Health justice – worldwide!Perspective from South

Dr. Narendra GuptaNational Jt. Convener People’s Health Movement India Coordinator, Prayas Centre for Health Equity Rajasthan

India

Berlin, Germany

17-18 SEPTEMBER 2010

Gandhiji's Mantra

"I will give you a talisman. Whenever you are in doubt, or when the self becomes too much with you, apply the following test. Recall

the face of the poorest and the weakest man whom you may have seen, and ask yourself, if the step you contemplate is going to be

of any use to him. Will he gain anything by it? Will it restore him to a control over his own life and destiny?

…………..for the hungry and spiritually starving millions?Then you will find your doubts and your self melt away."

The role of the health care provider for justice• Rudolph Virchow:

–“Health care providers are natural attorneys for the poor … If medicine is to really accomplish its great task, it must intervene in political and social life…”

Global Health Crisis

• Growing inequalities across and within countries.

• Health status of countries in south has not improved.

• Neo-liberal forces of market led globalisation cause for accelerating inequities in health.

A large proportion of the world’s population lacks access to food, education, safe drinking water, sanitation, shelter, land and its resources, employment and health care services.

Public services are not fulfilling people’s needs because they have deteriorated as a result of cuts in governments’ social budgets. Health services have become less accessible, more unevenly distributed and more inappropriate.

Current Global Health Spending

Basic Facts about South96 Lower & middle income countries

Mainly in

– Africa.

– Asia and the Pacific Region

Some are in

– in Western Asia

– in the Caribbean

Many are landlocked

Few are small islands

Some more facts…..

• Total LDC Population – 750 million (2005)

• Projected Population – 950 million (2015)

• Projected number of people living in extreme poverty – 470 million by 2015

Health Indicators in different regions

Life Expectancy

1990 2008

Neonatal Mortality

Rate (2008)

IMR (2008)

U-5 MR (2008)

MMR (2005)

African Region 51 53 40 85 142 900

America Region

71 76 9 15 18 99

South-East Asia Region

58 65 34 48 63 450

European Region

72 75 7 12 14 27

Eastern Mediterranean Region

61 65 35 57 78 420

Western Pacific Region

69 75 11 18 21 82

GLOBAL 64 68 26 45 65 400

Mortality (Income group wise)

Life Expectancy

1990 2008

Neonatal Mortality

Rate (2008)

IMR (2008)

U-5 MR (2008)

MMR (2005)

Low Income 54 57 37 76 118 650

Lower Middle Income

62 67 29 44 63 180

Upper Middle Income

68 71 11 19 23 91

High Income 76 80 04 06 07 09

GLOBAL 64 68 26 45 65 400

Cause Specific Mortality Rate (Per 100000 population) (Income group wise)

HIV/AIDS (2007)

Malaria (2006)

TB among HIV-

negative people (2008)

Low Income 87 56 48

Lower Middle Income

11 9.7 22

Upper Middle Income

65 0.6 8.4

High Income 4 - 1

GLOBAL 30 17 21

Cause Specific Mortality Rate (Per 100000 population) (region wise)

HIV/AIDS (2007)

Malaria (2006)

TB among HIV-

negative people (2008)

African Region 174 104 51

America Region 12 0.5 3.4

South-East Asia Region

13 2.1 28

European Region 11 - 6.5

Eastern Mediterranean Region

5 7.5 19

Western Pacific Region

5 0.3 15

GLOBAL 30 17 21

Percentage annual rate decline of under 5 mortality

157

70

26

11

109

36

155

0

20

40

60

80

100

120

140

160

180

Low Income Lower Middle Income Upper Middle Income High IncomePro

bab

ilit

y o

f d

yin

g b

y a

ge 5

per

1000 liv

e b

irth 1990 2008

Mortality rate in children U-5 years

Global Trends in Maternal Mortality

• Maternal mortality in the LDCs remains the highest. 890 deaths per 100,000 live births in the world.

• Under five mortality rate is 160 deaths per 1,000 live births compared to 86 in the rest of the world.

Birth attended by skilled birth attendants

T.B., Malaria & HIV/AIDS

2.1 million new TB cases were reported in 2004 mainly as a result of HIV/AIDS.

• Rate of new HIV/AIDS cases (3.2%) in LDCs remains the highest in the world.

Malaria

• Reduction in malaria prevalence in 15 LDCs but deterioration in 13 among 30 LDCs with trend data.

Access to Water & Housing

Water

• Only 58 % of the population in LDCs has access to improved water.

Slums

• Nearly 140 million people in LDCs live in poor housing conditions.

Income categories

Poverty

• Almost 50% of the population in LDCs lives on less than $1 a day.

• Rates of undernourishment over 40% reported in 10 LDCs.

Some more facts…..

• One billion people lack clean drinking water and 3 billion lack sanitation

–13,000-15,000 deaths per day worldwide from water-related diseases

• Hunger kills as many individuals in two days as died during the atomic bombing of Hiroshima

Population using improved sanitation facilities

Access to Essential medicines• 55 % of world’s citizens lack essential

health care because of very high costs of medicines. (WHO)

• Out of pocket healthcare expenditure is the second greatest cause of rural indebtedness in India today. Out of it 79% is on medicines.

In India

• Between 1999-2000, 32.5 million patients fell below the poverty line just after a single hospitalization. 40% of those hospitalized were forced to borrow money or sell assets to meet costs, and 23% of ill patients simply never seek treatment because of their inability to pay.

