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261. Making Markets for Merit Goods: The Political Economy of Antiretrovirals

Author:
Ethan Kapstein and Josh Busby
Publication Date:
08-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper examines the role of policy entrepreneurs and global activists in shaping the international market for antiretroviral drugs to combat HIV/AIDS. When ARVs first came on the market in the 1990s they were exceedingly expensive; the cost of treatment was upwards of $10,000 per year. These drugs were thus accessible only to those patients who had high incomes. But in 2006, the “international community,” meeting at a United Nations General Assembly Special Session (UNGASS), made an astonishing pledge to those who were infected with HIV. It proclaimed that there should be universal access to ARV treatment. This UNGASS, following up on an earlier historic UN special session devoted entirely to AIDS in 2001, marked the first time in history that the international community pledged itself to chronic care for the ill, which in this case includes the approximately 30 million people around the world estimated to be HIV positive. How do we explain the transformation of ARVs from private goods, which only a few could afford, into merit goods that were (at least declaratively) to be made available to everyone? In other words, how does a norm of “universal access to treatment”—that no person should be denied these life-extending drugs—become the ethical basis for global public policy with respect to pharmaceutical allocation? What are the lessons of the ARV story for other global issues? These are the primary questions we explore in this paper. Briefly, we argue that the policy entrepreneurs and activists who promoted the creation of a universal access to treatment regime—of the transformation of ARVs into global merit goods—relied on a combination of moral arguments and ideas with favorable material circumstances. From the ethical perspective, the task of these entrepreneurs was to convince the “international community” that access to ARVs was a “human right,” or conversely to convince decision-makers that it was morally wrong to allocate these life-enhancing drugs solely on the basis of ability to pay. But from a material standpoint, these arguments were greatly facilitated by the lowering prices of ARVs caused by a combination of differential pricing (that is, lower prices for drugs in the developing world than in the advanced welfare states) and competition from generics producers, coupled with increases in foreign aid spending devoted to HIV/AIDS and other diseases.
Topic:
Health, Human Welfare, Humanitarian Aid, and Political Economy

262. OEF Commentary on Avian Flu

Publication Date:
01-2009
Content Type:
Working Paper
Institution:
Oxford Economics
Abstract:
OEF has regularly provided scenario assessments of the economic impact of a wide range of risks to the global outlook from financial market volatility to banking crises to country studies to threats arising from less economy-based disturbances such as earthquake damage and the impact of health scares like the UK's foot and mouth outbreak and Asia's SARS attack of 2003.
Topic:
Economics, Globalization, Health, and Infectious Diseases
Political Geography:
Europe and Asia

263. Could swine flu tip the world into deflation?

Publication Date:
06-2009
Content Type:
Working Paper
Institution:
Oxford Economics
Abstract:
Health experts agree that, while the current flu epidemic that started in Mexico in April 2009 may weaken during the summer, it could re-appear in the autumn, possibly in a stronger form. Using historical benchmarks of previous flu pandemics and of the SARS episode, we estimate the economic impact of a global flu pandemic.
Topic:
Economics, Globalization, Health, and Infectious Diseases
Political Geography:
Mexico

264. Haiti after the Donors' Conference

Author:
Robert Maguire
Publication Date:
10-2009
Content Type:
Working Paper
Institution:
United States Institute of Peace
Abstract:
In April 2009, multilateral and bilateral donors pledged $353 million to support the government of Haiti's plan to alleviate poverty, mitigate the effects of natural disasters, and achieve sustained economic growth.
Topic:
Development, Health, Poverty, Third World, and Foreign Aid
Political Geography:
Caribbean

265. Bending the Productivity Curve: Why America Leads the World in Medical Innovation

Author:
Glen Whitman and Raymond Raad
Publication Date:
11-2009
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
The health care issues commonly considered most important today — controlling costs and covering the uninsured — arguably should be regarded as secondary to innovation, inasmuch as a medical treatment must first be invented before its costs can be reduced and its use extended to everyone. To date, however, none of the most influential international comparisons have examined the contributions of various countries to the many advances that have improved the productivity of medicine over time. We hope this paper can help fill that void.
Topic:
Health, Human Welfare, and Markets
Political Geography:
America

