Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings
Breaking News 131
Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings
Location: Manila, Philippines
by Andrea Rinaldi (COHRED)
The Global Forum on Research and Innovation for Health 2015 (http://www.forum2015.org/) aims to identify solutions to the world’s unmet health needs through research and innovation.
As world leaders shift their focus to the post-2015 Sustainable Development Goals, increased understanding of the impact of research and innovation on national health systems is of critical importance. Scientific research and innovation has transformative effects on not only health outcomes, but also on national economic growth and sustainable development.
Forum 2015 provides a platform where low and middle income countries take prime position in defining the global health research agenda that better suits their needs, in presenting solutions and in creating effective partnerships for action. Putting “People at the Center of Health Research and Innovation”, Forum 2015 will place much emphasis on empowering populations in low and middle income countries as leading role actors of their own future. The Council on Health Research for Development (COHRED), in partnership with the Philippine Department of Health and Philippine Department of Science and Technology, will host the Global Forum on Research and Innovation for Health in Manila, from 24-27 August 2015.
Forum 2015 will bring together all stakeholders who play a role in making research and innovation benefit health, equity and development. This includes high-level representatives from government, business, non-profits, international organizations, academic and research institutions and social entrepreneurs among others.
The Global Forum for Research and Innovation is the successor to the Global Forum for Health Research, last held in Cape Town, South Africa in 2012.
Save the date and register now!
Date:2015-08-24 to 2015-08-27.
For more information:
At the international level, there is a need to encourage fossil fuel divestment by governments, companies, and institutions in order to promote a healthy climate and a safe planet
by Matthew Rimmer*
Associate professor, Australian National University College of Law, Canberra
The Launch of Global Divestment Day in Australia, Photo: Matthew Rimmer
On the Global Divestment Day on the 13-14 February 2015, doctors and health professionals were at the forefront of the campaign for fossil fuel divestment. In Australia, medical professionals have pushed for fossil fuel divestment, climate action, and re-investment in renewable energy. Professor Fiona Stanley has been a key leader in the debate over public health and climate change, delivering a Monster Climate Petition to the Australian Parliament. In the United Kingdom, the British Medical Association has led the way, with its decision to divest itself of investments in coal, oil, and gas. The landmark report Unhealthy Investments has provided further impetus for the United Kingdom health and medical community to engage in fossil fuel divestment. In the United States and Canada, there is a burgeoning fossil fuel divestment movement. At an international level, there has been a growing impetus for climate action in order to address public health risks associated with global warming.
Doctors for the Environment Australia – Global Divestment Day Picture
In Australia, Doctors for the Environment have mounted a campaign for fossil fuel divestment. The group has emphasized: ‘Climate change is the biggest global health threat of the 21st century.’ The medical professionals emphasized that climate change was a present challenge for public health: ‘We are already experiencing significant changes in climate, increased extreme weather events, and health impacts.’ Doctors for the Environment stressed: ‘The current trajectory of emissions growth and warming will lead to a world not easily habitable, and with disastrous health effects for many.’ The group insisted: ‘Our generation has a rapidly closing window of time in which to act to avoid the worst health impacts of climate change.’ Doctors for the Environment emphasized: ‘We can all make our savings and super a force for health, not harm.’
Professor Fiona Stanley delivers the Monster Climate Petition to the Australian Parliament on the 3rd December 2014 – photo: Matthew Rimmer
Professor Fiona Stanley – a doctor and a paediatrician who was named Australian of the Year in 2003 – has been particularly vocal about the impact of climate change and public health.
Professor Fiona Stanley has expressed her concerns that the public health impacts of climate change have been politically ignored. She expressed her deep disquiet about the attacks upon climate science and climate scientists: ‘Once something does become politicised the science goes out the window’. She commented: ‘At a time when we need science to be used more than ever people are sort of denying the science and the second thing that’s happened with this politicisation of the climate change agenda is the denigration of scientists.’ Stanley insisted: ‘The mechanism of how we do the science has to be appreciated more by the politicians and bureaucrats who are trying to use the science to make really important policy changes that are going to affect the health and wellbeing of the population.’ Professor Fiona Stanley has maintained that the medical profession needed to do more to sell the health co-benefits of individual and community action on climate change.
Professor Fiona Stanley was the lead petitioner in the Monster Climate Petition. The petition by Australians to the House of Representatives demanded immediate and effective action to reduce carbon emissions.
