World trade vs world health
Big industries vs global health
Tobacco
Food &
beverages
Global cigarette consumption is increasing
0 1000 2000 3000 4000 5000 6000 70001900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2009
Top 10 countries with highest adult diabetes
cases
(Wild et al 2004)
Year 2000
Rank Country Adult cases (million)
Percentage
1 India 31.6 5.5 2 China 20.7 2.4
3 USA 17.6 8.8
4 Indonesia 8.4 6.7
5 Japan 6.8 6.7
6 Pakistan 5.2 7.7 7 Russia 4.6 4.2 8 Brazil 4.5 4.3
9 Italy 4.2 9.2
10 Bangladesh 3.2 4.6
Year 2030
Rank Country Adult cases (million)
Percentage
1 India 79.3 8.0 2 China 42.2 3.7
3 USA 30.2 11.2
4 Indonesia 12.2 10.6
5 Pakistan 13.8 8.7 6 Brazil 11.3 7.0 7 Bangladesh 11.1 7.7
8 Japan 8.9 8.8
Increasing consumption of processed food
and soft drinks in Asia*
Per capita consumption of coca-cola*
0 100 200 300 400 500 600 700 800Mexico USA Australia South Africa Brazil Germany Japan France Thailand China Indonesia
Top 10 pharmaceutical companies
Rank Company Country Revenue (billion USD)
1 Pfizer US 72.69
2 Johnson & Johnson US 63.75 3 Roche Switzerland 57.37 4 Novartis Switzerland 46.36 5 Sanofi-Aventis France 43.52 6 GlaxoSmithKline UK 40.42
7 Abbott US 32.80
8 AstraZeneca UK 31.60
Examples of double standards in drugs
Developed counties Developing countries
Aspirin (Bayer) Germany: Not for use in children under the age of 12 (risk of Reye’s syndrome -often fatal liver disease)
Brazil: Specifically promoted for children
Lesterol (Aventis) Withdrawn in USA in 1995, in Germany in 1998
Continued to be sold in Brazil until May 2004 Dipyrone (Boehringer
Ingelheim)
Not sold in Canada, Sweden, UK, USA
Irrational, Non-essential or
Hazardous Drugs, India 1999
Rank Brand name Producer Company
Headquarters
Description
1 Becosules Pfizer United States Irrational vitamin mixture
3 Corex Pfizer United States Irrational cough mixture
9 Liv-52 Himalaya India Useless liver drug
11 Dexorange
Franco-Indian
India/France Blood tonic
12 Digene Abbott United States Needless antacid
17 Combiflam Aventis France Irrational analgesic mixture
20 Polybion E Merck Germany Irrational vitamin mixture
21 Glucon-D Heinz United States Useless nutrients
22 Evion E Merck Germany Irrational vitamin mixture
25 Revital Ranbaxy India Oral ginseng tonic
Big industries vs global health
Tobacco
Food &
beverages
Contents of Ads in Medical Journal in Developing and
Developed Countries
Type of
information
Percent of ads containing
information
Developed
countries
Developing
countries
Indications
89
87
Contraindications
61
28
Warnings
55
29
Side effects
64
29
Prevalence of physician and drug industry
relationship
(Campbell et al 2007)
Industry provides
Prevalence
Meals
83
Pharmaceutical samples
78
Reimbursement for CMEs
26
Payment for consulting
18
Payment for speaker
16
Barriers to pharmaceutical promotions
Country Regulations
US Regulatory and cost hurdles
UK, France, Germany Fees, Budget pressures, restrictions, low incetives Russia Outlawed
Tactics of the corporations
Political
Public
relations
Finance
Product
Extra
Political tactics
Lobbying
Finance
Business
associations
Product tactics
Product
modification
Targeting
vulnerable
populations
Extra Legal tactics
Infiltrating
opposition
group
WHO private donor contribution
Donor USD
WHO budgetary allocations
Regular budget
Infectious Chronic Injury
Extra budgetary
WTO vs WHO?
Global trade governance
Global health governance
Centralized and comprehensive
architecture, strong legal
foundations, incentive and capacity
Unstructured plurality, fragmented,
diversified
Expanding membership, vast array of
(60) obligations for members
Expertise based influence,
non-binding collective action
Detailed, complex , legally binding
requirements per agreement
Not legally demanding
Compulsory comprehensive dispute
settlement
TRIPS and health
•
TRIPS mandate intellectual property protections that provide
20-year monopoly control
•
Limit
go er e ts’ a ilit to pro ide ge eri edi atio s
under publicly funded programs.
Length of clinical development (years)
0 1 2 3 4 5 6 7 8 9 10Three types of diseases
•
Type I diseases
are incident in both rich and poor countries, with large numbers
of vulnerable population in each.
•
Type II diseases
are incident in both rich and poor countries, but with a
substantial proportion of the cases in the poor countries
A policy agenda for a movement for a healthier future
(Freudenberg 2014)
•
E pa d o su ers’ right to k o a d orporatio s’ dut to
disclose the health consequences of corporate practices and
products
•
Require corporations to pay for the health and environmental
consequences of their products and practices
•
Establish global health standards for product design and marketing
•
Restore public ownership of science and technology
•
Restore the visible hand of government in public health protection
Strategies to promote public health
•
Biomedicine
•
Lifestyle modification