WHO estimates that 65% of India’s

population lacks regular access to

essential medicines. This is when INDIA

IS THIRD LARGEST PRODUCER OF

MEDICINES IN THE WORLD.

DRUG PRICING AND PRESCRIPTION OF

UNNECESSARY DRUGS MAIN CAUSE

Procurement through OPEN TENDER by GENERIC NAME

reveals the actual costs…

Generic Name of Drug Chittorgarh Tender Rate*

(Rs.)

Unit MRP Printed on pack / strip

(Rs.)

Albendazole Tab IP 400 mg 11.00 10 tablets 250.00

Alprazolam Tab IP 0.5 mg 1.40 10 tablets 14.00

Arteether 2 ml Inj 9.39 1 Injection 99.00

Amlodipine Tab 5 mg 2.50 10 tablets 22.00

Cetrizine 10 mg 1.20 10 tablets 35.00

Ceftazidime 1000 mg 52.00 1 Injection 370.00

Atorvastatin Tab 20 mg 18.10 10 tablets 170.00

Diclofenac Tab IP 50mg 2.20 10 tablets 25.00

Diazepam Tab IP 5 mg 1.90 10 tablets 29.40

Amikacin 500 mg 6.95 1 Injection 70.00

Large gap between manufacturing price & MRP !!!!!! Huge profits - at the cost of the poor.

Who is more important ?Drug manufacturers or our poor countrymen

40.50/-15100 mgNIMESULIDENISE

25/-10100 mgNIMESULIDENICIP

29/-10100 mgNIMESULIDENIMULID

20/-10100 mgNIMESULIDENIMLIN

Printed Max. Retail

No. of Tablets

PotencySalt name of medicine (Generic Name)

Name given by drug company (Brand Name)

THE PROBLEM : SAME MEDICINE : DIFFERENT PRICES

However, the stockist price of NICIP manufactured by Cipla is only Rs. 1.88/-

Antibiotic Injection

Drug manufacturing company

Name given by company

(Brand Name)

Salt name of medicine

(Generic Name)

Rate at which drug is purchased by the chemist

(Stockiest price)

ONE INJECTION

Rate at which drug is sold to the customer (Printed MRP)

Cadila Amistar 500 Amikacin 500 mg 8.00/- 70/-

German Remedies

Amee 500 Amikacin 500 mg 8.00/- 70/-

Wockhardt Zekacin 500 Amikacin 500 mg 9.90/- 70/-

Alembic Amikanex 500 Amikacin 500 mg 8.22/- 64.25/-

Intas Kami 500 Amikacin 500 mg 8.13/- 60/-

Unichem Unimika 500 Amikacin 500 mg 7.80/- 72/-

Ranbaxy Alfakim 500 Amikacin 500 mg 8.50/- 70/-

Cipla Amicip 500 Amikacin 500 mg 7.42/- 72/-

Antibiotic Injection

The price of generic medicine is : Rs. 6.75

Cipla’s 10 mg Cetrizine

Cipla’s Cetrizine 10 mg Brand Alerid MRP 37.50Cipla’s Cetrizine 10 mg

Brand Cetcip MRP 33.65

Cipla’s Cetrizine 10 mg Brand Okacet MRP 27.50

IF SOMEBODY IN YOUR FAMILY SUFFERS FROM BLOOD CANCER

There Are Three Options With The Doctor

GENERIC NAME BRAND NAME

NAME OF COMPANY

NO. OF CAPSULES

PRICE (Rs.)

M.R.P.

IMATINIB Cap. GLIVEC NOVARTIS 120 1,14,400/-

IMATINIB Cap. VEENAT NATCO 120 10,800/-

IMATINIB Cap. Imatib @ CIPLA 120 10,200/-

BUT, DO THE PATIENTS HAVE ANY OPTION . . . ? ? ?

Cipla supplies the generic version at just Rs. 6,500/- to Railway Hospitals

Promotion of Hazardous, Banned and Bannable Drugs

Contemporary Issues in Health & Justice

• 90% of research dollars spent on diseases affecting 10% of the world’s population

• Research on special populations (cultural minorities, prisoners, developing world, etc.) non existent.

• Role of institutional and for-profit IRBs• Use of placebo controls

• The cost of medicines is one of the largest factors contributing to this breach of human dignity.

Status of women

Women • do 67% of the world’s work

• receive 10% of global income

• own 1% of all property

Worldwide, every minute• 380 women become pregnant (190

unplanned or unwanted)

• 110 women experience pregnancy-related complications

• 40 women have unsafe abortions

• 1 woman dies from childbirth or unsafe abortion

Reason: Lack of access to reproductive

health services

Establish Health as basic right by• By global equitable distribution of

resources. • Transfer of technology• Stopping migration of skilled health

personnel from south to northern countries

• Abolition of international covenants and instrument which discriminate against southern countries.

Asian Social Forum - 2003

“The human right to health and health care must take precedence over the profits of corporations, especially the profiteering of pharmaceutical companies.”

The Cuenca Declaration 2005

PHM Global Global Action

A global mobilisation only can

ensure to bring about this

Change. Join

PEOPLE’s HEALTH MOVEMENT

• More information about PHM, visit• For further information visit

• www.phmovement.org

• www.phm-india.org

• www.ghwatch.org

• www.mfcindia.org

Thanks