Health Care, Gap Between Rich and Poor Persists, W.H.O. Says
November 11, 2004
By ELISABETH MALKIN
MEXICO CITY, Nov. 10 - Despite significant gains in medical
science, disparities in public health persist between rich
and poor countries, the World Health Organization said in a
report released here on Wednesday.
The report, released in advance of a W.H.O. meeting here
next week of health ministers from 30 countries, called for
more research into how health care is delivered. .
"Half of the world's deaths could be prevented with simple
and cost-effective interventions," said the report. "But
not enough is known about how to make these more widely
available to the people who need them," it continued.
The study said that inadequate health systems in developing
countries had been a constraint in global programs to
fights AIDS, tuberculosis and malaria. "Countries with few
resources struggle with creaking infrastructure, inadequate
financing, migrating doctors and nurses and lack of basic
information on health indicators," the study's authors
concluded.
The study pointed to market reforms in the health sector,
promoted by the World Bank in the 1980's, as one reason for
steadily weakening public health systems in developing
countries. The push toward privatization might have
accentuated disparities in the health care available to
rich and poor, the report said.
It also pointed to "gross inequities in the research
process at both global and national levels" and said
treatments in the developing world must be tailored to
local conditions.
For example, the report cited a study in Haiti that found
that babies born to mothers treated with antiretroviral
drugs to prevent the transmission of H.I.V. might then die
of congenital syphilis.
A second report released here on Wednesday, by the Global
Forum for Health Research, a Geneva-based nonprofit group,
found that spending on health research rose from $84.9
billion in 1998 to $105.9 billion in 2001.
Despite this, there has been little headway in closing the
gap between rich and poor countries in financing for
research into the infectious diseases that
disproportionately affect developing countries, like
malaria and tuberculosis, the report said.
The Global Forum, which will hold its own meeting parallel
to the W.H.O. conference, said that less than 10 percent of
spending on health research goes to study 90 percent of the
world's diseases.
"Very few infectious diseases are getting sufficient
attention," said Stephen Matlin, the group's executive
director. "They remain neglected diseases."
Pharmaceutical companies account for 48 percent of the
spending for medical research, reflecting in part the
increased cost of bringing a drug to market. The public
sector, led by rising budgets at the National Institutes of
Health in the United States, spends 44 percent of all
research funds. Private foundations and universities
account for the other 8 percent.
Pharmaceutical companies are reluctant to release
information about their research, Mr. Matlin said, but the
evidence is that much of their spending goes to developing
therapies for noncommunicable diseases prevalent in
wealthier countries.
Mr. Matlin pointed to mergers that have left the industry
in the hands of a few companies and speculated that "it may
be that larger companies are getting less innovative."
"Our direct concern is to see an increase in spending on
infectious diseases in low- and middle-income countries and
to change priorities," he said.
