GEOG 3692 exam 2
One argument for supporting drug patents is that by ensuring companies could profit from that drug for a certain number of years, it gives companies incentives to do research and development for other new drugs. Know 3 critiques of this which were offered in the film
- 1.3% (the % of profits spent on R&D) - 84% the % of global medication research funded by governments & public sources) - The large pharmaceutical companies are already the most profitable companies in the world.
What year was the first effective treatment (combination of 3 anti-retrovirals) was available and what did it cost per year per patient?
- 1996 - $15,000
three key themes as described by Marcos Cueto in the Declaration of Alma-Ata
- Concept of appropriate technology; a way to address the concentration of international health resources in urban hospital, which often left rural dwellers without access to medical care -critique of medical elitism: shits on top down health initiatives, increased community participation in health care, integration of western and traditional medical practices. -Declaration of frames health as an avenue for social and economic development
4 impacts of this consolidation of funding streams and what each means
- Consolidation of influence....... Can impose the priorities of powerful donors on poor countries with little input. -Towards more discretionary funding and away from core or longer-term funding - Towards defined multi-stakeholder governance and away from traditional government-centered representation and decision-making. It is possible that because donors have greater control over their funds and can more easily monitor how they are used, that there has been a net increase in funding for GH over what might have otherwise happened. - Towards narrower mandates or problem-focused vertical initiatives and away from broader systemic goals. Underinvestment in public health capacities such as investment in monitoring for epidemics/crises, disseminating information and health systems strengthening
the collaboration between Partners in Health (an international NGO) and the Rwandan government, look for examples of how the 8 aspects of PIH's Health Care Delivery Model (pp. 160-161) look on the ground in Rwanda
- Decrease user fees at clinics and schools - Involve community members at all levels - Pay attention to women and children ????
3 common ingredients of structural adjustment policies by the World Bank and IMF and how those impacted one Peruvian woman with tuberculosis
- Decreased social spending (ie education, health, social safety nets) - Privatization of formerly state-run initiatives - Imposed trade limits such as o Prohibitions from subsidizing local farm products o Prohibitions on charging tariffs on imports
origins of doctors without borders
- Founded in 1971 in response to Nigeria crisis and flood/independence struggle in Bangladesh - Heavily influences by the age of genocide and decolonization/ independent movements of the 1960s and 70s - Combined a realist rejection of utopian politics and romantic rejection of authority - Today: an international movement of 19 loosely inter connected groups - A more engaged and daring version of the red cross - Nobel peace prize, 1999 - Balance operational neutrality with a willingness to speak out
goals of a health system
- Keep people healthy- prevent disease - Treat people who are sick - Protect people from financial ruin due to costs of medical care
3 ways HIV is transmitted
- Unprotected sex - Vertical transmission - Injection drug use
What was fundamentally different about the relationship between this NGO and the Rwandan government compared to most NGOs?
- Way more support and funding and investment - Collaborate closely with the public sectors/communities ????
which country's health insurance system each of the following US health plans are similar to and why: Medicare, Veterans Administration, Medicaid, Employer-provided
- When it comes to treating veterans, we're like Britain and Cuba - For Americans over the age of 65 on Medicare, we're Canada - For working Americans who get insurance on the job, we're Germany (except our insurance companies are for profit) - For the population with no health insurance, we're Cambodia or Burkina Faso or rural India,
How can someone who has regular tuberculosis then develop MDRTB?
