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Summary Sustainable Health & Medical Technology
- Instelling
- Universiteit Utrecht (UU)
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1Sustainability, Health and Medical Technologies - Summary of the articles
Annemarie Buth
HC 3.
Chan, child survival
Adverse early experiences—eg, unstable caregiving, deprivation of love or nutrition, and stresses associated with neglect and
maltreatment— greatly increase the likelihood of poor health across the entire life course. The more numerous these
experiences, the greater the health risks. Adverse experiences in early childhood increase poor social and health outcomes:
low educational attainment, economic dependency, increased violence, crime, substance misuse, and depression, and a
greater risk of non-communicable diseases, such as obesity, cardiovascular disease, and diabetes.
Participants concluded that the time is right to scale up investment in early child development as a way to optimise health
outcomes along the life course. The health sector therefore has a unique responsibility, because it has the greatest reach to
children and their families during pregnancy, birth, and early childhood.
Promoting healthy child development is an investment in a country’s future workforce and capacity to thrive economically and
as a society. By ensuring that all children have the best first chance in life, we can help individuals and their communities to
realise their maximum potential, thereby expanding equality and opportunity for all.
Kulendran & Lancet, cancer and sustainable development
The expansion of digital technology will enable improved monitoring of cancer treatment resources and cancer registration,
which are vital before the implementation of appropriate control strategies.
A comprehensive health system in low-incomecountries involves cross-sectoral collaboration between many stakeholders,
including academic institutions, local governments, non-governmental organisations, patients’groups, and industry.
Much-needed investment for the development of health systems in low-income countries is likely to flourish by focusing
stakeholder support on the ethical dimensions of sustainability. Recipient countries should seek to maximise social benefit
(eg, promoting health worker education, maximizing vaccination quotas) and guarantee good fi nancial returns to donors.
Leisinger, Corporate Responsibilities in Context
There is a strong human rights argument for improving access to medicines. Given that morbidity and mortality can be reduced
by ‘good governance’ and spending resources according to actual needs, and that medicines are vital for good health, there is
a moral imperative for evidence-based policies and fair distribution of resources to improve access to medicines for the poor
and vulnerable.
Similarly, there is a strong economic argument for improving access to medicines in LMICs. Today, about 2.5 billion people
struggle to meet their basic needs. In a vicious circle of poverty and illness, poverty is a both cause and an effect of poor health
and lack of access to medicines. Since health of their bodies and minds is often the only asset of poor people, access to
medicines becomes particularly crucial for them.
Governments can facilitate significant progress toward improving access to medicines, even under budget constraints. For
example, governments can abolish import tariffs, duties, and sales taxes on medicines, which contribute little to government
budgets, unfairly tax the poor, and increase end-user prices of medicines in the public sector, sometimes by more than 80
percent.
The international community, nongovernmental organizations (NGOs) and the pharmaceutical industry share responsibilities
for improving access to medicines. However, their contributions will only be as effective as national political and social
constraints will allow.
Promising Corporate Responsibility Tools to Improve Access to Medicines
- Differential pricing: adapt prices for selected, particularly patent-protected, medicines to the purchasing power of consumers in different
countries and socio-economic groups (also known as tiered pricing).
- Donations: donate medicines for disease eradication programs or emergencies, adhering to WHO Guidelines for Drug Donations.
- Health system strengthening: provide support for broader health and development goals in developing countries.
- Patent pools: participate in voluntarily mechanisms to make intellectual property available to entities, including generic - manufacturers,
which develop and manufacture medicines.
, 2
- Patient access programs: participate in programs that provide free or subsidized medicines to targeted patient populations.
- Pro-bono research: donate research staff time, resources, or facilities to organizations that are developing essential medicines.
- Public-private partnerships: create formal partnerships with the public sector and NGOs to successfully implement the recommended tools
for corporate responsibility.
- Research and development investments: increase investment in medicines and vaccines for diseases affecting predominantly poor people
in the developing world (i.e., ‘neglected’ diseases).
- Stakeholder collaborations: engage with all stakeholders to ensure access-to-medicines initiatives address country priorities, are integrated
into national structures, and avoid ‘vertical’ and ‘parallel’ systems.
- Transfer of knowledge and collaboration on production in developing countries: create wholly-owned subsidiaries in-country or provide
licenses to local manufacturers.
- Voluntary licensing: participate in patent pools or negotiate licensing agreements with entities that develop and manufacture medicines
for patients in LMIC.
Consistent with encouraging multi-stakeholder discussions at the Third International Conference for Improving Use of
Medicines, we recommend the creation of “solution-stakeholder-teams” that include national governments, the international
community, NGOs, pharmaceutical companies, and academics from multiple disciplines including medicine, public health,
business, and ethics. Each team member brings unique perspectives and strengths to the development and implementation of
collaborative strategies for sustainably improving access to medicines
Musango, developing healthfinancing systems
African population lacks proper healthcare. Although inadequate funding for health is a fundamental problem,
inefficient use of resources is of great concern. There is need to generate robust evidence focusing on issues of
importance to ministry of finance. The current unsatisfactory state of health financing was mainly attributed to lack of
clear vision; evidence based plans and costed strategies.
