Global Effort Of Improving Health: Challenges And Options

Discuss about the Global Effort of Improving Health.

The World Health Organization (WHO) has published estimation that one-third of the global population has no access to the medicines they require. It has been found that improved access to the vital medicines would advance the global effort of improving health in the developing part of the world and for tackling key diseases like tuberculosis, HIV/AIDS and malaria. It is one of the considerations of WHO that fair access to safe and inexpensive medicines is fundamental for the achievement of the best possible health standard by everyone. In this context, the issue of medicine supply in developing countries is a major concern (WHO | Access to Medicines, 2017).

In the public sector of lower and middle income countries (LMIC), the average availability of generic medicines is just 38%, whereas, the private sector availability is higher, with an average of 64% (Leisinger, Garabedian & Wagner, 2012). However, the medicines of private pharmacies are not affordable. In developing countries, medicines build a huge economic burden on the healthcare systems and households, owing to the consumption of 25-65% of the total private and public health expenditure and 60-90% of the health expenditure in households (Leisinger, Garabedian & Wagner, 2012). Progressively more, demands are being put on the pharmaceutical industry for contributing towards the improvement of the access to medicines for the poor patients in the LMICs. Of the Millennium Development Goals, three of them are directly focusing on health issues – reduction in child mortality, improvement in maternal health and combating malaria, HIV/AIDS and other diseases (Roffe, 2012).

The WHO considers that in the developing countries, unacceptably low health outcomes are the result of the failure of health systems. The concern is that governments of most of the developing countries are spending majority of their resources on other sectors instead of health and education, and whatever little is applied are either wasted or misallocated due to politics or corruption. Despite international dedication and unprecedented donor support, efforts for improving access to medicines require a vast amount of improvement. In 2014 and 2015, the global drug spending increased by 9%, outpacing both the economic growth and overall health expenses (Moon, 2017). The highlight is that for long what the LMICs has been facing till date, the concern has reached the high income countries too. Inadequate innovation and unaffordable medicines have turned into global issues. Similar to climate change, they are in need of international cooperation and public policies.

Background

According to WHO (WHO | Access to non communicable diseases medicines, 2017) every year nearly 35 million people die because of Non Communicable Diseases (NCDs). Approximately 80% of this happens in the LMICs, which could have been avoided if they were treated with essential medicines. Unfortunately, the situation is generally poor in majority of the LMICs in terms of access to these chronic disease medicines. Approximately a decade ago, the crisis in medicine access pushed the elevation of infectious diseases towards being a foreign policy issue and became the reason for the mobilization of billions in global health support (Bollyky, 2013).

On the other hand, trade liberalization can have both a positive and negative influence on the access to medicines. It promotes transfer of goods and services, technologies and investments that can advance the access of medicines directly by expanding access. However, the benefits gets contested by displayed disparities in economic growth related to trade and investments, exacerbated income disparities  within countries and increased fiscal and food insecurity. In place of public health protections, trade liberalization also acts as a crucial upstream deciding factor of non-communicable diseases (NCDs). NCDs are one of the leading causes of death and disability worldwide today (Ebrahim et al., 2013). Trade liberalization is a driver of NCDs via two major pathways. The first is that it can facilitate the global diffusion of risky commodities that causes NCDs in the first place, like tobacco, alcohol and processed food across international borders. Transnational risk commodity corporations (TRCCs) manufacture, market and distribute these kinds of commodities on an international level and is considered as a key mechanism. Instead of helping with providing access to medicines for essential treatment, trade liberalization allows the TRCCs rapid movement of investments, production capacity, technologies, raw materials and final products across borders, driving consumption of risky commodities. Moreover, trade liberalization even supports the intellectual property rights of transnational pharmaceutical organizations and TRCCs. It potentially restrains the access to medicine and technologies that are used for the deterrence or cure of NCDs. The LMICs have the greatest need for NCD related essential medications (Baker, Kay & Walls, 2014).

The main reason behind the lack of access to medicines are multiple, however, the elevated prices are a huge barrier to required treatment. The World Trade Organization Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement provides 20 years of patent protection for pharmaceuticals and additionally counts in safeguarding options like compulsory licensing for making sure countries get the chance to override patents in cases where they become a barrier to the access of medications. The Millennium Development Goal No. 6 acknowledges the need to combat malaria, HIV/AIDS and other diseases, and goal 8E addresses the need for improving the accessibility of inexpensive medicines for the world’s poor. The access is not adequate in developing countries though (Hogerzeil et al., 2013).

Current Status

Majority of the Australians in some way have interacted with NCDs – they either had it themselves or knew someone who has. This has taken place despite of the country taking great strides in the direction of facing and tackling these diseases. Smoking related diseases have been controlled with the help of advertising, heavy tobacco taxes and changing mindsets regarding passive smoking. Due to this control, improved medical treatments and dietary improvements, large numbers of deaths that could have happened due to heart disease and stroke was taken care of. Even though the health system in Australia is not perfect, it is still much better than a lot of other countries. Australia has public education programs too, that have made such a big difference. However, the attention still falls short in terms of funding, health policy and program implementation for effective prevention (Moodie, Tolhurst & Martin, 2016). 