- bacteria becomes resistant to the drug - People do not complete a full course of TB treatment - Health care providers prescribe the wrong treatment (the wrong dose or length of time) - Drugs for proper treatment are not available - Drugs are of poor quality
three private mechanisms (ACA)
- dependent coverage provision - Individual mandate: Everyone must have coverage, or pay a penalty (in 2019 the penalty was removed) - Employer mandate: Employers with more than 50 employees must provide coverage or pay penalty
public mechanism (ACA)
- everyone covered whose income is less than 133% of federal poverty level - if state agrees o Before the expansion, states determined eligibility levels for Medicaid
doctors without borders
- focus on medical care, don't just work in war zones -balance operational neutrality with a willingness to speak out - independence and impartiality - they speak out, denouncing, standing up for victims against their murderers
benefits of NGOs
- innovative - more cost effective in service delivery - greater ability to target the poor and vulnerable - perhaps greater capacity to develop community based institutions - better able to promote popular participation seen as a alternative to government
4 "cultural roots" of the current global health system
- international health regulation - disaster and war victim relief - military medical research and hygiene - medical missionaries
difference between red cross and DWB
- neutrality, confidentiality, impartiality, and independence - SF will set up medical services as soon as it is practical, even if illegal - ICRC normally works with legal authorities to set up medical services - Denouncing or speaking up could inhibit access to patients who need them - When does not speaking up make the group complicit
moral and ethical dilemmas involved in the medical humanitarian response to the Rwandan refugee crisis
- refugee camps were ruled by the militia so they recruited people from there -how to tell who's a militia member or refugee, torn on whether to stay and provide aid or leave -refugee camps lacked hygiene and sanitation -is it acceptable for MSF to stay and assist people who had committed genocide
Socios en Salud implemented "DOTS-Plus" and explain what "DOTS-Plus" entailed
- so people wouldn't die - it entailed use of second line medications, monitoring with suptum culture, drug susceptibility testing and directly observed individualized therapy
What is the DOTS?
- stands for directly observed short treatment course to ensure that those infected were taking the drugs properly - it was cost effective - they didn't recommend something else because there is nothing else and all other treatment are too expensive
Doha Deceleration
-Allowed for countries to determine their own public health crises -reinforced the legality of all WTO members to issue "compulsory licenses" to produce medicines even when another country's patent covered that medicine
Why wasn't the grand vision of "health care for all" that was promoted in the Declaration of Alma-Ata ever realized?
-Didn't specify who would pay for all these implementations -Shift to selective primary health care
goals of the ACA
-Increase access to health insurance: - Decrease health care costs -Improve delivery of care
describe the specific arguments detailed in the NEJM article about why these decisions are causing alarm among public health professionals
-The US funds WHO pretty much with giving over 6 billion so certain things are now put on pause - they ensure drug safety - They develop guidelines for disease treatment, particularly for illnesses such as malaria and tuberculosis that predominantly affect the developing world. - pretty much is the main leader of health issues and solves them
James Love went to DC to lobby US activists to support generics for Africa. He described one reason they were opposed to supporting generic drugs for use in Africa. What was it?
-They didn't care, they felt like they had drugs - If they had cheap drugs in Africa they thought it might discourage research and development - If the Africans had cheap drugs it would mutate the virus because they would misuse them - Develop resistance
critiques of WHO
-Voluntary donors now decide financial priorities -inflexible
3 funders account for the majority of funding of the WHO, Gavi and the Global Fund
-WHO: USA, Uk and Bill & Melina gates foundation - Gavi: Gates foundation - Global Fund: others and USA
critiques of NGOs
-dependent on donor money, more often from abroad, often tired to policies of donor states - democratization - often recycle ideas from donors - don't always reach the poor
structural adjustment policies initially required decreased social spending and then triggered additional decreased spending due to the debt accrued.
-had to decrease funding for social programs to get the loans - to pay off the debt, countries often cut spending on social programs again -to get debt relief, often had to cut social program spending yet again
Alma Altas definition of primary care
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Know whether these RTAs are proven to impact maternal mortality, tuberculosis and under-5 mortality
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Know why governments of poor countries back off from challenging the drug patents
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how implementing Regional Trade Agreements can impact: body mass index, incidence of cardiovascular disease, consumption of edible oils, meats, processed foods and sugar-sweetened beverages
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Why was it problematic to use cost-effectiveness to make decisions about TB treatment in Peru?
