This document discusses guidance on ethical procurement for health and for protecting labour rights in medical supply chains. It is an update to an earlier document in response to evidence of abuse of worker rights at several factories manufacturing health-care products destined for global markets. Poor labour conditions should concern all those in health care. Work is inextricably correlated to physical and mental well-being: unsafe working conditions risk bodily injury; inadequate remuneration links to malnutrition, poor housing and lack of opportunity. Long or irregular working hours and a lack of respect at work contribute to stress, anxiety and depression. Working conditions found in the manufacture of some health-care products have been among the worse encountered anywhere. The document reports on the measures taken by other countries and that comply with the International Labour Organisation Declaration on fundamental principles and rights at work, as well as with local employment and health and safety legislation. For example for high-risk products, suppliers are contractually required to allow independent audit of manufacturing sites to identify problems and to oblige remedial action, a measure that has led to demonstrable improvements in working conditions for the people making products for the health-care system. The paper also notes that there are still limited measures for protection of health and safety in the growing global market for health-care products, estimated to soon be worth over US$ 500 billion annually.
Health equity in economic and trade policies
Debt relief should be financed as it is more efficient than new aid, and because it reduces the burden of managing aid, argues this paper from the UN Economic Commission for Africa. The paper says that debt relief is an important source of finance for African countries but on its own will be woefully insufficient to allow African countries to finance the Millennium Development Goals (MDGs) and achieve long-term debt sustainability. The paper also examines the rationale for further debt relief and the ways in which debt relief can be financed.
The World Bank and the home countries of corporations implicated in corruption in the Lesotho Highlands Water Scheme have many reasons to be shame-faced for the lack of support that Lesotho has been shown in its tenacious efforts to tackle corruption. At the very least the epitaph on the corruption and bribery trials needs to read that the conduct of international finance institutions and corporations in Lesotho must not be allowed to be repeated elsewhere.
In this article, the author considers ways in which multinational companies avoid paying taxes in Africa, thereby undermining government commitments to education, housing and health, among others. The predominant way in which capital is hidden in trade and moved abroad is argued to be through the pricing of imports and exports. While a wide range of actors are argued to use this strategy, the author argues that multinational companies are more easily able to do so as they operate through subsidiaries scattered across the world, and have multiple subsidiaries, with trading between and among subsidiaries of multinational companies comprising as much as 60% of global trade. This gives significant scope for the use of transfer pricing.
The author of this book argues that natural resources in Africa are a blessing, but the way they are plundered and used has turned them into a curse. Rich in natural resources, Africa has for a long time been a net supplier of energy and raw materials to the North. The current global climate crisis is rooted mainly in the wealthy economies' abuse of fossil fuels, indigenous forests and global commercial agriculture. But, without agreement about how to tackle this reality, the question often simply becomes ‘What can be done about Africa?’ rather than ‘What can we do together?’ Bassey examines the oil industry in Africa, probes the roots of global warming, warns of its insidious impacts and explores false 'solutions'. He demonstrates that the issues around natural resource exploitation, corporate profiteering and climate change must be considered together if Africa and the rest of the world are to save ourselves.
Transnational tobacco manufacturing and tobacco leaf companies engage in numerous efforts to oppose global tobacco control. One of their strategies is to stress the economic importance of tobacco to the developing countries that grow it. This study analyses tobacco industry documents and ethnographic data to show how tobacco companies used this argument in the case of Malawi, producing and disseminating reports promoting claims of losses of jobs and foreign earnings that would result from the impending passage of the Framework Convention on Tobacco Control (FCTC). In addition, they influenced the government of Malawi to introduce resolutions or make amendments to tobacco-related resolutions in meetings of United Nations organisations, succeeding in temporarily displacing health as the focus in tobacco control policymaking. However, these efforts did not substantially weaken the FCTC.
Malawi is the world’s largest producer of burley tobacco and its population is affected by the negative consequences of both tobacco consumption and production. In producer countries, tobacco control involves control of the whole tobacco supply chain, rather than only control of consumption. The authors reviewed the impact of tobacco cultivation in Malawi to illustrate through this example the economic, environmental, health and social issues faced by low- and middle-income countries that still produce significant tobacco crops. The authors placed these issues in the context of the sustainable development goals (SDGs), particularly goal 3a, which calls on all governments to strengthen the implementation of the World Health Organisation Framework Convention on Tobacco Control. Other goals address the negative effects that tobacco cultivation has on development. The authors suggest that without external assistance, Malawi has relatively limited capacity to develop alternatives to tobacco production that are economically viable, but could benefit greatly from becoming a party to the FCTC to receive assistance through the incorporation of the FCTC into the SDGs.
The number of smokers in Africa is anticipated to rise from 15.8% in 2010 to 21.9% by 2030, the largest projected increase in the world. The authors examine the role of the main tobacco companies operating in Africa: Philip Morris International, British American Tobacco, Imperial Brands and Japan Tobacco International, in this rise, and in the illicit trade in tobacco to force market entry into new and emerging markets. The authors point to the tactics used, including: preventing policy measures designed to control illicit tobacco trade by entering into voluntary partnerships with law enforcement and custom agencies, with governments not effectively enforcing existing laws; and using promotional tactics, including price reductions, coupons and giveaways to increase the demand and usage of tobacco. Tobacco companies consistently claim on their websites, in the media and in policy circles that they aim to stop illicit tobacco trade and only market to adult smokers. However, the authors raise that these tactics are recruiting a new generation of smokers in Africa.
Expert evaluations of the safety, efficacy and cost-effectiveness of pharmaceutical and medical devices, prior to marketing approval or reimbursement listing, collectively represent a globally important public good. The scientific processes involved play a major role in protecting the public from product risks such as unintended or adverse events, sub-standard production and unnecessary burdens on individual and governmental healthcare budgets. Most States now have an increasing policy interest in this area, though institutional arrangements, particularly in the area of cost-effectiveness analysis of medical devices, are not uniformly advanced and are fragile in the face of opposing multinational industry pressure to recoup investment and maintain profit margins. This paper examines the possibility, in this context, of States commencing negotiations toward bilateral trade agreement provisions, and ultimately perhaps a multilateral Treaty, on safety, efficacy and cost-effectiveness analysis of pharmaceuticals and medical devices.
This report aims to inform the ongoing discussions and processes on developing a new business model for antibiotics. It is based on the premise that delinkage, seeking to separate the return on investment from antibiotic sales volume, should be the principle underpinning any new business model. It calls on governments to invest significantly in antibiotic R&D by financing a broad menu of incentives across the antibiotic life-cycle, with the highest incentives targeted at the development of antibiotics directed at the greatest health threats arising from antibiotic resistance. Contributions from countries should be coordinated within a globally agreed framework. Finally, global access should, together with conservation, be a priority for any new business model fostering innovation. The report makes several recommendations based on findings. The authors suggest that a new business model needs to be developed in which the return on investment in R&D on antibiotics is delinked from the volume of sales.There should be increased public financing of a broad menu of incentives across the antibiotic life-cycle is required, targeted at encouraging the development of antibiotics to counter the greatest microbial threats. The assessment of current and future global threats arising from resistance should be updated periodically in order to identify which classes of product are a priority for incentives. The delinkage model should prioritize both access and conservation. Domestic expenditures on the model need to be globally coordinated, including through the establishment of a secretariat, and global participation in the model is the ultimate goal.