Pharmaceutical growth versus health equity in India: when markets fail
TL;DR: It is found that growth in the pharmaceutical and biotech sectors in India has been characterized by multiple handicaps and oligopoly, with the nature of expansion not having relevance for the disease profiles in India.
Abstract: To reveal inequity in health in India. The global paradigm of the knowledge economy propounds that growth and equity will occur if there is a free-market economy without state intervention and if patents are provided as incentives for innovation. In this paper, we explore the veracity of this thesis by investigating growth in the pharmaceutical and biotech sectors in India, and by looking at equity issues through the lens of gender health and health costs for poor consumers. We used data from current publications to support this thesis. We found that growth has been characterized by multiple handicaps and oligopoly, with the nature of expansion not having relevance for the disease profiles in India. The scenario of gender health and health costs of the poor is grim due to state retrenchment and neglect of the provision of public good, such as in health matters. One can conclude that equity has not occurred under a growing pharmaceutical sector. This finding has huge implications for public policy in India and other emerging nations.
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TL;DR: In this paper, the authors argue that land redistribution and customized Intellectual Property rights (IPR) for communities as a whole may be the way forward provided there is political will, and they argue that the health situation of tribal people is becoming dire.
Abstract: With globalization, developing countries have been adopting the model of knowledge economy with its flagship features standardized patents and Corporate Social Responsibility (CSR). This model is supposed to deliver growth and equity through standardized patents and through market corrections of asymmetrical power between the corporations and general public via CSR. However, under this model, distributional equity has been declining. Instead of knowledge increasing and creating more equity, the traditional healthknowledge of tribal people (mostly poor) in India is being denuded along with innovation. This has been due to bio-piracy by multinational corporations. In addition, insensitive state policies that focus on growth policies at the expense of equity have exacerbated the situation. Under such circumstances, the health situation of tribal people is becoming dire. The authors argue that land redistribution and customized Intellectual Property rights (IPR) for communities as a whole may be the way forward provided there is political will.
9 citations
Cites background from "Pharmaceutical growth versus health..."
...But, the knowledge economy fails to take into account the initial inequity that arises due to lack of access to knowledge-bases due to lack of ownership or tenure of forestlands because of repressive government policies (Mukhopadhyay & Paul, 2018)....
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Journal Article•
01 Jan 2011-Centre for Health Research; Faculty of Health; Institute of Health and Biomedical Innovation
TL;DR: In this article, the authors assess the ways in which a TBA training program in India has been successful in disseminating evidence-based knowledge on birthing practices, and suggest an integration of local and evidencebased knowledge is needed to improve the training.
Abstract: Training birth attendants (TBAs) provide essential maternal and infant health care services during delivery and ongoing community care in developing countries. Despite inadequate evidence of relevance and effectiveness of TBA training programmes, there has been a policy shift since the 1990s in that many donor agencies funding TBA training programmes redirected funds to providing skilled attendants during delivery. This study aimed to assess the ways in which a TBA training programme in India has been successful in disseminating evidence-based knowledge on birthing practices. TBAs practicing within 16 villages targeted by training programme initiatives were administered with structured questionnaires. The post training birthing practices of trained (24) and untrained (14) TBAs was compared and birthing practices adopted by women assisted by trained (16) and untrained (9) TBAs was analysed. Positive post training practices were hand washing, use of a clean blade for cutting the cord, immediate breastfeeding and weighing of babies. Nevertheless, the training could be further improved with up to date and evidence-based information and more comprehensive instructions. The findings suggest an integration of local and evidence-based knowledge is needed to improve the training. Raising community awareness of public health measures related to maternal and child health is also recommended.
5 citations
01 Jan 2018
TL;DR: In this paper, the authors examined socio-demographic factors associated with partial vaccination and non-vaccination among Indian children during 1998 and 2008, and the reasons for nonvaccination were analyzed qualitatively.