To further assist in better access to medicines, the Australian delegation can speak up regarding what they have learnt about in their fight against NCDs and the non-availability of medicines. There needs to be efforts to reduce the population in Asia and Pacific who because of NCD have lost their eyesight. These conditions have had a greater negative impact than many other conditions, both communicable and non-communicable. For better access of medicines, first there is a need of intervention by extremely qualified health practitioner to make sure proper use is done of the medicines. The state and territory government with the pharmaceutical industry must cooperate to take up responsibility of the regulatory arrangements of essential medicines. A cooperative action must continue to ensure efficient, modern registration and schedules that are consistent with the community interest and best practice principles (Department of Health | National Medicines Policy Document, 2014).

WHO’s Ex-Director General, Margaret Chan opined that essential medicines can act as interventions, and if they are used properly can even save millions of lives each year and trim down needless suffering. It is already proven that mortality and morbidity can be reduced with the help of good governance, smart resource spending in accordance with the real needs, and good health requires medicine. A moral imperative exists that equal distribution of resources for the improvement of medicinal access for the needy and vulnerable. Governments have the option of taking the step of facilitating noteworthy progress in the direction of development of medicinal access, even if there are budget restraints, such as abolishment of sales tax, import tariffs and duties on medicines. In some instances, capacity and efficacy in the public sector are low and adoption of strategies placing huge workload on public institutions might prove to be detrimental. It is the shared responsibility of the pharmaceutical industry, international community and nongovernmental organizations (NGOs) to improve the access to medicines. The international community can attempt coordination, concentrate on improving health systems over vertical programs and evaluating the different required and unnecessary effects of interventions. NGOs need to be given better opportunities so that they can contribute to the achievement of the global health goals. NGOs can campaign for increased and better-coordinated health care resources and promotion of sustainable health systems. It is the responsibility of the pharmaceutical industry to the provision of success to essential and affordable drugs in the LMICs (Leppo et al., 2013).

Conclusion

Proper actions and effective mechanisms to make sure the access to medicine is possible assist in the quality and proper use of those medicines. It is the responsibility of a Minister for Health to make sure misuse and misallocation of essential medicines does not happen. WHO’s ultimate goal of providing access to everyone on this planet of medicines is the only way to avoid such life harming disease like HIV/AIDS, tuberculosis and malaria. The current problem of access to medicines can be solved somewhat by reviewing the existing practices and incorporating the suggested steps.

References

Baker, P., Kay, A., & Walls, H. (2014). Trade and investment liberalization and Asia’s noncommunicable disease epidemic: a synthesis of data and existing literature. Globalization and health, 10(1), 66.

Bollyky, T. J. (2013). Access to drugs for treatment of noncommunicable diseases. PLoS medicine, 10(7), e1001485.

Department of Health | National Medicines Policy Document. (2014). Health.gov.au. Retrieved 27 July 2017, from https://www.health.gov.au/internet/main/publishing.nsf/content/national-medicines-policy

Ebrahim, S., Pearce, N., Smeeth, L., Casas, J. P., Jaffar, S., & Piot, P. (2013). Tackling non-communicable diseases in low-and middle-income countries: is the evidence from high-income countries all we need?. PLoS medicine, 10(1), e1001377.

Hogerzeil, H. V., Liberman, J., Wirtz, V. J., Kishore, S. P., Selvaraj, S., Kiddell-Monroe, R., ... & Lancet NCD Action Group. (2013). Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration. The Lancet, 381(9867), 680-689.

Leisinger, K. M., Garabedian, L. F., & Wagner, A. K. (2012). Improving access to medicines in low and middle income countries: corporate responsibilities in context. Southern med review, 5(2), 3.

Leppo, K., Ollila, E., Pena, S., Wismar, M., & Cook, S. (2013). Health in all policies-seizing opportunities, implementing policies. Sosiaali-ja terveysministeriö.

Moodie, A. R., Tolhurst, P., & Martin, J. E. (2016). Australia’s health: being accountable for prevention. Med J Aust, 204(6), 223-225.

Moon, S. (2017). Powerful Ideas for Global Access to Medicines — NEJM. New England Journal of Medicine. Retrieved 27 July 2017, from https://www.nejm.org/doi/full/10.1056/NEJMp1613861#t=article

Roffe, P. (2012). Negotiating health: Intellectual property and access to medicines. Earthscan.

WHO | Access to Medicines. (2017). World Health Organization. Retrieved 27 July 2017, from https://www.who.int/publications/10-year-review/medicines/en/

WHO | Access to non communicable diseases medicines. (2017). World Health Organization. Retrieved 27 July 2017, from https://www.who.int/medicines/areas/policy/access_noncommunicable/en/