Professor Fiona Stanley emphasized the need for effective and co-ordinated action on climate change:
If our governments are to develop effective policy responses to climate change they need to work with the science and the scientists. Science is never perfect, but to ignore it is very dangerous. My whole life has been about prevention, getting the best scientific data to develop preventative strategies in public health. Where are our Departments of Climate Change and Health? Or similar units in other depts. We need a coordinated, whole of government, climate change strategy. And we need it now!
Professor Fiona Stanley delivered the Monster Climate Petition, along with other key representatives, to the Australian Parliament on the 3rd December 2014
The Monster Climate Petition was organised by the Victorian Women’s Trust. It was inspired by the historical act of 30,000 women, submitting a petition for the vote for women in 1891. The petition sought to draw ‘the attention of the House the damage to the earth’s climate and its oceans from humanity’s continuing and increasing carbon emissions and the consequent severe risks to the future health, safety and well-being of our children and our children’s children and future generations’. The petition asked ‘the House to respect the science and build a safe climate future for our children and grandchildren and generations to come by enacting immediate and deep reductions to Australia’s carbon emissions’. The petition also asked ‘the House to commit to and actively promote and support global strategies for immediate and deep reductions to global emissions at every relevant international forum.’ The petition was designed to spur on climate action at the G20 talks in Brisbane, and encourage the development of a substantial international climate framework at the Paris climate talks in 2015.
In Australia’s neighbour New Zealand, there has also been concerns about the public health impacts of climate change. Dr Sudhvir Singh, a Registrar at the Auckland District Health Board, has been a prominent voice in the debate. In a piece for The Lancet, Dr Sudhvir Singh and his associates argued that ‘anthropogenic climate change poses a grave and immediate danger to human health and survival around the world.’ He insisted: ‘Whether through heatwaves, extreme weather events, drought, starvation, altered disease vectors, or water contamination causing diarrhoea, poverty, mass migration, or resultant conflicts, all are at risk.’ Singh and his colleagues insisted that ‘the substantial health and economic co-benefits of reducing climate change emissions are clear.’
2. United Kingdom
Health professionals in the United Kingdom have been at the forefront of the campaign for fossil fuel divestment and climate action.
In an influential piece in The British Medical Journal in March 2014, David McCoy and his colleagues called upon hospitals, universities, medical societies, and pharmaceutical and medical companies to engage in divestment from fossil fuel companies. The writers maintain: ‘We should push our own organisations (universities, hospitals, primary care providers, medical societies, drug and device companies) to divest from fossil fuel industries completely and as quickly as possible, reinvest in renewable energy sources, and move to “renewable” energy suppliers.’ The writers concluded: ‘If we are to avoid catastrophic climate change and bequeath a sustainable planet worth living on, we must push, as individuals and as a profession, for a transformed, sustainable, and fair world.’
In April 2014, the group Fossil Free Health was established by health professionals and students in order to encourage wider fossil fuel divestment within the medical establishment. The campaign was focused upon the British Medical Association, Royal Colleges, and the Wellcome Trust. Fossil Free Health explained:
Divesting will send an important message to the world that climate change is real and requires immediate preventative action through a drastic reduction of greenhouse gas emissions and rapid transition to a zero-carbon world. Such changes may be considered disruptive and difficult, but are necessary and can bring enormous benefits to human health and well-being both in the short term and in the years and decades to come.
Alice Bell reflected: ‘It’ll be interesting to see how this new medical push on fossil fuel divestment plays out.’ 
In June 2014, the members of the British Medical Association voted to end its investments in the fossil fuel industry, and increase investment in renewable energy. The motion passed call upon the Association to ‘transfer their investments from energy companies whose primary business relies upon fossil fuels to those providing renewable energy sources.’ Medical student and Healthy Planet UK Coordinator, Isobel Braithwaite, commented on the decision: ‘By adding the voice of health professionals, this decision will add considerable momentum to the international movement for divestment from fossil fuels.’ David McCoy, public health doctor and Chair of Medact, congratulated the BMA on taking a leadership role in the fight against climate change: ‘In the same way that ethical investors choose not to profit from tobacco and arm sales, the health community worldwide is correctly calling for divestment from another set of harmful activities.’
In 2015 in the United Kingdom, a coalition of doctors, nurses, and health professionals released the report, Unhealthy Investments: Fossil Fuel Investment and the UK Health Community. The work has been co-published by the health non-government organisations, Medact, Healthy Planet UK, the Climate and Health Council, Medsin and the Centre for Sustainable Healthcare. The report has the striking cover image of an x-ray taken a person who lives near a coal-fired plant in China.
