2016 GH Sesi 4 YM World trade vs world health
World trade vs world health
Yodi Mahendradhata
Which industries poses major risks
to global health?
Big industries vs global health
Tobacco
Food &
beverages
Pharma
Cars
Global cigarette consumption is increasing
7000
Cigarettes in billions
6000
5000
4000
3000
2000
1000
0
1900 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
Year 2030
Rank
Country
Adult cases
(million)
Percentage
Rank
Country
Adult cases Percentage
(million)
1
India
31.6
5.5
1
India
79.3
8.0
2
China
20.7
2.4
2
China
42.2
3.7
3
USA
17.6
8.8
3
USA
30.2
11.2
4
Indonesia
8.4
6.7
4
Indonesia
12.2
10.6
5
Japan
6.8
6.7
5
Pakistan
13.8
8.7
6
Pakistan
5.2
7.7
6
Brazil
11.3
7.0
7
Russia
4.6
4.2
7
Bangladesh
11.1
7.7
8
Brazil
4.5
4.3
8
Japan
8.9
8.8
9
Italy
4.2
9.2
9
Philippines
7.8
10.2
10
Bangladesh
3.2
4.6
10
Egypt
6.7
9.7
Sales of unhealthy food is rising
Increasing consumption of processed food
and soft drinks in Asia*
*Baker et al (2014)
Per capita consumption of coca-cola*
800
700
600
500
400
300
200
100
0
Mexico
USA
Australia
South Africa
Brazil
Germany
Japan
France
Thailand
China
Indonesia
http://www.statista.com/statistics/271156/per-capita-consumption-of-soft-drinks-of-the-coca-cola-company-by-country/
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
9
Merck & Co.
US
28.54
10
Bristol-Myers Squibb
US
19.98
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Withdrawn in USA in 1995, in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
Marketed in Brazil, Central
America, Mexico, Pakistan,
South Africa
Irrational, Non-essential or
Hazardous Drugs, India 1999
Producer
Company
Headquarters
Description
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
FrancoIndian
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
Rank
Brand name
1
National Commission on Macroeconomics – Access to Essential Drugs and Medicine
Big industries vs global health
Tobacco
Food &
beverages
Pharma
Cars
Tactics of multinational
corporations?
Contents of Ads in Medical Journal in Developing and
Developed Countries
Type of
information
Percent of ads containing
information
Developed
Developing
countries
countries
Indications
89
87
Contraindications
61
28
Warnings
55
29
Side effects
64
29
Herxheimer. International Journal of Health Services 1993;23:161-72.
Prevalence of physician and drug industry
relationship (Campbell et al 2007)
Industry provides
Meals
Pharmaceutical samples
Reimbursement for CMEs
Payment for consulting
Payment for speaker
Reimbursement for travel, food, lodging at professional meetings
Payment for serving on as an advisory board
Free tickets to cultural or sporting events
Any gift or money relationship
Prevalence
83
78
26
18
16
15
9
7
94
Barriers to pharmaceutical promotions
Country
Regulations
US
Regulatory and cost hurdles
UK, France, Germany
Fees, Budget pressures, restrictions, low incetives
Russia
Outlawed
Developing countries
???
Tactics of the corporations
Political
Public
relations
Product
Finance
Extra
legal
Political tactics
Lobbying
Finance
Business
associations
Corporate
foundations
Public Relations tactics
Spokespersons
Health
professions
organizations
Corporate
news
Corporate
science
Corporate
social
responsibility
Advertising
Product tactics
Product
modification
Targeting
vulnerable
populations
Manipulating
science
Extra Legal tactics
Infiltrating
opposition
group
Illegal activity
WHO private donor contribution
Donor
USD
Gates Foundation
148,174,632
Rotary International
27,038,394
Novartis switzerland
211,933,675
World Lung Foundation
10,396,059
Sanofi-Aventis
9,909,802
Kobe Group
9,000,000
WHO budgetary allocations
Regular budget
Extra budgetary
Infectious
Infectious
Chronic
Chronic
Injury
Injury
World trade vs world health?
WTO vs WHO?
Global trade governance
Centralized and comprehensive
architecture, strong legal
foundations, incentive and capacity
Global health governance
Unstructured plurality, fragmented,
diversified
Expanding membership, vast array of Expertise based influence, non(60) obligations for members
binding collective action
Detailed, complex , legally binding
requirements per agreement
Not legally demanding
Compulsory comprehensive dispute
settlement
No compulsory dispute settlement or
enforcement
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
under publicly funded programs.
edi atio s
• Affects access to medications for life-threatening conditions in
low-income countries
Loss of sales (%) from patent expirations (2010-2012)
100
90
80
70
60
50
40
30
20
10
0
Length of clinical development (years)
10
9
8
7
6
5
4
3
2
1
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
New drug discovery and development
Three 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
• Type III diseases are those that are overwhelmingly or exclusively incident in the
developing 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
• Prevent corporations from using their money and power to
manipulate democratic prcesses
Strategies to promote public health
• Biomedicine
• Lifestyle modification
• Changing corporate practices!