In order to explore possible pathways for moving African countries past the existing obstacles and bottlenecks,
and towards universal coverage, three panel discussions were organized on health financing. Several themes and
questions were highlighted during the panel discussions, this paper will focus on four key issues: (i) lowering financial
barriers to access to health care by improving and extending prepaid and pooling
mechanisms including the question of user fee exemptions; (ii) mobilization of domestic and international
resources for health; (iii) efficiency and equity in the use of resources including incentive for health workers; and
(iv) making evidence based health financing policy decisions.
Improving health in Africa is a driver for long-term economic growth and development. Declaration on Universal Health
Coverage which noted the need to “work together in our own countries on the development and use of transparent
financial mechanisms, accountability and reporting, and monitoring and measuring of health system performance
and outcomes. Such actions support the progressive realization of universal health coverage in an efficient, sustainable,
and publicly accountable manner”.
The three panel discussions organized to date have already contributed to improving the collaboration between the two
ministries and to ensure that optimal funding to the health sector produces desirable results and overall national
development. Finally, the dialogues need to be based on a clear health financing strategy. This strategy can firstly be
used for forging some level of common vision; here the concept of universal health coverage will be of great importance
in order to focus the dialogues on context specific vision on how to move towards it.
Rottingen, mapping available health research
This report confirms that substantial gaps in the global landscape of health R&D remain, especially for and in low-
income and middle-income countries. Too few investments are targeted towards the health needs of these countries.
Better data are needed to improve priority setting and coordination for health R&D, ultimately to ensure that resources
are allocated to diseases and regions where they are needed the most. The establishment of a global observatory on
health R&D, which is being discussed at WHO, could address the absence of a comprehensive and sustainable
mechanism for regular global monitoring of health R&D.
“10/90 Gap” indicates that only a small proportion of global health research expenditure is spent on diseases that
have a large burden of preventable mortality in low-income and middle-income countries. One crucial contributing
factor is the inadequate investment in R&D to address the specific health problems of poor populations.
, 3
A global observatory on health R&D is needed because our understanding of what health R&D is undertaken, and
where, by whom, and how, is very scarce, and such knowledge is necessary to improve priority setting and
coordination for health R&D.
Increased transparency would enable countries to be accountable for public investments in health R&D and make
knowledge more widely available so that researchers can more easily identify research projects that are similar to their
own and make incremental improvements to existing research. A global observatory on health R&D would be helpful,
and could ultimately enable adequate financing for priority areas, aid efficient use and targeting of low resources, and
improve investment decisions through avoidance of duplication and improvement in coordination.
Tusting, socioeconomic development as intervention against malaria
Our aim was to assess whether socioeconomic development can contribute to malaria control. Although we would not
recommend discontinuation of existing malaria control efforts, we believe that increased investment in interventions to
support socioeconomic development is warranted, since such interventions could prove highly effective and sustainable
against malaria in the long term.
Our findings suggest that low socioeconomic status is associated with roughly doubled odds of clinical malaria
or parasitaemia in children compared with higher socioeconomic status, within a locality. The association between
socioeconomic status and malaria is not definitive evidence for the direction of causality, since the poorest households
are not only more susceptible to the disease, but are also more vulnerable to its costs, such that the disease itself can
induce poverty.
Wealth is probably protective against malaria, since it renders prophylaxis and treatment more affordable and
is positively associated with other beneficial factors, including better-educated parents (which improves prophylaxis and
treatment for children), increased housing quality (which reduces house entry by malariatransmitting mosquitoes), and
improved nutritional status of children (which could increase their subsequent ability to cope with malaria infection)
Malaria and poverty therefore constitute a vicious cycle for the poorest households, exacerbating differences in health
and wealth.
HC 4.
Bouzid, The Effectiveness of Public Health Interventions to Reduce the Health Impact of Climate Change
The main climate sensitive diseases are West Nile fever, dengue fever, Chikungunya fever, malaria, leishmaniasis, tick-
borne encephalitis, Lyme borreliosis, Crimean-Congo haemorrhagic fever, spotted fever rickettsioses, Yellow
fever, Rift Valley fever, cholera, waterborne diseases, floods, droughts, cyanobacteria, and heat stress.
Arthropod-borne diseases are infections spread by insect (mosquitoes and sandflies) or arachnid (ticks) vectors [2].
Major shifts in the epidemiology of several vector-borne diseases and appearances on new continents have been
predicted as a result of climate change.
Waterborne diseases are also likely to be influenced by climate change. The importance of climate as a driver of disease
risk is derived from observations that waterborne disease outbreaks are often preceded by heavy rainfall. The impact of
droughts on health through reduced access to water in affluent countries is not clear, but effects in resource poor
countries are likely to be dramatic
The effects of disasters such as floods, extreme droughts, storms and hurricanes on human health seem to be mostly
indirect (mediated through vector and waterborne diseases), nevertheless, acute injuries, fatalities and mental health
illnesses are also significant public health outcomes but their management and prevention (disaster preparedness and
response planning) are beyond the scope of this study.
Concentrations of air pollutants (mainly ozone and particulate matter) would increase with greenhouse gas emissions
and higher temperatures
Lancet, health and climate change
Although vector-borne diseases will expand their reach and death tolls, especially among elderly people, will increase
because of heatwaves, the indirect eff ects of climate change on water, food security, and extreme climatic events are
likely to have the biggest eff ect on global health. The recognition by governments and electorates that climate change
has enormous health implications should assist the advocacy and political change needed to tackle both mitigation and
adaptation.
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