The work has a powerful foreword written by Martin McKee, a Professor of European Public Health at the London School of Hygiene and Tropical Medicine. McKee noted that ‘health professionals have understood the urgency of the health threat posed by man-made climate change for years, and the evidence has only become stronger with time.’ He recognised that climate change and the air pollution associated with fossil fuels poses substantial hazards to health:
Unless we keep most known reserves of fossil fuels underground, the 21st century will see a rise in average global temperatures unprecedented in human history. Though we are only in the early stages of this process, we can already see the severe consequences for human health, with extreme weather events, food insecurity, displacement of populations and civil unrest. There are also many other health effects of dependence on fossil fuels, from the resulting air pollution, physical inactivity and unhealthy diets. We may risk the very survival of our civilisation.
Martin McKee draws comparisons between the debate over tobacco control and climate change. He noted: ‘Taken together, [the hazards of climate change] may be even greater than those posed by tobacco.’ Martin McKee observed that ‘the fossil fuel industry is increasingly using the tactics developed by the tobacco industry, sowing doubt about the very existence of man-made climate change.’ He maintained the ‘UK health profession led the way in the tobacco divestment movement two decades ago, putting the issue firmly on the political agenda, strengthening public understanding of the risks, and paving the way for stronger anti-tobacco legislation.’ Martin McKee noted: ‘This report shows why, in 2015, fossil fuels can no longer be considered an ethical investment.’
The report Unhealthy Investments contends that health organisations in the United Kingdom and elsewhere should end investment in the 200 largest publicly-listed fossil fuel companies, over a period of five years. The report stressed: ‘It is arguably both immoral and inconsistent for the health sector to continue to invest in industries known to harm health, given its clear responsibility to protect health.’ The report emphasized that there were both financial and moral imperatives for fossil fuel divestment:
Ending fossil fuel investments makes financial as well as moral sense. Portfolios which exclude investments in fossil fuel companies can perform as well as those with no such screening criteria, and may indeed outperform them. Moreover, such investments may carry significant long-term financial risk, as international action to address climate change will dramatically devalue investments in coal, oil, and gas. A societal move away from fossil fuels – which would be supported by the adoption of more sustainable and responsible investment strategies – can not only reduce health impacts from climate change, but brings independent short-term health benefits.
The report concludes in its executive summary: ‘The health sector bears a uniquely privileged role in public discourse – divestment provides an opportunity to state unambiguously the need for a transition to a more sustainable society, for the health of people and planet alike.’
In addition to fossil fuel divestment, the report recommended reinvestment in public health. The report concluded: ‘Many of the health problems our patients suffer could be lessened – if not prevented entirely – through measures to transfer our supply from fossil fuels to renewable energy, improving air quality and levels of physical activity.’ The report maintained: ‘Focused investments in areas such as clean energy, building insulation, waste management and many others can help to achieve these twin aims, and often offer strong financial returns in addition.’
3. North America
In North America, there has been a powerful movement for fossil fuel divestment, led by Professor Bill McKibben, and Naomi Klein. Pioneering universities, religious institutions, cities, and even philanthropic organisations have agreed to support fossil fuel divestment.
The group Health Care without Harm has highlighted the critical role played by the health care sector in combatting climate change. Gary Cohen, the President of Health Care without Harm, makes the case for health care to transition away from fossil fuels:
Health care can also divest from fossil fuels or freeze current investments in fossil fuel holdings. They can move their endowment investments from fossil fuels to alternative companies. Similarly, they can provide their employees with mutual fund retirement options that are fossil fuel free.
Cohen stressed: ‘The other critical role that health care can play is to exercise its moral and political power to support policy to rein in climate change, to stop subsidizing dirty energy and instead put a price on carbon emissions.’ He emphasized that health care professionals could provide transformative leadership in the debate over climate change: ‘If they can step up and speak to the health issues related to our continued addiction to fossil fuels and the health benefits of investing in cleaner energy, they can help tip the political debate in this country and around the world regarding the urgency to act on climate change.’
The group has stressed that ‘Divestment or freezing fossil fuel holdings is another important strategy for addressing climate change.’ Health Care without Harm comments: ‘The continued burning of fossil fuels will dramatically effect food production, water availability, air pollution, and the emergence and spread of human infectious diseases.’ Health Care without Harm emphasizes: ‘Divestment can be a powerful tool to help bring attention to these risks and the effect they will have on public health and the overall health of the planet’. The group maintains: ‘By divesting or freezing fossil fuel holdings, the health sector can stand up for human health as it did in the 1990’s, when leading hospitals, health organizations, and medical schools divested their tobacco holdings to bring attention to the harm being caused by smoking.’