World Trade vs
World Health
Yodi Mahendradhata
Which industries poses major risks
to global health?
Big industries vs global health
Tobacco
Food &
beverages
Pharma
Cars
Global cigarette consumption is increasing
7000
Cigarettes in billions
6000
5000
4000
3000
2000
1000
0
1900 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
Year 2030
Rank
Country
Adult cases
(million)
Percentage
Rank
Country
Adult cases Percentage
(million)
1
India
31.6
5.5
1
India
79.3
8.0
2
China
20.7
2.4
2
China
42.2
3.7
3
USA
17.6
8.8
3
USA
30.2
11.2
4
Indonesia
8.4
6.7
4
Indonesia
12.2
10.6
5
Japan
6.8
6.7
5
Pakistan
13.8
8.7
6
Pakistan
5.2
7.7
6
Brazil
11.3
7.0
7
Russia
4.6
4.2
7
Bangladesh
11.1
7.7
8
Brazil
4.5
4.3
8
Japan
8.9
8.8
9
Italy
4.2
9.2
9
Philippines
7.8
10.2
10
Bangladesh
3.2
4.6
10
Egypt
6.7
9.7
Sales of unhealthy food is rising
Increasing consumption of processed food
and soft drinks in Asia*
*Baker et al (2014)
Per capita consumption of coca-cola*
800
700
600
500
400
300
200
100
0
Mexico
USA
Australia
South Africa
Brazil
Germany
Japan
France
Thailand
China
Indonesia
http://www.statista.com/statistics/271156/per-capita-consumption-of-soft-drinks-of-the-coca-cola-company-by-country/
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
9
Merck & Co.
US
28.54
10
Bristol-Myers Squibb
US
19.98
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
Marketed in Brazil, Central
America, Mexico, Pakistan,
South Africa
Irrational, Non-essential or
Hazardous Drugs, India 1999
Producer
Company
Headquarters
Description
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
FrancoIndian
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
Rank
Brand name
1
National Commission on Macroeconomics – Access to Essential Drugs and Medicine
Big industries vs global health
Tobacco
Food &
beverages
Pharma
Cars
Tactics of multinational
corporations?
Contents of Ads in Medical Journal in Developing and
Developed Countries
Type of
information
Percent of ads containing
information
Developed
Developing
countries
countries
Indications
89
87
Contraindications
61
28
Warnings
55
29
Side effects
64
29
Herxheimer. International Journal of Health Services 1993;23:161-72.
Prevalence of physician and drug industry
relationship (Campbell et al 2007)
Industry provides
Meals
Pharmaceutical samples
Reimbursement for CMEs
Payment for consulting
Payment for speaker
Reimbursement for travel, food, lodging at professional meetings
Payment for serving on as an advisory board
Free tickets to cultural or sporting events
Any gift or money relationship
Prevalence
83
78
26
18
16
15
9
7
94
Barriers to pharmaceutical promotions
Country
Regulations
US
Regulatory and cost hurdles
UK, France, Germany
Fees, Budget pressures, restrictions, low incetives
Russia
Outlawed
Developing countries
???
Tactics of the corporations
Political
Public
relations
Product
Finance
Extra
legal
Political tactics
Lobbying
Finance
Business
associations
Corporate
foundations
Public Relations tactics
Spokespersons
Health
professions
organizations
Corporate
news
Corporate
science
Corporate
social
responsibility
Advertising
Product tactics
Product
modification
Targeting
vulnerable
populations
Manipulating
science
Extra Legal tactics
Infiltrating
opposition
group
Illegal activity
WHO private donor contribution
Donor
USD
Gates Foundation
148,174,632
Rotary International
27,038,394
Novartis switzerland
211,933,675
World Lung Foundation
10,396,059
Sanofi-Aventis
9,909,802
Kobe Group
9,000,000
WHO budgetary allocations
Regular budget
Extra budgetary
Infectious
Infectious
Chronic
Chronic
Injury
Injury
World trade vs world health?
WTO vs WHO?
Global trade governance
Centralized and comprehensive
architecture, strong legal
foundations, incentive and capacity
Global health governance
Unstructured plurality, fragmented,
diversified
Expanding membership, vast array of Expertise based influence, non(60) obligations for members
binding collective action
Detailed, complex , legally binding
requirements per agreement
Not legally demanding
Compulsory comprehensive dispute
settlement
No compulsory dispute settlement or
enforcement
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
under publicly funded programs.
edi atio s
• Affects access to medications for life-threatening conditions in
low-income countries
Loss of sales (%) from patent expirations (2010-2012)
100
90
80
70
60
50
40
30
20
10
0
Length of clinical development (years)
10
9
8
7
6
5
4
3
2
1
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
New drug discovery and development
Three 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
• Type III diseases are those that are overwhelmingly or exclusively incident in the
developing 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
• Prevent corporations from using their money and power to
manipulate democratic prcesses
Strategies to promote public health
• Biomedicine
• Lifestyle modification
• Changing corporate practices!
World Trade vs
World Health