Campaign for Fighting Diseases Blog

How the Hong Kong text affects health

Here's a quick look at how the latest WTO draft agreement affects health.

Services. While the agreement doesn't seem to roll back liberalisation in services, neither does it do much to push it forward - particularly with regards to LDCs. 

I've already written about the huge benefits that LDCs could gain if they were to open up to genuine competition in services, so it's a shame the text is not more explicit. Moreover, the lack of positive movement on this issue is a depressing testament to the effectiveness of the ideological scaremongering undertaken by the NGOs.

Tariffs on drugs. I didn't see anything on this in the draft text. Admittedly, I only got to look at it for a few minutes before Julian swiped it (he's commenting live on CNN right about now)!

TRIPS and public health. This was done and dusted before the negotiators got together in Hong Kong this week, and is now effectively a dead issue.  This closure renders many of the activist campaigns that were set up to campaign against TRIPS null and void.

Is that why members of MSF's Access to Medicines campaign have been running around Hong Kong all week trying desperately, but unsuccessfully, to resurrect the issue? Hopefully we will be hearing a lot less from them in future.

I'll post more when I've given the text a closer inspection.

Bring on the GATS!

While much of the bluster in Hong Kong has been over agriculture, it seems that the General Agreement on Trade in Services (GATS) is rapidly becoming another controversial sticking point.

Left-wing activists and trade unions are pushing the line that the GATS will require wholesale privatisations of public services and utilities, bringing with it extortionate user charges and social chaos. This spin is being eagerly lapped up by certain developing countries.

This is misleading.  GATS retains flexibilities which allows signatories to opt in and opt out of what they choose.

But the real shame is that poorer countries stand to gain a great deal from the GATS.  Competition and private provision of utilities such as water would be a good thing . The majority of public utility monopolies in poorer countries provide a woeful service. Access to water is often determined by bribes or favour-calling from friends in the bureaucracy.

Where water has been privatised - such as in Chile and Guinea - both supply, quality and access rates have increased dramatically.

More broadly, it is worth pointing out that no country has ever got rich from agriculture alone. Services are where the money is.

Lower-income countries should be doing everything in their power to encourage the development of service sectors in order to provide both jobs and prosperity. The GATS is a useful tool for moving in this direction.

Free trade myths and realities # 2

Myth: The Agreement on Trade in Services (GATS) violates fundamental human rights to services such as water and healthcare.

Reality: GATS would not lead to the privatization of services, even though this would almost certainly be a good thing. Governments rarely supply services in a reliable, cost-effective manner. In poor countries, the often fail altogether to supply essential services, such as delivery of clean water. Private providers would at least supply these services.

If the service is privatized in a transparent and efficient manner, or if the government simply ceases to oppress private providers, it is likely that the poor will be far better off. Insurance systems in poor countries exist only for the very wealthy, and governments’ own barriers to healthcare provision present far more problems for access to healthcare than does competition by foreign businesses. Public health agencies in poor countries often suffer from corruption, bureaucracy, and lack of accountability to poor people who most need those services.

Free trade myths and realities # 1

Myth: Trade and globalization is causing the rampant spread of infectious diseases

Reality: Trade and globalization have significantly reduced rates of infant mortality and increased life
expectancy. Increased commerce and cheaper, faster transport means that there are more people are on the move now than ever before, which in principle could lead to increased spread of diseases such as SARS. However, increased commerce has also led to increased wealth and to improved technologies. As a result, the burden of disease has declined in both rich and poor countries. For much of human history, life expectancy was between 20 and 30 years. By 1998 it had increased to 66.9 years worldwide.

NEW PAPER: Free trade for better health

Things seem to be going fairly flatly over here in Hong Kong on the first day of the WTO meeting.  So far, most ministers have simply said that they are not especially hopeful that they will agree anything.

They should keep trying! Increased trade liberalisation could bring huge benefits for the poor of the world, especially with regard to their health.

This new CFD paper shows that the last 50 years of trade liberalisation has had a significant impact on global health, driving up life expectancies and reducing the burden of age-old diseases. 

This is because free trade is clearly linked with rising prosperity, which allows people to buy improvements in sanitation, nutrition and living conditions.

Secondly, free trade has helped spread health-related technologies all over the world from the countries in which they were first discovered.  In the years following the Second World War, the global spread of drugs such as penicillin – a medicine discovered and developed in Britain – had a massive impact on mortality in many poor countries. Similarly, the spread of other technologies developed in rich countries, such as DDT, have significantly reduced the incidence of malaria worldwide.

Click here to read the paper in full.

Freedom to trade in Hong Kong

I'm shortly off to Hong Kong to get ready for next weeks Ministerial Trade meeting.

International Policy Network will be keeping you up to date with events at our trade blog, www.freedomtotrade.org/blog.

Hopefully the forces of protectionism and vested-interest will not prevail in Hong Kong, although things are looking shakey at the moment.  But keep an eye on the Freedom to Trade Blog to understand what's really going on.

Democratically Deficient Dinosaurs

Here at the Campaign for Fighting Diseases, we've long been concerned about the way in which unaccountable, unelected international NGOs have been colonising the World Health Organization (itself unaccountable and undemocratic) and influencing policy.

I was at a recent consultation in Stockholm about the strategic direction of the WHO, and was rather taken  aback by the agenda they are proposing for the next decade.  In a nutshell, it read like an Oxfam policy document. And as we know, Oxfam and their ilk cling to a set of outmoded beliefs formed in the Senior Common Rooms of the radical 1960s. 