Health Care without Harm also calls for reinvestment in renewable energy: ‘Clean technology investments make sense for hospitals.’ The group says: ‘Investments in renewables and energy efficiency help reduce incidence of asthma, heart disease, and the spread of infectious disease by reducing the harmful effects of greenhouse gas emissions. Investments in technologies like combined heat and power (CHP), make hospitals more resilient in the face of extreme weather events. By increasing the overall level of investment, the health sector can reduce the health impacts of climate change, save money on energy costs, and help accelerate the transition to a clean energy economy.’
Announcing his EPA reforms, President Barack Obama has emphasized the public health impacts of climate change. He stressed: ‘We don’t have to choose between the health of our economy and the health of our children.’ Obama commented: ‘As president, and as a parent, I refuse to condemn our children to a planet that’s beyond fixing.”
4. International Organisations
Notably, a number of international organisations have considered the interaction between public health and climate change, and the benefits of policy action, such as fossil fuel divestment.
In 2014, the Intergovernmental Panel on Climate Change has highlighted the public health impacts of climate change. Three Australian Contributors to the report – Anthony McMichael, Colin Butler, and Helen Louise Berry – discussed the findings in respect of climate change and public health: ‘Human-driven climate change poses a great threat, unprecedented in type and scale, to well-being, health and perhaps even to human survival.’ The scholars warned: ‘During at least the next few decades, the chapter states, climate change will mainly affect human health, disease and death by exacerbating pre-existing health problems.’ The writers predicted: ‘The largest impacts will occur in poorer and vulnerable populations and communities where climate-sensitive illnesses such as under-nutrition and diarrhoeal disease are already high – thus widening further the world’s health disparities.’
World Health Organization, ‘Climate Change: A Threat to Human Health’
In August 2014, the World Health Organization held a landmark conference on health and climate. The conference sought to ‘enhance resilience and protect health from climate change’, ‘identify the health benefits associated with reducing greenhouse gas emissions and other climate pollutants’; and ‘support health-promoting climate change policies.’
In her opening remarks, Dr Margaret Chan, the Director-General of the World Health Organization, emphasized: ‘Debates about climate change are still not giving sufficient attention to the profound effects that climate variables have on health’. She observed that, in her personal view, the health effects of climate change are what matters most: ‘Climate and weather affect the air people breathe, the food they eat, and the water they drink.’
Dr Flavia Bustreo, the WHO Assistant Director-General, stressed that health and climate change raised larger issues about development and human rights.  She said: ‘Vulnerable populations, the poor, the disadvantaged and children are among those suffering the greatest burden of climate-related impacts and consequent diseases, such as malaria, diarrhoea and malnutrition, which already kill millions every year.’ The Doctor observed: ‘Without effective action to mitigate and adapt to the adverse effects of climate change on health, society will face one of its most serious health challenges’.
The meeting called for stronger action on climate-related health risks. The World Health Organization stressed: ‘Previously unrecognized health benefits could be realized from fast action to reduce climate change and its consequences.’
Health experts at the event called on the medical summit to divest from fossil fuels.
At the United Nations Climate Summit 2014 in New York, there was a thematic session devoted to climate change, health, and jobs. The panel moderator, Dr Richard Horton, editor of The Lancet, stressed the health benefits arising from climate action:
The climate crisis is not all bad news – there is a climate dividend to be grasped. There are opportunities for wellbeing and jobs. Part of the challenge is to communicate the threats that climate change presents to health. These are well known, including changes in patterns of disease and mortality, to nutrition, and water and sanitation, and population migration. But it is better to emphasize the opportunities. Changes to diet, electricity generation, transportation, will bring benefits to our wellbeing. We need concrete actions to turn this opportunity into a reality.
Gro Harlem Brundtland – a member of the Elders; the former Norwegian leader and past World Health Organization Director-General – emphasized that human health and planetary health are closely linked. She commented: ‘The key reasons why we became concerned about environmental destruction and climate change in the first place is the threat that it presents to our health and to our future’. She emphasized the need for governments to reduce fossil fuel subsidies. The United Nations Secretary General Ban Ki-Moon highlighted how the United Nations Climate Summit 2014 has promoted ‘reducing pollution for improved health.’
