Next Steps for Elevating Health on Trade and Investment Policy Agendas; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

Despite intergovernmental calls for greater policy coherence to tackle rising non-communicable diseases (NCDs), there has been a striking lack of coherence internationally and nationally between trade and health sectors. In this commentary, I explore the arguments by Lenucha and Thow in relation to barriers for greater coherence for NCDs, apply them to regional trade agreements, and point to next steps in research and advocacy for greater attention to health and NCD prevention in government trade agendas

Predictive Mapping of Transmission Risk of a Soil-Transmitted Helminth across East Africa: Findings from Community Prevalence Surveys

Background: Despite being identified as a major health concern and neglected tropical disease, Ascariasis, caused by Ascaris lumbricoides, a soil-transmitted helminth, ranks among the most common infections worldwide. Methods: Based on prevalence data from the community surveys across East Africa for 1975-2009, we used ecological niche modeling to summarize and predict the spatial distribution of A. lumbricoides’ transmission risk. Results: Projection of this model across East Africa identified 51.4% of the region as suitable for A. lumbricoides transmission, with least suitable areas in the Sahara and the Somali-Chalbi deserts. Partial area under the curve (AUC) tests based on independent data showed that our model predictions were better than random expectations in predicting infection risk of A. lumbricoides; the model successfully identified areas of high and low infection risk in Ethiopia and Eritrea. Conclusions: Although preliminary, this occurrence-environment mapping approach provides predictions that can guide education and mitigation efforts in the broader East African region

Failing the global south: power and resistance in medicines governance

This thesis examines the history, conflicts and transformations in global medicines governance over fifty years. Developments in medicines R&D, production, access, and regulation are situated within broader shifts in the global political economy. This enables an understanding of specific events over time, including turning points, major actors and interests served

Public health over private wealth: rebalancing public and private interests in international trade and investment agreements

The emerging global trade and investment regime is a site of ongoing contestation between states, powerful industry actors and civil society organisations seeking to infuence the formation of legal rules, principles, practices and institutions. The inclusion of major transnational tobacco, alcohol and ultraprocessed food companies seeking to influence governments in these processes has resulted in the expanded distribution and consumption of unhealthy commodities across the globe, overshadowing many of the positive impacts for health hypothesised from liberalised trade. The growing number of pathways for market actors to exert undue influence over national and international regulatory environments provided by agreements, such as the Comprehensive and Progressive Agreement for Trans-Pacific Partnership, has given many cause to be concerned. In the context of continued commitment by states to international trade and investment negotiations, we present several avenues for public health scholars, advocates and practitioners to explore to rebalance public and private interests in these deals

Global health governance : framework convention on tobacco control (FCTC), the Doha Declaration, and democratisation

Global public health agreements are heralded as a success for the affirmation of the right to health within a complex and contested political landscape. However, the practical implementation of such agreements at the national level is often overlooked. This article outlines two radically different global health agreements: The Doha Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement and Public Health; and the Framework Convention on Tobacco Control (FCTC). We identify significant challenges in their implementation, particularly for low and middle income countries. Shifts in the policy network constellations around these two agreements have allowed for some positive influence by civil society. Yet industry influence at the national level constrains effective implementation and those affected by these policies have largely been left on the periphery. The broader provisions of these two agreements have been watered down by vested interests and donor conditions. We advocate for both activist and academic actors to play a significant role in highlighting the consequences of these power asymmetries. Deliberative democracy may be the key to addressing these challenges in a way that empowers those presently excluded from effective participation in the policy process.<br /

Next Steps for Paid Parental Leave In Australia: Roundtable Discussion Report

The Roundtable identified many opportunities and levers to improve Australia's scheme in the future. One of the most recurring themes, agreed upon by policy influencers and academics alike, was the need to improve gender equality around Australia's paid parental leave scheme and facilitate the use of the scheme by fathers. Lessons from Iceland on dedicated leave provisions for mothers and fathers and associated gender equity benefits provide one potential model for Australia.This report was commisioned by Families Australi

Tackling NCDs: the need to address Alcohol industry interference and policy incoherence across sectors; Comment on 'Towards preventing and managing conflict of interest in nutrition policy?'

Ralston et al highlight the ways that different actors in global nutrition governance conceptualise and frame the role of non-state actors in governance arrangements, including the potential for conflict of interest (COI) to undermine global health efforts. The authors argue that the World Health Organization (WHO) draft tool on managing COI in nutrition policy is an important innovation in global health, but that further research and refinement is needed for operationalising the management of COI with diverse actors in diverse contexts. In this commentary, reflecting on strategic framing and industry interference in policy-making, we argue for the urgent need for states and intergovernmental organisations to prevent alcohol industry interference in the development of national and global alcohol policy. We argue that policy incoherence remains a key barrier, where governments pursue health goals in the health sector while pursuing exports and market liberalisation of health harmful commodities in the trade secto

Australian COVID-19 policy responses: Good for health equity or a missed opportunity?

