Fighting the Diseases of Poverty

New Book: Fighting the Diseases of Poverty
Edited by Philip Stevens

Order a copy from Transaction publishers

Full text PDF (1,613 kb)

Introduction (pdf: 73 kb)
Philip Stevens

Chapter 1: Wealth, health and the cycle of progress (pdf: 216 kb)
Indur Goklany
Human beings are currently healthier and living longer than any other point in history. This is due to the "mutually reinforcing, co-evolving forces of economic growth, technological change and free trade."

Chapter 2: South Africa's healthcare under threat (pdf: 107 kb)
Johan Biermann
South Africa is part of a global trend to centralise and increase the role of government in healthcare provision. Recent reforms in the country have failed to take into account the many shortcomings of 'socialised' systems like Britain's NHS, and will emasculate the world-class private sector while failing to improve provision for the poor.

Chapter 3: Corruption in public health (pdf: 373 kb)
Maureen Lewis

(This chapter was originally published by the Center for Global Development (CGD), a Washington, D.C.-based think tank, as Governance and Corruption in Public Health Care Systems, Working Paper number 78. To access this and other CGD research, visit www.cgdev.org)

Donors and recipient governments have historically responded to healthcare funding needs without properly considering effectiveness and outcomes. As a result, corruption in health bureaucracies in less developed countries has largely gone addressed, severely blunting the effectiveness of donor funding. Health-related MDGs will be very difficult to meet unless the institutional factors that incentivise corruption are addressed.

Chapter 4: Diseases of Poverty and the 10/90 gap (pdf: 85 kb)
Philip Stevens
Activists claim that global pharmaceutical R&D is more concerned with developing lifestyle drugs for western markets than it is for developing drugs for the diseases of poverty. They therefore claim that market driven R&D is contributing to a health crisis in less developed countries. An analysis of WHO/UN data shows this presumption to be highly misleading, in large part because the disease burden of less developed countries increasingly resembles that of their wealthier peers. The real problem in these countries is distributing basic, cheap off-patent medicines to those in need.

Chapter 5: Increasing access to medicines (pdf: 144 kb)
Prof Khalil Ahmed, Franklin Cudjoe, Eustace Davie, Dr John Kilama, Prof Marín Krause, Andrés Mejia, Barun Mitra, Nonoy Oplas, Martín Simonetta, Philip Stevens, Jose Luis Tapia, Margaret Tse, Jasson Urbach
Access to medicines in less developed countries is hindered by a series of self-generated policy failures including: weak healthcare infrastructure, regulatory environments that are hostile to health insurance markets and other risk-pooling mechanisms, taxes, tariffs and price controls on medicines. Intellectual property is rarely a barrier to access to medicines. Rather, it a vital incentive for the development of new drugs for the diseases of poverty.

Chapter 6: Cost effective means of fighting the diseases of poverty (pdf: 83 kb)
Prof Khalil Ahmed, Franklin Cudjoe, Eustace Davie, Dr John Kilama, Prof Marín Krause, Andrés Mejia, Barun Mitra, Nonoy Oplas, Martín Simonetta, Philip Stevens, Jose Luis Tapia, Margaret Tse, Jasson Urbach
Many UN sponsored global disease programmes, including those for malaria and HIV/AIDS, have been expensive failures. This is frequently because planners in Geneva often have little idea of the reality faced by people on the ground, and are sometimes pressured into making questionable strategic decisions by outside political and NGO pressure. With HIV/AIDS, expensive and difficult treatment programmes have been prioritised over prevention, despite the lack of workable health infrastructure. With malaria, political pressures lead to the neglect of DDT for vector control, despite its demonstrable success in reducing prevalence. As a result, expensive and grandiose UN programmes have failed. Meanwhile, political activism is hindering the uptake of genetically-modified crops which could address many of the health problems associated with malnutrition.

Chapter 7: Counterfeit medicines in Less Developed Countries: problems and solutions (pdf: 76 kb)
Julian Morris & Philip Stevens
Counterfeit medicines are an increasing health problem in less developed countries, where the majority of the global supply is manufactured. These manufacturers thrive in countries in which there is a weak rule of law, the legal system is corrupt, and trade marks and other forms of intellectual property are not respected or enforced. Reform of these areas is imperative.

Chapter 8: The value of vaccination (pdf: 99 kb)
David Bloom, David Canning and Mark Weston
Vaccination programmes have led to the virtual eradication of preventable childhood diseases in wealthy countries. However, 3 million people die from vaccine-preventable diseases every year in less developed countries. Donors have not given sufficient resources to these programmes because they have looked at the narrow benefits of averted medical costs, instead of looking at the broader economic benefits of a healthier and therefore more productive population. As a result, donor support for vaccination has stalled since the 1970s and 1980s as other health problems have become more politically pressing.

Chapter 9: The World Health Organisation: a time for reconstitution (pdf: 101 kb)
Richard Wagner
An examination of the WHO's budget for 2006-7 reveals less than half is allocated to communicable diseases, and the majority is spent on issues that are of little concern to the poor such as road safety and obesity. These 'politically correct' activities are seemingly intended to satisfy the political demands of the WHO's funders - predominantly wealthy countries - and to ensure a steady flow of funds to sustain its own bureaucracy. Meanwhile, far too much of its budget is spent on public relations and bureaucratic self-promotion.

Notes (pdf: 57 kb)

Sources (pdf: 95 kb)