Presentation on theme: "Health justice – worldwide! Perspective from South"— Presentation transcript:
1Health justice – worldwide! Perspective from South Dr. Narendra GuptaNational Jt. Convener People’s Health Movement IndiaCoordinator, Prayas Centre for Health Equity Rajasthan IndiaBerlin, Germany17-18 SEPTEMBER 2010
2Gandhiji'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."
3The 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…”
4Global 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.
5A 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.
6Public 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.
12TB 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 Income875648Lower Middle Income119.722Upper Middle Income650.68.4High Income4-1GLOBAL301721
13TB 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 Region17410451America Region120.53.4South-East Asia Region132.128European Region11-6.5Eastern Mediterranean Region57.519Western Pacific Region0.315GLOBAL301721
14Percentage annual rate decline of under 5 mortality
16Global 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.
18T.B., Malaria & HIV/AIDS2.1 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.MalariaReduction in malaria prevalence in 15 LDCs but deterioration in 13 among 30 LDCs with trend data.
19Access to Water & Housing Only 58 % of the population in LDCs has access to improved water.SlumsNearly 140 million people in LDCs live in poor housing conditions.
20Income 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.
21Some more facts…..One billion people lack clean drinking water and 3 billion lack sanitation13,000-15,000 deaths per day worldwide from water-related diseasesHunger kills as many individuals in two days as died during the atomic bombing of Hiroshima
23Access 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.
24In IndiaBetween , 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.
25WHO 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
26Chittorgarh Tender Rate* (Rs.) MRP Printed on pack / strip (Rs.) Procurement through OPEN TENDER by GENERIC NAME reveals the actual costs…Generic Name of DrugChittorgarh Tender Rate* (Rs.)UnitMRP Printed on pack / strip (Rs.)Albendazole Tab IP 400 mg11.0010 tablets250.00Alprazolam Tab IP 0.5 mg1.4014.00Arteether 2 ml Inj9.391 Injection99.00Amlodipine Tab 5 mg2.5022.00Cetrizine 10 mg1.2035.00Ceftazidime mg52.00370.00Atorvastatin Tab 20 mg18.10170.00Diclofenac Tab IP 50mg2.2025.00Diazepam Tab IP 5 mg1.9029.40Amikacin 500 mg6.9570.00Large gap between manufacturing price & MRP !!!!!!Huge profits - at the cost of the poor.
31THE PROBLEM : SAME MEDICINE : DIFFERENT PRICES 40.50/-15100 mgNIMESULIDENISE25/-10NICIP29/-NIMULID20/-NIMLINPrinted Max. RetailNo. of TabletsPotencySalt 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
32Antibiotic Injection 8.13/- 60/- 7.80/- 72/- 8.50/- 7.42/- Drug manufacturing companyName given by company (Brand Name)Salt name of medicine(Generic Name)Rate at which drug is purchased by the chemist (Stockiest price)ONE INJECTIONRate at which drug is sold to the customer (Printed MRP)CadilaAmistar 500Amikacin 500 mg8.00/-70/-German RemediesAmee 500WockhardtZekacin 5009.90/-AlembicAmikanex 5008.22/-64.25/-IntasKami 5008.13/-60/-UnichemUnimika 5007.80/-72/-RanbaxyAlfakim 5008.50/-CiplaAmicip 5007.42/-
34The price of generic medicine is : Rs. 6.75 Cipla’s 10 mg CetrizineCipla’s Cetrizine 10 mgBrand Alerid MRP 37.50Cipla’s Cetrizine 10 mgBrand Okacet MRP 27.50Cipla’s Cetrizine 10 mgBrand Cetcip MRP 33.65The price of generic medicine is : Rs. 6.75
35IF SOMEBODY IN YOUR FAMILY SUFFERS FROM BLOOD CANCER There Are Three Options With The Doctor
36BUT, DO THE PATIENTS HAVE ANY OPTION . . . ? ? ? GENERIC NAMEBRAND NAMENAME OF COMPANYNO. OF CAPSULESPRICE (Rs.)M.R.P.IMATINIBCap. GLIVECNOVARTIS1201,14,400/-Cap. VEENATNATCO10,800/-Cap.CIPLA10,200/-Cipla supplies the generic version at just Rs. 6,500/- to Railway HospitalsBUT, DO THE PATIENTS HAVE ANY OPTION ? ? ?
40Contemporary Issues in Health & Justice 90% of research dollars spent on diseases affecting 10% of the world’s populationResearch on special populations (cultural minorities, prisoners, developing world, etc.) non existent.Role of institutional and for-profit IRBsUse of placebo controls
41The cost of medicines is one of the largest factors contributing to this breach of human dignity.
42Women Status of women do 67% of the world’s work receive 10% of global incomeown 1% of all property
43Worldwide, every minute 380 women become pregnant (190 unplanned or unwanted)110 women experience pregnancy-related complications40 women have unsafe abortions1 woman dies from childbirth or unsafe abortionReason: Lack of access to reproductivehealth services
44Establish Health as basic right by By global equitable distribution of resources.Transfer of technologyStopping migration of skilled health personnel from south to northern countriesAbolition of international covenants and instrument which discriminate against southern countries.
48The Cuenca Declaration 2005 PHM GlobalGlobal ActionThe 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.”
49A 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
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