At the international level, there is a need to encourage fossil fuel divestment by governments, companies, and institutions in order to promote a healthy climate and a safe planet.
 Doctors for the Environment Australia, ‘Divestment FAQs’, http://dea.org.au/images/general/Divestment_FAQs_9-2-15.pdf
 Fran Kelly, ‘Health Impacts of Climate Change being Politically Ignored: Stanley’, Radio National Breakfast, 17 April 2014, http://www.abc.net.au/radionational/programs/breakfast/former-australian-of-the-year-attacks-climate-sceptics/5396302
 Sudhvir Singh et al. ‘The Importance of Climate Change to Health’, (2011) 378.9785 The Lancet 29-30.
 David McCoy, Hugh Montgomery, Sabaratnam Arulkumaran and Fiona Godlee, ‘Climate Change and Human Survival’, (2014) 348 British Medical Journal g2351 (Published 26 March 2014).
 Fossil Free Health, http://www.medact.org/campaign/fossil-free-health/
 Alice Bell, ‘Will the Medical Establishment Stop Investing in Fossil Fuels’, The Guardian, 8 April 2014, http://www.theguardian.com/science/political-science/2014/apr/08/will-the-medical-establishment-stop-investing-in-fossil-fuels
 Medact, ‘UK Doctors Vote to End Investments in the Fossil Fuel Industry’, 25 June 2014, http://www.medact.org/news/uk-doctors-vote-end-investments-fossil-fuel-industry/
 Alistair Wardrope and Isobel Braithwaite, Unhealthy Investments: Fossil Fuel Investment and the UK Health Community, 2015.
 Health Care without Harm, ‘Investment and Divestment’, https://noharm-uscanada.org/issues/us-canada/investment-divestment
 Suzanne Goldberg, ‘Obama Heralds Health Benefits of Climate Plan to Cut Power Plant Emissions’, The Guardian, 31 May 2014, http://www.theguardian.com/world/2014/may/31/obama-climate-change-epa-power-plant-health
 Alexandra Phelan and Matthew Rimmer, ‘IPCC Makes Climate A Human Rights Issue’, New Matilda, 1 April 2014, https://newmatilda.com/2014/04/01/ipcc-makes-climate-human-rights-issue
 Anthony McMichael, Colin Butler, and Helen Louise Berry, ‘Climate Change and Health: IPCC Reports Emerging Risks, Emerging Consensus’, The Conversation, 30 March 2014, http://theconversation.com/climate-change-and-health-ipcc-reports-emerging-risks-emerging-consensus-24213
 Dr Margaret Chan, ‘WHO Director-General Addresses Conference on Health and Climate’, Opening Remarks at the Conference on Health and Climate, Geneva, Switzerland, 27 August 2014, http://www.who.int/dg/speeches/2014/health-climate-conference/en/
 World Health Organization, ‘WHO Calls for Stronger Action on Climate-Related Health Risks‘, 27 August 2014, http://www.who.int/mediacentre/news/releases/2014/climate-health-risks-action/en/
 United Nations, ‘Health Experts Call on Medical Sector to Divest from Fossil Fuels’, News, 19 August 2014, http://www.un.org/climatechange/summit/2014/08/ngos-urge-medical-sector-divest-fossil-fuels/
 United Nations, ‘Climate, Health, Jobs’, United Nations Climate Summit 2014, http://www.un.org/climatechange/summit/2014/08/climate-health-jobs/
*Dr Matthew Rimmer is an Australian Research Council Future Fellow, working on Intellectual Property and Climate Change. He is an associate professor at the ANU College of Law, and an associate director of the Australian Centre for Intellectual Property in Agriculture (ACIPA). He holds a BA (Hons) and a University Medal in literature, and a LLB (Hons) from the Australian National University, and a PhD (Law) from the University of New South Wales. He is a member of the ANU Climate Change Institute. Dr Rimmer is the author of Digital Copyright and the Consumer Revolution: Hands off my iPod, Intellectual Property and Biotechnology: Biological Inventions, and Intellectual Property and Climate Change: Inventing Clean Technologies. He is an editor of Patent Law and Biological Inventions, Incentives for Global Public Health: Patent Law and Access to Essential Medicines, Intellectual Property and Emerging Technologies: The New Biology, and Indigenous Intellectual Property: A Handbook of Contemporary Research. Rimmer has published widely on copyright law and information technology, patent law and biotechnology, access to medicines, plain packaging of tobacco products, clean technologies, and traditional knowledge. His work is archived at SSRN Abstracts and Bepress Selected Works.