Abstract: Background Despite almost three decades of the Universal Immunization Program in India, a little more than half the children aged 12–23 months receive the full schedule of routine vaccinations. We examined socio-demographic factors associated with partial-vaccination and non-vaccination and the reasons for non-vaccination among Indian children during 1998 and 2008. Methods Data from three consecutive, nationally-representative, District Level Household and Facility Surveys (1998–99, 2002–04 and 2007–08) were pooled. Multinomial logistic regression was used to identify individual and household level socio-demographic variables associated with the child’s vaccination status. The mother’s reported reasons for non-vaccination were analyzed qualitatively, adapting from a previously published framework. Results The pooled dataset contained information on 178,473 children 12–23 months of age; 53%, 32% and 15% were fully vaccinated, partially vaccinated and unvaccinated respectively. Compared with the 1998–1999 survey, children in the 2007–2008 survey were less likely to be unvaccinated (Adjusted Prevalence Odds Ratio (aPOR): 0.92, 95%CI = 0.86–0.98) but more likely to be partially vaccinated (aPOR: 1.58, 95%CI = 1.52–1.65). Vaccination status was inversely associated with female gender, Muslim religion, lower caste, urban residence and maternal characteristics such as lower educational attainment, non-institutional delivery, fewer antenatal care visits and non-receipt of maternal tetanus vaccination. The mother’s reported reasons for non-vaccination indicated gaps in awareness, acceptance and affordability (financial and non-financial costs) related to routine vaccinations. Conclusions Persisting socio-demographic disparities related to partial-vaccination and non-vaccination were associated with important childhood, maternal and household characteristics. Further research investigating the causal pathways through which maternal and social characteristics influence decision-making for childhood vaccinations is needed to improve uptake of routine vaccination in India. Also, efforts to increase uptake should address parental fears related to vaccination to improve trust in government health services as part of ongoing social mobilization and communication strategies.
5 citations
TL;DR: In this paper, the authors evaluate the ways in which emerging countries have made use of the flexibilities available under the TRIPS Agreement to espouse their social and economic concerns, and determine whether coordination, learning or emulation has taken place between these countries.
Abstract: As their economic clout increases, emerging powers are becoming policy-shapers in their own right. This chapter evaluates the ways in which emerging countries have made use of the flexibilities available under the TRIPS Agreement to espouse their social and economic concerns. We consider one of the most significant and controversial of these flexibilities: compulsory licensing as a tool for providing access to essential medicines. Our analysis focuses on India and Brazil as the two most vocal actors on the international scene opposing strong intellectual property (IP) protection. It compares Brazil and India’s patterns of domestic implementation so as to gain a more granular understanding of the law and practice of compulsory licensing in these countries. A further aim of the chapter is to determine whether coordination, learning or emulation has taken place between these countries. If it has, does it explain the diffusion of compulsory licensing practices and, if not, what has led to the particular implementation design chosen? The results are somewhat puzzling, but all the more interesting as they reveal that India and Brazil, despite their shared IP strategies at the international level, have chosen different TRIPS implementation paths domestically. We find no evidence of coordination but of processes of learning and emulation taking place.
4 citations
Posted Content•
TL;DR: The authors argue that conflict of laws and international law share a general goal of contributing to global order in a world of territorially defined states with diverse laws, and identify areas of doctrinal overlap between the two fields.
Abstract: In the United States, there is a tendency for international law scholars to view conflict of laws as outside their discipline, and for conflict-of-laws scholars to view their discipline as separate from international law. This was not always the case: Joseph Story, in his classic 1834 commentaries on conflict of laws, conceived of the field as “private international law.” This essay calls for a new dialogue between conflict of laws and international law. It argues that conflict of laws and international law share a general goal of contributing to global order in a world of territorially defined states with diverse laws; it identifies areas of doctrinal overlap between the fields, using illustrations from the Restatement of Foreign Relations Law and the Restatement of Conflict of Laws; it shows both how conflict of laws might help international law address challenges such as fragmentation, and how international law provides foundations for conflict of laws; and it identifies new trends in interdisciplinary international law/international relations scholarship that extend beyond public international law to include conflict of laws.
4 citations
References
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Book•
01 Jan 2006
2,331 citations
"Pharmaceutical growth versus health..." refers background in this paper
...The Hausmann et al. (2011) adolescent fertility rate (births per 100,000 women aged 15–19) was 45 in 2011 (Langer et al. 2015)....
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TL;DR: This paper focused on Foucault's analysis of two forms of neo-liberalism in his lecture of 1979 at the College de France: German post-War liberalism and the liberalism of the Chicago School.
Abstract: This paper focuses on Foucault's analysis of two forms of neo-liberalism in his lecture of 1979 at the College de France: German post-War liberalism and the liberalism of the Chicago School. Since the course is available only on audio-tapes at the Foucault archive in Paris, the larger part of the text presents a comprehensive reconstruction of the main line of argumentation, citing previously unpublished source material. The final section offers a short discussion of the methodological and theoretical principles underlying the concept of governmentality and the critical political angle it provides for an analysis of contemporary neo-liberalism.