Anyway, to try and redress this, I thought it would be worth bringing the issue to the attention of the wider public.  You can read the results here.

The real causes of ill health in Africa.

We were lucky enough to have the Ugandan John Kilama from the Global Biosciences Development Institute over for lunch today.

John argued that most of the debate about health in Africa, which focuses on such things as the cost of medicines and intellectual property, is totally wide of the mark.

In fact, the African healthcare crisis is completely homegrown.  John pointed out the egregious taxes and tariffs most African governments impose onto imported medicines, as well as the daedalean complexity of getting a new drug registered before it can be sold.

More fundamentally, a mixture of political and economic oppression, as well as general governmental incompetence, keeps most Africans poor and unable to afford the kind of living conditions that most of us enjoy in the west. This is the reason why diseases such as diarrhoea and  chest infections  kill so many.

It's great to hear Africans making these points.  John is going to be appearing on the BBC while he's visiting London, so do keep an eye out of for him.

Rockstar doctors

Tomorrow, Bono (with Alicia Keys) will release a re-recording of the 1986 hit "Don't Give Up" on iTunes in order to help raise funds for a charity providing free AIDS medicines to Africans.

Given the dilapidated health-care infrastructure in many parts of Africa, it makes some sense for charities to deliver and administer treatment for illness and diseases in resource-poor settings.  Indeed, the Rotary Club has been successful in all but eliminating Polio by spearheading and managing vaccination programmes where public health ministries have failed.

But the African healthcare crisis is about more than delivering AIDS medicines. It has far deeper roots.

Without the economic conditions to create wealth in the first place, millions of people living in absolute poverty will die needlessly, and not just of headline grabbing diseases like AIDS, but from diarrhoea and respiratory infections.  These two claim the lives of 15,000 Africans a day - far more than HIV/AIDS.

Admittedly, singing about aids drugs is slightly sexier than clean water and good nutrition and all of the other (seemingly unnoticed) things that came to more prosperous countries long ago.  But these things are still far away from the vast majority of those who live in absolute poverty.

If Bono, and others like Annie Lennox, actually wanted to make a serious contribution to the lives of these millions, they could start by pointing out the real reasons why Africa is poor: the repressive regimes that restrict economic freedoms.  Without them, people will be hard pushed to afford clean water and hygienic living conditions - which are absolutely fundamental to good health. 

Until we get the basics right, there's no chance of ever being spared Bono's philanthropic warbling - or even that of his great grandchildren.

AIDS: a disease of oppression

I was on the BBC World Service last night, making the case that HIV/AIDS can be characterised as a "disease of oppression".

Firstly, political oppression makes it difficult to get the prevention message out, which is absolutely fundamental to stopping the spread of the disease.

Look at what happened in Thailand in 2003, for example: the government decided to crack down on drug users, imprisoning thousands and killing others. Since then, infection rates have soared among drug users.

Economic oppression stops people from creating the kind of prosperity that has left the west largely insulated from the disease. Many governments of poor countries restrict the ability of people to trade freely or set up businesses, resulting in poverty and unemployment. In these situations, drug abuse and prostitution are rife.

Furthermore, counterproductive government policies - such as restrictive planning laws and a lack of land title - are directly responsible for slums, which are highly conducive to the spread of HIV/AIDS.

These are all things that could be countered with government policies that empower people to engage freely in economic activity, rather than preventing them from doing so - which is far too often the case.

I expand on these points in an article I recently had published in, among other places, China's Standard.

WHO's striking!

The last few days seem to have been a bit of a WHO-bashing fest on this blog, and to those readers who are sympathetic to the agency, I apologise (well, reservedly).

However, the story that the WHO staffers have gone on strike over pay and conditions is too good to pass up without comment.

So I will leave that to this excellent article, taken from the National Review Online.

Taxed to death

Interesting article in the UK Guardian here about the Global Fund, which is threatening to pull the plug on grants to Nigeria over transparency issues.

Where the article falls down is on the cost of drugs issue.  The Guardian hack says that Nigerians can't afford ARV medicines because of the health user-fees imposed on the country by the World Bank and IMF programmes of the 1980s.

That's not really the point. The point is that all medicines imported in Nigeria are subject to eye-wateringly high taxes and tariffs - imposed by none other than the government of Nigeria!

A 2003 study by the European Commission showed that the Nigerian government inflates the cost of imported medicines by some 34 per cent with its various levies. This is a highly regressive form of taxation, because it hits the poor and sick hardest.

So before we start bleating about costs and asking the west for more aid, we should ask the governments of these countries to do something simple, easy and right. Make all medicines - both domestic and imported - free of any kind of tax.

You can read more about taxes and tariffs on medicines here.

Health fascism

It looks as if I was slightly inaccurate with the post below.  In fact, the BBC asked a representative of the WHO to appear on their programme to justify their decision to stop hiring smokers.

I can understand the WHO's sudden shyness as it is a slightly ridiculous position to defend.

At this rate, it won't be long before they stop hiring other people who in engage in risky behaviour.  Those who aspire to work at the WHO and are partial to a burger and a bit of booze should probably think about applying elsewhere.

And as for those who drive big, polluting cars...

Cluck cluck

I've been invited on to the BBC World Service's Newshour programme tonight (2000 GMT) to discuss World AIDS Day.

The producers also invited a representative from the World Health Organization to debate the issues with me. But they now seem to have pulled out on the basis that "they don't want to talk with" me.

Bearing in mind the huge amounts of money the WHO spends on PR and communications, you would have thought that they would be able to put up a pretty good spin doctor. But maybe a coherent defence of "3 by 5" is a task too far?