266. Health Financing and Health Outcomes in the Eastern Mediterranean Region

Author:
Marwa Farag
Publication Date:
11-2009
Content Type:
Working Paper
Institution:
Belfer Center for Science and International Affairs, Harvard University
Abstract:
This paper presents an overview of health spending and health outcomes in the WHO Eastern Mediterranean region over the time period 1995-2006, using cross-country and over-time comparisons. Overall, the region experienced improvements in health outcomes measured in terms of reductions in infant, under-5 child mortality and maternal mortality. However, there are notable exceptions to this trend of declining mortality in countries such as Afghanistan. In addition to providing an overview of changes in health outcomes and health spending over the 12-year period, the paper examines the following two issues: 1) The responsiveness of health care spending to changes in a country's income, and 2) The impact of spending on health care services on health outcomes. The methodological approach adopted in this paper is multivariate regression analysis. I employ random effects models with year dummies, which are appropriate for panel data analysis. I also use double-log formulas for econometric necessity and ease of interpreting the results. The findings indicate that a 1 percent increase in GDP per capita is associated with 0.89 percent increase in health spending in the region and that income growth does not explain all the variation in health spending, indicating that other factors, such as the organization of the health care system, influence health care spending levels. This is an important finding because it suggests that on the one hand cost-containment and on the other mobilizing more funds for the health care sector are possible with appropriate interventions. The findings on the importance of spending on health care for achieving better health outcomes demonstrate that investing in health care matters; a 1 percent increase in health spending is associated with 0.11 percent reduction in infant mortality and 0.14 percent reduction in under-5 child mortality. These results are likely to be underestimating the effect of health spending because of the inclusion of a country's income in the models. Gender parity in secondary school education also had a significant impact on reducing infant and child mortality. Government effectiveness had a strong and significant effect on reducing maternal mortality. The results contradict the notion that increases in income through better nutrition and living conditions alone are responsible for improvements in health outcomes. The results of this analysis clearly indicate that investing in health care also matters.
Topic:
Health
Political Geography:
Afghanistan, Europe, Middle East, and Arabia

267. The uncertain legitimacy of occupational health policies

Author:
Emmanuel Henry
Publication Date:
01-2009
Content Type:
Working Paper
Institution:
Centre for European Political Sociology
Abstract:
Because they deal with issues of bodily integrity and health, the policies managing occupational risks reveal the contradictions of public action in the field of occupational relationships, and the fragile compromises to which they lead. This paper sets out to question the difficulties related to the legitimisation of public policies in the field of workplace health. We analyse the reasons why these policies are difficult to legitimate and present an overview of the solutions that have been elaborated to answer this problem. The recent evolutions of public health policies, notably the arrival of new actors in traditional arenas of negotiation tend to weaken these compromises and force actors to elaborate new modes of action. These evolutions should then be analysed by taking into account other public policies, in order to determine to what extent the management of occupational risks is undergoing the same transformations or if this field remains unaffected.
Topic:
Health, Human Welfare, and Politics
Political Geography:
Europe

268. Using Indicators to Encourage Development? Lessons from the Millennium Development Goals

Author:
Richard Manning
Publication Date:
01-2009
Content Type:
Working Paper
Institution:
Danish Institute for International Studies (DIIS)
Abstract:
The Millennium Declaration included a highly significant innovation – universal, support by the world's governments for a short list of development results to be, achieved by a set date. As the target year of 2015 approaches, the paper compares the, MDG framework that emerged from the Declaration with other ways of measuring, and incentivising progress, sets out some initial hypotheses about its impact and addresses issues about its structure and coverage. This leads to proposals about how to, get the best value from the MDGs over the years to 2015 and five hypotheses about, how the world might approach the issue of what framework, if any, to put in place, to measure and incentivise development progress after 2015.
Topic:
Development, Health, Human Welfare, Humanitarian Aid, International Cooperation, International Political Economy, Third World, and United Nations

269. Pricing and Access: Lessons from Randomized Evaluations in Education and Health

Author:
Michael Kremer and Alaka Holla
Publication Date:
01-2009
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
This paper surveys evidence from recent randomized evaluations in developing countries on the impact of price on access to health and education. The debate on user fees has been contentious, but until recently much of the evidence was anecdotal. Randomized evaluations across a variety of settings suggest prices have a large impact on take-up of education and health products and services. While the sign of this effect is consistent with standard theories of human capital investment, a more detailed examination of the data suggests that it may be important to go beyond these models. There is some evidence for peer effects, which implies that for some goods the aggregate response to price will exceed the individual response. Time-inconsistent preferences could potentially help explain the apparently disproportionate effect of small short-run costs and benefits on decisions with long-run consequences.
Topic:
Development, Economics, Education, Health, Human Welfare, and Markets

270. The Future of Foreign Assistance Amid Global Economic and Financial Crisis

Author:
Laurie A. Garrett
Publication Date:
01-2009
Content Type:
Working Paper
Institution:
Council on Foreign Relations
Abstract:
Though the United States of America faces its toughest budgetary and economic challenges since the Great Depression, it cannot afford to eliminate, or even reduce, its foreign assistance spending. For clear reasons of political influence, national security, global stability, and humanitarian concern the United States must, at a minimum, stay the course in its commitments to global health and development, as well as basic humanitarian relief. The Bush administration sought not only to increase some aspects of foreign assistance, targeting key countries (Iraq and Afghanistan) and specific health targets, such as the President's Emergency Plan for AIDS Relief and the President's Malaria Initiative, but also executed an array of programmatic and structural changes in U.S. aid efforts. By 2008, it was obvious to most participants and observers that too many agencies were engaged in foreign assistance, and that programs lacked coherence and strategy. Well before the financial crisis of fall 20 08, there was a strong bipartisan call for foreign assistance reform, allowing greater efficiency and credibility to U.S. efforts, enhancing engagement in multilateral institutions and programs, and improving institutional relations between U.S. agencies and their partners, including nongovernmental organizations (NGOs), recipient governments, corporate and business sector stakeholders, faith-based organizations (FBOs), academic-based implementers and researchers, foundations and private donors, United Nations (UN) agencies, and other donor nations.
Topic:
Foreign Policy, Debt, Development, Economics, Health, and United Nations
Political Geography:
United States