Health and Health Care in India Policy implications for Europe

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1 Health and Health Care in India Policy implications for Europe David Taylor Professor of Pharmaceutical and Public Health Policy University College London School of Pharmacy Dr Jennifer Gill Research Fellow University College London School of Pharmacy Brussels Press Club, October 17 th 2013

2 This presentation Outlines health related needs in India, and the reasons for limited national progress since the 1950s Analyses current domestic and international policy challenges in areas such as universal health care (UHC) provision and affordable medicines supply Considers EU interests and responsibilities with regard to supporting global health improvement and fostering mutually beneficial trade and economic development

3 India today India has a population of about 1,250 million nearly 20% of the world s people in just over 2% of its land surface India s GDP has grown eightfold since But the average per capita GDP is only $1500, and the country has significant balance of trade and government spending deficits India is the world s largest exporter of generic medicines the US is its biggest single customer in value terms. However, several hundred million Indians lack reliable access to basic pharmaceutical care

4 Healthy life expectancy, men and women, 2010 India is fighting on two fronts: it has the world s largest infectious disease burden combined with a rapidly increasing number of people living with non-communicable diseases such as diabetes and the consequences of strokes and heart attacks. Yet it spends less of its GDP on publicly funded health care than virtually any other nation, and its population has increased by a quarter of a billion since the start of the century

5 AT THE SAME TIME India's Attack on Innovation New Delhi's discrimination against U.S. firms harms jobs and intellectual property THE WALL STREET JOURNAL September 25 th 2013 Indian Prime Minister Manmohan Singh's visit to Washington on Friday is an opportunity......over the last 18 months, India has denied, revoked or otherwise attacked the patents of 15 of the 45 or so patented medicines on the Indian market. In March, for example, Indian officials authorized a local company to copy Bayer's innovative Nexavar cancer drug, citing the fact that the drug was not manufactured locally.

6 The Context Towards Global Demographic and Epidemiological Transition Crude birth and death rates

7 A Late, Slow, Indian Transition Process

8 Factors Underlying India s Health Challenges British colonial failings and abuses The scale of the country and the nature of its lands The strength of Indian traditions Natalist values and inequalities linked to social fragmentation, limited educational progress and on occasions deliberate exploitation or corruption The Amritsar massacre, April 1919 Policy failings associated with dysfunctional relationships between the Federal Government and State administrations Lack of popular demand for enhanced universal/public health care

9 Successes and Controversies The launch in 2005 of the National Rural Health Mission and in 2008 of the RSBY insurance initiative The Planning Commission for India s publication of Universal Health Coverage plans in 2011 Manmohan Singh s (stalled?) commitment to improved generic medicines supply, and to increasing public spending on health to 2.5% of GDP by 2017 The 2013 introduction of a Food Law entitling c.800 million Indians to a monthly supply of 5kgs of subsidised rice or wheat The current lack of progress with the India- EU Free Trade Agreement, and with regard to topics such as India s controls on inward capital investment and asset ownership Carbon dioxide emissions, European and North American industrialisation before 1960 was not the main driver of global warming

10 European needs, interests and responsibilities Facilitating global demographic, epidemiological and social transition Ensuring good world-wide access to presently available essential medicines and other technologies, without undermining the conditions necessary for further innovation and the ability of EU Member States to generate income from high risk research based enterprise Protecting the global environment and atmospheric and other pollution Challenging corrupt practices and counter-productive policies, both domestically and internationally

11 Strategic opportunities Future trends in Indian health spending? European agencies and industry ought wherever possible to promote informed awareness of the benefits of adequately funded universal health care systems and active ageing, and the value of international mechanisms for purchasing new health technologies for use in very poor settings There are mutual benefits to be gained from greater partnering between EU MSs and individual Indian States India s current total (public and private) health spend is reported to be just over 4% of GDP, of which about 20% is accounted for by medicine costs at manufacturers prices The EU could and should do more to lead global efforts to maintain and strengthen intellectual property rights for C21 pharmaceutical innovators, together with treatment access rights for the world s poor

12 Thank you

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