Poor Health and Poverty Are Linked

Geneva-The pharma industry has given a guarded welcome to a World Health Organization report that explicitly links poverty and poor health. The report comes from the Commission on Macroeconomics and Health (CMH), which was set up by WHO secretary-general Gro Brundtland two years ago. It says eight million lives a year could be saved if rich countries gave 0.1 percent of their gross national product (GNP) to health services for poorer countries and if poorer countries increased health spending by 1 percent of gross domestic product (GDP) by 2007. The economic benefits of that spend would be more than $360 billion a year from 2015 to 2020.

Although the report has been largely ignored by the US govern-ment, some European politicians and the World Bank have wel-comed it as evidence of the need for concerted action to tackle ill health in poor countries and its impact on economic development there. CMH is led by Harvard economist Jeffrey Sachs, and its members include Eduardo Aninat, deputy managing director of the International Monetary Fund (IMF), and Supachai Panitchpakdi, designate director-general of the World Trade Organization-giving a hard-nosed economic edge to data supporting the common-sense notion that poverty and ill health are inextricably linked.

Dr. Harvey Bale, director-general of the International Federation of Pharmaceutical Manufacturers Associations, says he welcomes the broad thrust of the report and the debate it will generate. He supports the report's finding that "the importance of investing in health has been greatly underestimated." But Bale also lists several objections, criticizing the report's proposals for formalized differentiated pricing systems and its suggestion that compulsory licensing can improve access to medicines. He argues that patents are no barrier to access, which can be addressed only through a massive increase in funding.

Bale says the report unduly emphasized patented medicines and "potentially inappropriate" devices for making them available. Yet there are few patents on innovative medicines in poor countries, which are likely to be given an additional ten-year extension for meeting World Trade Organization levels of intellectual property protection. Another problem, Bale says, is the wording of the text suggesting that the industry should take the lead in achieving access to medicines: "This is manifestly inappropriate, and quite impractical. The prime role in achieving access for their populations must lie with country governments.

"The poorest countries must commit such resources as they can and work on their healthcare delivery systems. Rich countries must provide much greater resources in the form of grants. Industry will play its part, but a failure to emphasize the lead role of governments allows the lack of action by many national governments to escape needed scrutiny."