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Health justice – worldwide! Perspective from South

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. The role of the health care provider for justice. Rudolph Virchow:

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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. 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…”

  3. 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.

  4. 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.

  5. 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.

  6. Current Global Health Spending

  7. 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

  8. 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

  9. Health Indicators in different regions

  10. Mortality (Income group wise)

  11. Cause Specific Mortality Rate (Per 100000 population) (Income group wise)

  12. Cause Specific Mortality Rate (Per 100000 population) (region wise)

  13. Percentage annual rate decline of under 5 mortality

  14. Mortality rate in children U-5 years

  15. 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.

  16. Birth attended by skilled birth attendants

  17. 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.

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

  19. 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.

  20. 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

  21. Population using improved sanitation facilities

  22. 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.

  23. In India • Between 1999-2000, 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.

  24. 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

  25. Procurement through OPEN TENDER by GENERIC NAME reveals the actual costs… Large gap between manufacturing price & MRP !!!!!! Huge profits - at the cost of the poor.

  26. Who is more important ? Drug manufacturers or our poor countrymen

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

  28. Antibiotic Injection

  29. Antibiotic Injection

  30. Cipla’s10 mgCetrizine Cipla’sCetrizine 10 mg Brand Alerid MRP 37.50 Cipla’sCetrizine 10 mg Brand Okacet MRP 27.50 Cipla’sCetrizine 10 mg Brand Cetcip MRP 33.65 The price of generic medicine is : Rs. 6.75

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

  32. Cipla supplies the generic version at just Rs. 6,500/- to Railway Hospitals BUT, DO THE PATIENTS HAVE ANY OPTION . . . ? ? ?

  33. Promotion of Hazardous, Banned and Bannable Drugs

  34. 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

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

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

  37. 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

  38. 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.

  39. Asian Social Forum - 2003

  40. 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.”

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

  42. More information about PHM, visit • For further information visit • www.phmovement.org • www.phm-india.org • www.ghwatch.org • www.mfcindia.org

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