Global spending on prescription medicines will accelerate next year to exceed $1tn for the first time, fuelled by the launch of more innovative drugs and rising health expenditure in emerging markets led by China. The rise was projected by the IMS Institute for Healthcare Informatics. The rise is attributed in part to emerging markets, where rising demand for healthcare paid out of pocket by the growing middle class is being matched by an expansion in universal health coverage programmes to extend provision, with targeted public health policies such as rising vaccination rates. The jump comes at a time of growing use of cheaper off-patent generic medicines, predicted to grow from 27 per cent to 36 per cent of the global market by 2017 and as high as 63 per cent in the fast-growing emerging economies. The report projects that two-thirds of the total medicines market in 2017 will be accounted for by the eight markets of the US, France, Germany, the UK, Italy and Spain, as well as China and Japan, which will also be responsible for nearly 60 per cent of the total growth in spending.
Health equity in economic and trade policies
Global trade and international trade agreements have transformed the capacity of governments to monitor and to protect public health, to regulate occupational and environmental health conditions and food products, and to ensure affordable access to medications. Proposals under negotiation for the World Trade Organization's General Agreement on Trade in Services (GATS) and the regional Free Trade Area of the Americas (FTAA) agreement cover a wide range of health services. Public health professionals and organizations rarely participate in trade negotiations or in resolution of trade disputes. The linkages among global trade, international trade agreements, and public health deserve more attention than they have received to date. (abstract only)
The 2012/13 edition of the Global Wage Report looks at the macroeconomic effects of wages, and in particular at how current trends are linked to equitable growth. Among the major findings of the report are that the gap between wage growth and labour productivity growth is widening, the difference between the top and bottom earners is increasing, and the labour income share is declining. Workers are receiving a smaller slice of the economic pie than before. These worrying changes affect the key components of aggregate demand – particularly consumption, investment and net exports – that are necessary for recovery and growth. The report looks at the reasons for these trends, which range from the increasing financial and trade globalization to advances in technology and the decline in the power of trade unions and reduced union density. Raising average labour productivity remains a key challenge which must involve efforts to raise the level of education and the capabilities that are required for productive transformation and economic development. The development of well-designed social protection systems would allow workers and their families to reduce the amounts of precautionary savings, to invest in the education of their children, and to contribute towards stronger domestic consumption demand and raise living standards. The report calls for internal and external “rebalancing” to achieve more socially and economically sustainable outcomes within and across countries, proposing policy actions beyond labour markets and national borders.
This ILO report examines the evolution of real wages globally and by region, as well as the relationship between minimum wages and inequality, and the wage impacts of COVID-19 . It identifies the conditions under which minimum wages can reduce inequality and how adequate minimum wages, statutory or negotiated, can play a key role in a human-centred recovery from the pandemic.
This paper describes research strategies to address the relation between globalisation and social determinants of health through an equity lens, and invites dialogue and debate about preliminary findings. The first part of the paper identifies and defends a definition of globalisation and describes key strategic and methodological issues. The second part describes a number of key ‘clusters’ of pathways leading from globalisation to equity-relevant changes in SDH. The third part provides a generic inventory of potential interventions, based in part on an ongoing program of research on how policies pursued by the G7/G8 countries affect population health outside their borders.
Alternative reports on global health, presented at the second People's Health Assembly in Ecuador this week, question the free-market, neoliberal economic model and view it as the cause of many of the health problems facing humanity today. These include the indiscriminate use of toxic products in agriculture, pollution caused by the oil industry, the consumption of transgenic crops, the destruction of the urban environment by pollution, and the commercialisation of health services. The reports by the Global Health Watch and the Observatorio Latinoamericano de Salud see a healthy life as a fundamental human right, the enjoyment of which depends on economic, political and social factors.
This paper argues that the dollar-a-day poverty is pervasive and persistent in most Least Developed Countries because they are caught in an international poverty trap. It highlights the fact that poverty is perpetuated by vicious domestic circles through which the high incidence and severity of poverty constrain national economic growth, and that the current form of globalisation is tightening rather than loosening the international poverty trap. In response to this, the author states that policies underlying international development cooperation, focusing on Poverty Reduction Strategy Papers (PRSPs) have not changed sufficiently to enable countries to escape the trap and realise the opportunity for fast poverty reduction through economic growth.
In Zambia, a woman named Chileshe is dying of AIDS. She was infected by her now dead husband, who once worked in a textile plant along with thousands of others but lost his job when Zambia opened its borders to cheap, second-hand clothing. Resorting to work as a street vendor, he would get drunk and trade money for sex - often with women whose own husbands were somewhere else working, or dead, and who desperately needed money for their children. Desperation, she thought, is what makes this disease move so swiftly; she recalls that a woman from the former Zaire passing through her village once said that the true meaning of SIDA, the French acronym for AIDS, was "Salaire Insuffisant Depuis des Années" (Schoepf, 1998).
Chileshe's is one of four stories we used in a report that has just been published by Canada's Centre for Social Justice (Labonte, Schrecker & Sen Gupta, 2005b) to dramatize the health impacts of transnational economic integration ('globalization'). It is a composite, like the stories used in the World Bank's 1995 'World Development Report'. The Centre for Social Justice report, which grew out of a contribution to the first 'Global Health Watch Report' (forthcoming in July at http://www.ghwatch.org), directly challenges the elite religion of neoliberal, market-oriented economic policy, as promoted by agencies like the World Bank and the International Monetary Fund. Drawing on an extensive research base, we describe the causal pathways that link globalization to unequal and deteriorating health outcomes by way of increasing inequalities in access to the social determinants of health, and policies that tilt the economic playing field even more steeply toward the rich countries.
Globalisation is a key context for the study of social determinants of health (SDH). Broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives. This first article of a three-part series, describes the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. This paper explains the rationale for defining globalisation with reference to the emergence of a global marketplace, and the economic and political choices that have facilitated that emergence. It identifies a number of conceptual milestones in studying the relation between globalisation and SDH over the period 1987–2005, and shows that because globalisation comprises multiple, interacting policy dynamics, reliance on evidence from multiple disciplines (transdisciplinarity) and research methodologies is required. So, too, is explicit recognition of the uncertainties associated with linking globalisation – the quintessential "upstream" variable – with changes in SDH and in health outcomes.
This article is the third in a three-part review of research on globalisation and the social determinants of health (SDH). The third article of the series discusses how interventions to reduce health inequities by way of SDH are inextricably linked with social protection, economic management and development strategy.