ‘driving’ it?• TRIPS and the WTO• Health worker Migration

A few initial points…• Massive area• Short amount of time• More questions than answers!

(hopefully!)• Do ask questions!

What does ‘global health’ mean?

Global health IS NOT• just Infectious diseases

medicine

Perspectives•‘peeling onions’!

•Taking it further: actions

the big issues that matter in health:

globalisation… poverty… development…

A (brief) definition• We believe that global health is a broad

discipline that develops students' understanding of the local, national and international determinants of health and healthcare delivery.

• Through studying global health, students examine the wider influences of health such as poverty, debt, globalisation, healthcare financing, human rights, famine, environment, violent conflict and the movement of populations. Global health draws from a number of disciplines including politics, economics, sociology, demography, anthropology, epidemiology and philosophy.

Globalisation

Unlearning…

What is globalisation?•Economic globalisation:

–obstacles to trade and movements between countries progressively reduced

Economic globalisation• Is it happening?

– YES– World exports of goods and services almost

tripled in last thirty years– Levels of commercial investment (FDI) have

increased substantially– Daily turnover in world’s foreign exchange

markets has increase from $1 billion in 1970 to over $1 trillion today

– Huge declines in transport and communication costs

Economic globalisation• Why is it happening?

– Competition and the search for new markets

– Technological changes (particularly in the communications sphere)

– International policies and agreements (e.g. WTO agreements)

Globalisation - broader definition• Globalisation can also be defined as processes that are

changing the ways in which people interact across boundaries, notably physical (such as the nation-state), temporal (such as instantaneous communication via

email), and cognitive (such as cultural identity). The result is a redefining of human societies across many spheres, economic, political, cultural, technological and so on. As such, globalisation affects the health of different people in very different ways. How good or bad globalisation happens to be for you will be influenced by socioeconomic status, sex, education, age, geographical location, and other factors.

» Lee, K et al. BMJ 2002;324:44 ( 5 January )

What are the effects?• Economic growth• Economic instability• Rise in inequalities

• Effects of trade agreements – eg TRIPS

Growth• Positive effects:

– (expected) increased openness of countries to trade and investment

• Negative effects: – un-preparedness of economies

for global competition– effects of instability

Changes in income inequalities

• Global distribution of income has worsened

• At national level, many countries seem to have experienced a worsening of income inequalities

• Why? Could it be related to globalisation?

where are they?

TRIPS

What?

•Trade-•Related aspects of

•Intellectual•Property•Rights

Progress must be made. It is estimated that by improving access to existing medicines and vaccines, approximately 10 million lives could be saved every year: 4 million in Africa and South-East Asia alone. [DIFD, 2004, p8]

• estimated 1.7 billion people lack access to essential medicines

• unchanged for two decades (WHO, 2004)• particularly concentrated in Africa and India;

– around 80% in low income countries– remaining 20% are almost all poorest in middle income

countries (WHO, 1999).

A timeline: GATT to WTO

• 1947: Geneva 23 countries• 1949: Annecy 13• 1951: Torquay 38• 1956: Geneva 26• 1960-1: Dillon Round 26• 1964-7: Kennedy Round 62• 1973-9: Tokyo Round 102• 1986-94: Uraguay Round123

• 1995: established…

WTO• Currently over 150 members (and

growing)• Mandate:

– Trade liberalisation– Trade negotiations– Dispute settlement

• Established 1st January, 1995• 1999: Failed to launch new round,

Seattle• 2001: Doha Round Launched• 2003: Cancun…• 2005: Hong Kong… struggling on

TRIPS• (one aspect of) globalisation in

action• Uruguay 1994• Legally binding• AND enforceable• Global patent protection (allows

monopoly production and sale for life of patent)

• ‘Our combined strength enabled us to establish a global private sector-government network which laid the groundwork for what became TRIPS’– Edmund Pratt, CEO, Pfizer

Trade vs Health• 1998: first WHO guidance re

implementation of TRIPS• “considerable concern among the

pharmaceutical industry”, “that no priority should be given to health over intellectual property considerations” Directorate General for Trade of the European Commission, 1998

• 1999: Seattle: Battles re Essential Medicines Patents

• 2001: Doha Declaration – a success?

The Doha Declaration“…while reaffirming our commitment to

the TRIPS Agreement, we affirm that the Agreement can and should be implemented in a manner supportive of WTO Members’ right to protect public health and, in particular, to promote access to medicines for all.”

• Go ahead for generic production/import?

Doha declaration 2001• TRIPS should be interpreted in a

manner which supports governments’ attempt to protect public health– emphasised flexibility already in TRIPS– extension for LDCs until 2016– recognised problem of compulsory

licensing in countries with insufficient or no manufacturing capacity and resolved to find a solution to this issue

Fast forward to 2007• Doha declaration never used (but

nearly!)– ? unworkable

• Countries without domestic generic industries?

• WTO paralysis?• TRIPS+• India Glivec court case… watch

out

Emerging issues

• Regional free-trade agreements e.g. FTAA– IP included under the agreement– US proposals would

• restrict grounds for compulsory licensing• extend patent holders monopoly beyond

20 years• give five years ‘data exclusivity’ on

pharmaceutical test data, delaying entry of generics

Emerging issues• NGOs attempting to strengthen

developing countries’ capacity to make use of flexibilities in TRIPS

• Proposals for R&D funds for neglected diseases– raises issue of public sector R&D and

how it is exploited• Drug donation; corporate social

responsibility or PR smokescreen?

Importance of networks• US Commercial interests needed

support from across the world to make TRIPS happen

• Surveillance + economic coercion crucial to maintaining commercial power in this area

• Weaker actors also have to create global networks as a counterpoint

Final thoughts• Complicated issues…

… but important!• ‘Themes’

– Power relationships; trade and finance decision-makers; commercial interests; governments

– increasing influence of CSOs

questions?questions?