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Health justice – worldwide! Perspective from South

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1 Health justice – worldwide! Perspective from South
Dr. Narendra Gupta National Jt. Convener People’s Health Movement India Coordinator, Prayas Centre for Health Equity Rajasthan India Berlin, Germany 17-18 SEPTEMBER 2010

2 Gandhiji's Mantra "I will give you a talisman. Whenever you are in doubt, or when the self becomes too much with you, apply the following test. Recall the face of the poorest and the weakest man whom you may have seen, and ask yourself, if the step you contemplate is going to be of any use to him. Will he gain anything by it? Will it restore him to a control over his own life and destiny? …………..for the hungry and spiritually starving millions? Then you will find your doubts and your self melt away."

3 The role of the health care provider for justice
Rudolph Virchow: “Health care providers are natural attorneys for the poor … If medicine is to really accomplish its great task, it must intervene in political and social life…”

4 Global Health Crisis Growing inequalities across and within countries.
Health status of countries in south has not improved. Neo-liberal forces of market led globalisation cause for accelerating inequities in health.

5 A large proportion of the world’s population lacks access to food, education, safe drinking water, sanitation, shelter, land and its resources, employment and health care services.

6 Public services are not fulfilling people’s needs because they have deteriorated as a result of cuts in governments’ social budgets. Health services have become less accessible, more unevenly distributed and more inappropriate.

7 Current Global Health Spending

8 Basic Facts about South
96 Lower & middle income countries Mainly in Africa. Asia and the Pacific Region Some are in in Western Asia in the Caribbean Many are landlocked Few are small islands

9 Some more facts….. Total LDC Population – 750 million (2005)
Projected Population – 950 million (2015) Projected number of people living in extreme poverty – 470 million by 2015

10 Neonatal Mortality Rate (2008)
Health Indicators in different regions Life Expectancy Neonatal Mortality Rate (2008) IMR (2008) U-5 MR (2008) MMR (2005) African Region 51 53 40 85 142 900 America Region 71 76 9 15 18 99 South-East Asia Region 58 65 34 48 63 450 European Region 72 75 7 12 14 27 Eastern Mediterranean Region 61 35 57 78 420 Western Pacific Region 69 11 21 82 GLOBAL 64 68 26 45 400

11 Neonatal Mortality Rate (2008)
Mortality (Income group wise) Life Expectancy Neonatal Mortality Rate (2008) IMR (2008) U-5 MR (2008) MMR (2005) Low Income 54 57 37 76 118 650 Lower Middle Income 62 67 29 44 63 180 Upper Middle Income 68 71 11 19 23 91 High Income 80 04 06 07 09 GLOBAL 64 26 45 65 400

12 TB among HIV-negative people (2008)
Cause Specific Mortality Rate (Per population) (Income group wise) HIV/AIDS (2007) Malaria (2006) TB among HIV-negative people (2008) Low Income 87 56 48 Lower Middle Income 11 9.7 22 Upper Middle Income 65 0.6 8.4 High Income 4 - 1 GLOBAL 30 17 21

13 TB among HIV-negative people (2008)
Cause Specific Mortality Rate (Per population) (region wise) HIV/AIDS (2007) Malaria (2006) TB among HIV-negative people (2008) African Region 174 104 51 America Region 12 0.5 3.4 South-East Asia Region 13 2.1 28 European Region 11 - 6.5 Eastern Mediterranean Region 5 7.5 19 Western Pacific Region 0.3 15 GLOBAL 30 17 21

14 Percentage annual rate decline of under 5 mortality

15 Mortality rate in children U-5 years

16 Global Trends in Maternal Mortality
Maternal mortality in the LDCs remains the highest. 890 deaths per 100,000 live births in the world. Under five mortality rate is 160 deaths per 1,000 live births compared to 86 in the rest of the world.

17 Birth attended by skilled birth attendants

18 T.B., Malaria & HIV/AIDS 2.1 million new TB cases were reported in 2004 mainly as a result of HIV/AIDS. Rate of new HIV/AIDS cases (3.2%) in LDCs remains the highest in the world. Malaria Reduction in malaria prevalence in 15 LDCs but deterioration in 13 among 30 LDCs with trend data.

19 Access to Water & Housing
Only 58 % of the population in LDCs has access to improved water. Slums Nearly 140 million people in LDCs live in poor housing conditions.

20 Income categories Poverty
Almost 50% of the population in LDCs lives on less than $1 a day. Rates of undernourishment over 40% reported in 10 LDCs.

21 Some more facts….. One billion people lack clean drinking water and 3 billion lack sanitation 13,000-15,000 deaths per day worldwide from water-related diseases Hunger kills as many individuals in two days as died during the atomic bombing of Hiroshima

22 Population using improved sanitation facilities

23 Access to Essential medicines
55 % of world’s citizens lack essential health care because of very high costs of medicines. (WHO) Out of pocket healthcare expenditure is the second greatest cause of rural indebtedness in India today. Out of it 79% is on medicines.

24 In India Between , 32.5 million patients fell below the poverty line just after a single hospitalization. 40% of those hospitalized were forced to borrow money or sell assets to meet costs, and 23% of ill patients simply never seek treatment because of their inability to pay.