The current patent system encourages the pharmaceutical industry to develop pre-existing drugs rather than innovate. Fifty-five percent of the new drugs developed have no therapeutic added value. What are we doing about this?
by Jesse Frederik*
If we want to entice drug manufacturers to innovate, we have to pay for it, in the form of innovation grants, tax allowances, publicly funded preliminary research and – the most important measure – patents.
Innovation costs money, and hence a pharmaceutical company that comes up with a new drug has the sole right to produce it, usually for a period of twenty years. The temporary monopoly enables drug manufacturers to charge a higher price and recoup their investment in research and development for the drug.
One of the criticisms of the current patent system is that it provides an incentive to invest in what are known as ‘me-too’ drugs – drugs that do not actually improve on existing drugs therapeutically but are ‘copies’ that differ enough from the original to enable them to be patented.
The market for drugs for chronic illnesses such as depression and diabetes is so big that it is more profitable to invest in a ‘me-too’ drug than in a revolutionary new drug that offers uncertain financial returns.
What does the drug add?
‘Me-too’ innovation consequently takes place on a gigantic scale. The Geneesmiddelenbulletin has been publishing drug ratings of new drugs on the Dutch market for over ten years now. This independent monthly drugs bulletin examines whether there is enough publicly available research into a new drug and whether the quality of that research is adequate, then rates the drug on that basis.
Instead of investing in genuinely new drugs the pharmaceutical industry puts its money into medical solutions to problems for which solutions already exist.
The Geneesmiddelenbulletin examined over 112 drugs between September 2000 and February 2014, and what did it find? No less than 55% of the drugs it looked at had no therapeutic added value; 7% percent were even worse than those already available; in the case of 35% it was doubtful whether they had any added value; and only 4% were considered to improve on the existing remedies.
The Netherlands is no exception here, and similar results can be found in most countries. The French counterpart of the Geneesmiddelenbulletin previously concluded that less than 25% of new drugs provided a better alternative to what was already on the market, and around 15-20% were in fact worse.
In other words, to a large extent the pharmaceutical industry invests not in genuinely new drugs but in medical solutions to problems for which solutions already exist. On the other hand, the introduction of ‘me-too’ drugs does solve a problem caused by patents: lack of competition. As companies are not free to copy patented drugs, the only way to provide any competition at all is to come up with similar but not identical ones.
The question is whether this makes up for the waste of research funds. If there are already patent-free alternatives on the market, or several other brands, it is doubtful whether yet another drug will actually add anything.
To give an example, the cholesterol-lowering drug Pitavastatin was approved in August 2009 in the United States. It had no clear therapeutic added value. It was the eighth anti-cholesterol pill to be marketed, and the patents for three of these pills had already expired, making them even cheaper than the new one.
What is being done about this?
The European authorities are not doing much at the moment to stem the flood of ‘me-too’ drugs. The European Medicines Agency assesses new drugs solely in terms of their safety and efficacy compared with a placebo (a ‘pretend’ drug). Whether a new drug is less effective than existing alternatives does not matter.
Some EU member states do have policies in this area. Germany passed a new law in November 2010 that makes drugs more expensive if they have no therapeutic added value. A pharmaceutical company must prove to the regulatory authority that its product is better than the alternatives available; if it is not able to do so, the German health insurance fund will set a lower wholesale price for the drug.
The Norwegians went even further than the Germans: until 1992 they had a ‘medical needs clause’ in their legislation, which required the authorities only to allow ‘products that are needed’ onto the Norwegian market. In practice the local regulator therefore only approved a small number of drugs that had the best benefit-risk ratios for patients.
Norway eventually had to relinquish this clause in 1992, as a result of acceding to the European Economic Area. In 1992 only 13.8% of Norwegian applications for drug approvals were for ‘me-too’ drugs; by 1995 the figure had risen to 32.4%.
In order to get pharmaceuticals companies to focus on genuine innovation, the European Public Health Alliance and Wemos are lobbying the European Commission to consider solutions of this kind. The authorities need to attach more importance to therapeutic added value in their drugs policies.
Whatever the solution may be, one thing is clear: it is imitation – not innovation – that pays under current patent law. And that was never the intention.