1,862 citations
"Pharmaceutical growth versus health..." refers background in this paper
...State legitimacy would then subsist as a form of sovereignty limited to guaranteeing economic activity (Lemke 2001; Schiavo 2015)....
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TL;DR: This work identifies key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India and suggests principles that will help to ensure a more equitable health care for India's population.
Abstract: In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population.
798 citations
"Pharmaceutical growth versus health..." refers background in this paper
...In 2004, public health expenditure as part of GDP was 0.9%, per capita health expenditure was US$ 31, and OOPE as a percentage of private health expenditure was 93.8% (Jain 2010)....
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...According to Balarajan et al. (2011), India accounts for one-fifth of maternal deaths and one-quarter of child deaths in the world....
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...This is despite the fact that communicable diseases, maternal and perinatal conditions, and nutritional deficiencies contribute to 36% of deaths and 42% of disability-adjusted life years in India (Balarajan et al. 2011; Wirtz et al. 2017)....
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...In 2008–09, India’s total expenditure on health was 4.1% of gross domestic product (GDP), with overall public expenditure accounting for 1.10% of GDP (Balarajan et al. 2011; Ginsburg et al. 2017)....
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...Moreover, according to Balarajan et al. (2011), whereas the cost of medicines on the essential drug list rose by 15%, the cost for non-pricecontrolled drugs or those not on the essential drug list rose by 137% between 1996 and 2006....
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Book•
15 May 2003TL;DR: In this paper, the domestic origins of a trade-based approach to intellectual property are discussed, including the Intellectual Property Committee and transnational mobilization, and the life after TRIPS: aggression and opposition.
Abstract: 1. Introduction 2. Structures, agents, and institutions 3. US intellectual property rights in historical perspective 4. The domestic origins of a trade-based approach to intellectual property 5. The Intellectual Property Committee and transnational mobilization 6. Life after TRIPS: aggression and opposition 7. Conclusion: structured agency revisited.
637 citations
"Pharmaceutical growth versus health..." refers background in this paper
...…laws based on the moral wellsprings of the multistakeholder social arena, but as demonstrated in the history of the TRIPS regime (Löfgren 2018; Sell 2003), particularly in the context of hegemonic, yet non-altruistic decision-making by the US (Helfer and Austin 2011), states have typically…...
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...As a result, there has been a continuous battle to integrate human rights and development into the TRIPS agreement (Chorev and Shadlen 2015; Gleeson et al. 2015; Sell 2003, 2007; Sell and Prakash 2004; The Corner House 2004)....
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...The result was the establishment of TRIPS in the World Trade Organization (WHO) which signified the emergence of ‘private power leading to public law’ (Johns and Wellhausen 2016; Sell 2003)....
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...As Sell (2003) argues, advanced states in cahoots with their corporations instituted a regime of patents due to heavy protectionist lobbying of their corporate sector, wanting to ensure that any competition undermining their advantage was blocked (Cohen 2008; Cutler and Dietz 2017; Whytock 2016)....
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TL;DR: In this article, the authors present a multilevel review of the literature on CSR in developing countries and highlight the key differentiators and nuanced CSR-related considerations that qualify it as a distinctive field of study.
Abstract: Given the rising interest in corporate social responsibility (CSR) globally, its local expressions are as varied as they are increasingly visible in both developed and developing countries. This paper presents a multilevel review of the literature on CSR in developing countries and highlights the key differentiators and nuanced CSR-related considerations that qualify it as a distinctive field of study. This review entails a content analysis of 452 articles spanning two-and-a-half decades (1990–2015). Based on this comprehensive review, the authors identify the key differentiating attributes of the literature on CSR in developing countries in relation to depictions of how CSR is conceived or ‘CSR Thinking’ and depictions of how CSR is practiced and implemented or ‘CSR Doing’. The authors synthesize from there five key themes that capture the main aspects of variation in this literature, namely: (1) complex institutional antecedents within the national business system (NBS); (2) complex macro-level antecedents outside the NBS; (3) the salience of multiple actors involved in formal and informal governance; (4) hybridized and other nuanced forms of CSR expressions; and (5) varied scope of developmental and detrimental CSR consequences. The paper concludes by accentuating how the nuanced forms of CSR in the developing world are invariably contextualized and locally shaped by multi-level factors and actors embedded within wider formal and informal governance systems.
503 citations