25 WHO estimates that 65% of India’s population lacks regular access to essential medicines. This is when INDIA IS THIRD LARGEST PRODUCER OF MEDICINES IN THE WORLD. DRUG PRICING AND PRESCRIPTION OF UNNECESSARY DRUGS MAIN CAUSE

26 Chittorgarh Tender Rate* (Rs.) MRP Printed on pack / strip (Rs.)
Procurement through OPEN TENDER by GENERIC NAME reveals the actual costs… Generic Name of Drug Chittorgarh Tender Rate* (Rs.) Unit MRP Printed on pack / strip (Rs.) Albendazole Tab IP 400 mg 11.00 10 tablets 250.00 Alprazolam Tab IP 0.5 mg 1.40 14.00 Arteether 2 ml Inj 9.39 1 Injection 99.00 Amlodipine Tab 5 mg 2.50 22.00 Cetrizine 10 mg 1.20 35.00 Ceftazidime mg 52.00 370.00 Atorvastatin Tab 20 mg 18.10 170.00 Diclofenac Tab IP 50mg 2.20 25.00 Diazepam Tab IP 5 mg 1.90 29.40 Amikacin 500 mg 6.95 70.00 Large gap between manufacturing price & MRP !!!!!! Huge profits - at the cost of the poor.

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28 Who is more important ? Drug manufacturers or our poor countrymen

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31 THE PROBLEM : SAME MEDICINE : DIFFERENT PRICES
40.50/- 15 100 mg NIMESULIDE NISE 25/- 10 NICIP 29/- NIMULID 20/- NIMLIN Printed Max. Retail No. of Tablets Potency Salt name of medicine (Generic Name) Name given by drug company (Brand Name) However, the stockist price of NICIP manufactured by Cipla is only Rs. 1.88/- 31

32 Antibiotic Injection 8.13/- 60/- 7.80/- 72/- 8.50/- 7.42/-
Drug manufacturing company Name given by company (Brand Name) Salt name of medicine (Generic Name) Rate at which drug is purchased by the chemist (Stockiest price) ONE INJECTION Rate at which drug is sold to the customer (Printed MRP) Cadila Amistar 500 Amikacin 500 mg 8.00/- 70/- German Remedies Amee 500 Wockhardt Zekacin 500 9.90/- Alembic Amikanex 500 8.22/- 64.25/- Intas Kami 500 8.13/- 60/- Unichem Unimika 500 7.80/- 72/- Ranbaxy Alfakim 500 8.50/- Cipla Amicip 500 7.42/-

33 Antibiotic Injection

34 The price of generic medicine is : Rs. 6.75
Cipla’s 10 mg Cetrizine Cipla’s Cetrizine 10 mg Brand Alerid MRP 37.50 Cipla’s Cetrizine 10 mg Brand Okacet MRP 27.50 Cipla’s Cetrizine 10 mg Brand Cetcip MRP 33.65 The price of generic medicine is : Rs. 6.75

35 IF SOMEBODY IN YOUR FAMILY SUFFERS FROM BLOOD CANCER
There Are Three Options With The Doctor

36 BUT, DO THE PATIENTS HAVE ANY OPTION . . . ? ? ?
GENERIC NAME BRAND NAME NAME OF COMPANY NO. OF CAPSULES PRICE (Rs.) M.R.P. IMATINIB Cap. GLIVEC NOVARTIS 120 1,14,400/- Cap. VEENAT NATCO 10,800/- Cap. CIPLA 10,200/- Cipla supplies the generic version at just Rs. 6,500/- to Railway Hospitals BUT, DO THE PATIENTS HAVE ANY OPTION ? ? ?

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38 Promotion of Hazardous, Banned and Bannable Drugs

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40 Contemporary Issues in Health & Justice
90% of research dollars spent on diseases affecting 10% of the world’s population Research on special populations (cultural minorities, prisoners, developing world, etc.) non existent. Role of institutional and for-profit IRBs Use of placebo controls

41 The cost of medicines is one of the largest factors contributing to this breach of human dignity.

42 Women Status of women do 67% of the world’s work
receive 10% of global income own 1% of all property

43 Worldwide, every minute
380 women become pregnant (190 unplanned or unwanted) 110 women experience pregnancy-related complications 40 women have unsafe abortions 1 woman dies from childbirth or unsafe abortion Reason: Lack of access to reproductive health services

44 Establish Health as basic right by
By global equitable distribution of resources. Transfer of technology Stopping migration of skilled health personnel from south to northern countries Abolition of international covenants and instrument which discriminate against southern countries.

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46 Asian Social Forum

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48 The Cuenca Declaration 2005
PHM Global Global Action The Cuenca Declaration 2005 “The human right to health and health care must take precedence over the profits of corporations, especially the profiteering of pharmaceutical companies.”

49 A global mobilisation only can ensure to bring about this Change
A global mobilisation only can ensure to bring about this Change. Join PEOPLE’s HEALTH MOVEMENT

50 For further information visit
More information about PHM, visit For further information visit

51 Thanks


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