*A translation of an article in Dutch by journalist Jesse Frederik in De Correspondent: https://decorrespondent.nl/1856/Waarom-de-farmaceutische-industrie-niet-in-nieuwe-medicijnen-investeert/125083421760-cad52bbe
Published under permission by Ella Weggen, Wemos Foundation
Breaking News Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings
Modern transport planning has rapidly moved away from an expensive, outdated system of car-dependent suburban sprawl. Understanding that health is different from and more than healthcare, wider societal discourse needs to apply planning’s lessons learned to move away from a singular focus on healthcare that is similarly expensive and outdated
by Lawrence Loh
Dalla Lana School of Public Health Toronto University, and Director of Programs at The 53rd Week Ltd
Introduction – systems in crisis
North America is seeing an outdated paradigm coming of age.
The system as developed is showing wear and tear, with breaks and cracks everywhere influencing the experience of system users and those tasked with maintaining it. System users are also getting older; staying longer, working harder, and wearing out faster. Infrastructure meant to maintain and support the system is also starting to give, unable to cope with demand. There is almost never enough funding to keep the system optimally functioning; congestion frequently occurs, fraying tempers and leaving people fuming as they wait. Workers try their best to patch the system, but ultimately, they’re just keeping up as this antiquated mode of thinking continues to influence our health and well-being.
Lest you think I am referring to a contemporary healthcare system, I am actually talking about a similarly complex system that is often the lifeblood of modern North American cities: road transport and the suburban-urban divide.
The parallels with healthcare, though, are hard to miss.
Growing literature has documented the surging costs of healthcare in many industrialised nations. Consuming 18% of the United States’ Gross Domestic Product (GDP), at least one model put forward by the Brookings Institute calls for that proportion to be 25% within the next two decades. Many other countries are seeing the same increase in their GDP share of health. Occurring at the same time, are pressures around quality of care received, accountability, waiting lists and access to care, and insurance reform and models of remuneration; of course, underpinned by long-term economic stagnation that continues to rob governments of critical revenues.
In this environment, funding for healthcare professional salaries are being frozen or axed and hospital budgets are being held constant to encourage rationalization exercises and doing “more with less.” Yet demand for healthcare services continues unabated. Aging populations continue to fuel the inexorable rise of chronic diseases, which contribute the bulk of population mortality and morbidity; emerging infectious diseases, mental health issues, and injuries continue to take their toll, and even anti-science groups burden the system through the resurgence of vaccine-preventable communicable disease and complications arising from alternative therapies.
Some advocates espouse a time-tested solution: “An ounce of prevention is worth a pound of cure”; simple and elegant to state, but seemingly difficult to disseminate. Unfortunately, the understanding that healthcare is not health continues to elude the understanding of those who need to hear it most: policymakers, regulators, civil society, and the private sector, to name a few. Whether this is due to a limited availability of robust evidence for population-level health programs, personal ideology, inertia, or otherwise, it is often too easy for key stakeholders to commit the focus of funding and resources to the acute healthcare system, rather than pursuing the broader concept that health is shaped every day by every policy, every program, and every decision taken.
The advocates that call for a paradigm shift understand that health is more than just healthcare and building health is what happens outside the walls of a hospital, but in our neighbourhoods and our communities. They also believe reducing the causes of ill-health is critical to reducing future healthcare demand. They call for thinking about lifestyle choices, community contexts, outreach and opportunities, to give people the resources they need to make the healthy choice the easy choice. The goal is to keep people healthy and out of the increasingly unwieldy healthcare system; stemming the burden of disease by prevention and health promotion.
This alternative paradigm has driven health to build partnerships with urban planning. In this cross-over field, city policy stakeholders consider how cities and urban streetscapes influence our health and wellbeing. Working together, they make cities more likely to support the health of their residents through transport policy, commercial policy, school policy, and so on.
Keeping people healthy. Reducing the burden of disease through policy. Reducing demand on the healthcare system. Perhaps not-so-novel concepts.
So then, why is there still such a focus on pouring resources into acute care?
And returning to our first example: what can we learn from transport planning about shifting away from an obsolete paradigm?
Building your way out of traffic
The field of transport planning has looked at demand for a while now, and a growing body of literature is showing what we intuitively know about the old suburban sprawl paradigm.
The news, quite simply, is not unexpected. But it’s also not good—on many levels.
Using metrics such as quality of life, economics, physical and mental well-being, community cohesiveness, and even (ironically) travel times, the post-war suburbs that really mushroomed in North America in the 70s and 80s are mostly bad news, on a daily and long-term basis.