COVID-19 shines a spotlight on social and health inequities: the already widening inequities in life expectancy, premature death, noncommunicable diseases and mental health issues in Australia will get worse as a consequence of COVID-19 if progressive, long-term multisectoral action is not taken. This report examines the health equity implications of 156 social and economic policy measures introduced by the Australian Federal and State/Territory Governments in response to the pandemic. The wide-ranging and rapid policy responses to COVID-19 risks and impacts is impressive, showing that if there is political will action can happen. A number of positive measures were introduced to address employment, household income, and standard of living. These could go a long way to keeping people well and reducing health inequities. They must however not return to conditions that will keep people in poverty. Policies must ensure a decent standard of living and fair working conditions as we move forward. To prevent an accumulation of disadvantage and health inequities throughout the life course, the temporary supports for childcare should continue and enable access to free childcare for, at the very least, socially disadvantaged households. None of the housing-related measures that were introduced addressed the medium and long term housing precariousness that is prevalent in Australia. Unless this is fixed, social and health inequities will continue to widen. Investment in social housing could help address the gap in housing, job creation and income growth, and reduce homelessness. Policy measures introduced to support aged care, disability services, the arts and family violence are very helpful in the short term. However, there is a need for sustained and adequate funding to these sectors and organisations, particularly going forward when it is likely that these organisations will play a more vital role than ever in helping to rebuild communities. COVID-19 has initiated an enormous intergenerational transfer of debt. The health consequences will be felt for decades, possibly generations. But austerity cannot be the policy response going forward. Long-term investment is vital across the conditions of daily living. Action on the structural drivers of health inequity is essential. Without action on climate change, health inequities will be exacerbated. Good social policy is good climate adaptation policy, and good for health. Climate change mitigation must focus on the consumptagenic system – the institutions, policies, processes, actors, and ideas that embed, facilitate, and normalise the dominance of a system addicted to growth and profits irrespective of the environmental, social, and health costs. ‘Bouncing back better’ from COVID-19 could see a healthier, more equitable and sustainable Australia if political leaders choose to use this unfortunate event to drive positive societal change. We cannot have deregulations in social, health and environment sectors in order to "kickstart the economy", nor the dominance of certain gender, economic and political lenses in the recovery governance processes. Governing going forward requires a new social compact, supported by a national whole of government health equity strategy

What is the impact of intellectual property rules on access to medicines? A systematic review

BACKGROUND: It is widely accepted that intellectual property legal requirements such as patents and data exclusivity can affect access to medicines, but to date there has not been a comprehensive review of the empirical evidence on this topic. The World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) requires Member States to implement minimum standards of intellectual property protection including patents for pharmaceutical products, but also contains ‘flexibilities’ designed to address barriers to access to medicines. National intellectual property laws can also include TRIPS-plus rules that go beyond what is required by TRIPS. We aimed to systematically review literature that measures the impact of intellectual property rules on access to medicines, whether implemented as a result of TRIPS, TRIPS-plus provisions in other trade agreements, or unilateral policy decisions. METHODS: We searched Proquest, SCOPUS, Web of Science, PubMed, JSTOR, Westlaw and Lexis Nexis. Peer reviewed articles, government reports and other grey literature were included. Articles were eligible for inclusion if they were quantitative, in English, included a measure of cost, price, availability of or access to medicines, were about intellectual property or data exclusivity rules and published between January 1995 and October 2020. Ninety-one studies met our inclusion criteria. We systematically reviewed the studies’ findings and evaluated their quality using a modified quality assessment template. RESULTS AND CONCLUSION: Five broad overarching themes and 11 subthemes were identified based on the articles’ foci. They were: trade agreements (divided into EU FTAs and those that include the USA); use of TRIPS flexibilities (divided into compulsory licencing and parallel importation); patent expiry/generic entry/generic pathway (divided into comparative studies and single country studies); patent policies (also divided into comparative studies and single country studies) and TRIPS-plus rules (divided into data exclusivity, patent term extensions and secondary patenting). Most studies focused not on specific trade agreements, but on TRIPS-plus provisions, which can also be found within some trade agreements. The main finding of this review is that the stronger pharmaceutical monopolies created by TRIPs-plus intellectual property rules are generally associated with increased drug prices, delayed availability and increased costs to consumers and governments. There is evidence that TRIPS flexibilities can facilitate access to medicines although their use is limited to date. There were few studies that included resource poor settings, signalling a need for greater research in such settings where the impact on access to medicines is likely to be more damaging. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12992-022-00826-4