Trends increasingly show the adoption of alternative paradigms: young professionals in North America are increasingly getting out of their cars and move into downtown cores of cities, repopulating neighbourhoods that had long been abandoned in the latter twentieth century flight to the burbs. Surveys have time and time again showed that a younger generation desires mixed development and amenities, community and experiences, and the option of using active transport to get to and from work. The resulting benefits pay off in dividends on their quality of life, the money saved on avoiding congestion or maintaining a vehicle, and the creativity and innovation that comes from chance meetings and community development.
Urban planners are increasingly favouring denser, more mixed-use urban forms as opposed to suburban sprawl for the many demonstrated benefits. They have known for a long time that you can’t build your way out of traffic. Called the “induced demand phenomenon”, the idea that a congested road can be relieved by building another road is often put to rest when the existence of that road, in turn, leads to greater demand and use. New roadways simply add to the congestion problem rather than solve it.
New roadways also add to the maintenance problem that exists in many suburban environments today. Roads built in the 80s and 90s, together with their parallel utilities, are coming to the end of their lifecycle and need to be maintained to ensure suburban residents continue to enjoy their quality of life. When costs of upkeep along with costs of congestion are factored in, sprawl actually becomes a much pricier proposition than living in an urban setting.
Knowing that they can’t build their way out of congestion, and that doing so just creates a greater resource sink, planners are increasingly pursuing a different paradigm. By redeveloping dense urban centres and fostering mixed use planning, changing from a focus on moving motor vehicles in and out of the core to instead building human-sized communities, planners are aiming to cut sprawl and mitigate its effects, particularly reducing demand for road transport at the source.
Of course, it’s a careful balancing act for policymakers in a complex ecosystem where reasonable alternatives (e.g. public transport) should exist, and it’s equally challenging when folks may seem stuck in the old paradigm (e.g. “why aren’t you fixing my road?”). In many ways, though, transport planning is returning to the ideas that built the cities of the old world, which were built for walking. The new paradigm being pursued in cities today are thus, in some ways, a return to our roots.
Et tu, health?
So what can health learn about returning to its own roots, where an ounce of prevention is worth a pound of cure? It’s important to note that the concept is not new. Major organizations, public health professionals and other health advocates have long pushed the concept of health as a resource for daily life, and not merely something to think about when one falls ill. Many in the field are familiar with the Ottawa Declaration, the World Health Organization’s definition of health, and the various principles around social determinants of health.
Thomas Edison, one of history’s great thinkers, once stated ““The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.” How do we get there, and what can we learn from the shift that has taken place in urban planning?
It’s about winning hearts and minds outside of the ongoing discourse, and really just committing to working with others towards action.
Urban planning very quickly moved away from a paradigm that wasn’t working and that wasn’t amenable to being built out of, and they did so by building alliances and altering the conversation. For health and healthcare, the trouble lies in the fact that acute healthcare still dominates so much of the wider societal conversation about health. One notices that acute healthcare still swallows the bulk of the budgets of many health ministries. There is an almost never-ending discourse in Western countries around healthcare specific topics, such as access and wait-times, insurance reforms, standards and accountability, primary care versus specialty training, and health human resource planning.
With all this focus on healthcare, it’s not surprising that the broader idea of health gets lost in the wider discourse. In many ways, though, the constant focus on healthcare is similar to the induced demand of traffic. Building another hospital without addressing the causes of ill health is like building another roadway without changing the base assumption that sprawl exists. Like planners moved to ask “why sprawl”, health must move to ask “why only healthcare?”
It is clear that we cannot fix the demand for healthcare by building our way out of it. Health, together with key partners, must change the discourse towards taking the alternative paradigm more seriously, and encourage the populace to sign on. Focusing the discourse solely on a system that treats people when they are ill minimizes “keeping people healthy” as a societal imperative.
A broader public discourse about keeping people healthy is needed to bring the concept of health in all policies into public consciousness. It will take partnerships with leaders willing to shoulder responsibility. It will take multisectoral collaboration. It will take support for research and evaluation to determine what works and what does not, and it will take political appetite to make difficult decisions and calls. But the alternative is similar to where a suburban dystopia was taking us in the urban planning world.
Today’s discourse on health must pivot away from a singular focus on healthcare. Only by recognizing and addressing the myriad underlying causes that drive healthcare demand can we achieve true health for all.
Based in Toronto, Dr. Lawrence Loh is a public health physician at Public Health Ontario, adjunct lecturer in Clinical Public Health at the Dalla Lana School of Public Health at the University of Toronto, and Director of Programs at The 53rd Week Ltd. To learn more about The 53rd Week and its efforts to incorporate health into short-term medical volunteering abroad, visit http://www.53rdweek.org/
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