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evergreening
Allows a pharmaceutical company to extending a patent for minor improvements or changes to a drug
Deductible
Amount you must pay before you begin receiving any benefits from your insurance company
Describe the role of accompagnateurs in their successful treatment of HIV
An accompagnateurs was a paid community health worker who nade daily home visits to ensure the ingestion of medications and patients had access to food
health key sector: access and equity
Any disparities by sex, age, ethnicity, income, education, location?
Health key sector: Demographic & Epidemiologic Change
Changes in the population or changes in the patterns of disease. A health system needs to be able to respond to these.
TRIPS plus
- enact tougher or more restrictive conditions than were initially part of TRIPS- as part of bilateral trade negotiations with the US and the EU - Removed the right for countries to determine their own public health crises
critiques of the world bank
-Governed by the wealthiest countries and therefore represents their interests - Structural adjustment policies often negatively impacted the poor
describe the rationale for the Trump Administrations decision to withhold funding and withdraw from the WHO
-Trump thought that China had kept the Corona Virus from WHO and had influence on WHO - He has also thought this partnership was disadvantageous for Americans
structure of WHO
-each region of the world has regional offices and one country has one vote -develops guidelines, convenes experts, provides technical expertise
Explain some reasons that health care in the U.S. is so expensive
-states regulate the prices - Americans are afraid of communists - pharmaceutical companies - so many insurance companies competing - no price control
Does the mckeown hypothesis hold true for HIV as it did for tuberculosis in the past?
No it doesn't because HIV is about medicine not determinants of health
health key sector: stewardship (governance)
Quality of governance—is it open/transparent? Clear rules/ regulations? Are rules enforced?
health key sector: quality of care
Safe, effective, patient-centered, timely, efficient, equitable
TRIPS
Set minimum standards for protection of intellectual property rights and agree to common standards in patent laws
This wont hurt a bit film: Explain why the U.S. has employer-provided health insurance
competing against other employers, they offer better health insurance so people see them more attractively
public health system
government-run or government funded or both
premiums
monthly payments to have insurance
temoignage in relation to MSF
not just to witness, but also to speak out (bearing witness) MSF never speaks asks the permission of a given population to speak out on their behalf temonignage tool box -quiet diplomacy -transfer of information -denunciation -accusation -withdrawal of a mission
how is TB spread?
spread in the air from one person to another
issues/critiques of the ACA
• Health insurance premiums, in many cases, have gone up • Some people still cannot afford to get health care • Difficulty getting young, healthy individuals to sign up for individual insurance • Difficulties with roll-out of the websites for purchasing insurance • President Obama's original assurance that "If you like your plan, you can keep it" did not hold true -Some physicians won't accept plans from the exchanges - decreases health care provider access even if now have insurance access
health key sector: Financial Protection & the Provision of Universal Coverage
Financing the system without denying healthcare coverage to poor & without making people go bankrupt. Goal: universal coverage for basic package of health services
origins of red cross
Founded in 1849, in response to Crimean war and battle of Solferino Found (Henry Dunant) received the first noble peace prize in 1901 Dunant heavility influenced by witnessing events during WWI - Horrible wounds to soldiers - ICRC became institutionalized as the civilian auxiliary to national, armies
health key sector: financing of a health system
How to fund sufficiently, how to find funding to cover more or to keep covering what system is supposed to cover with changing costs (new tech, drugs, aging pop increase costs)
active TB
Infected, symptomatic and contagious
health key sector: human resources issues
Issues related to health system staff members (includes having sufficient staff, well-trained staff, distributed throughout country where needed, salaries to keep people, high quality work conditions, not losing top skilled workers to other countries/settings).
4 specific examples of how international pharmaceutical companies and the governments of developed countries blocked the ability of developing countries to access generic HIV drugs.
The U.S. response when the South African government was considering generic HIV drugs The response of European leaders and pharmaceutical companies to the Indian company Cipla's offering of HIV triple therapy for $800 per person per year -People were shocked and no one took him up on it or took him seriously The U.S. response to the immediate need for Cipro to be available for treatment of anthrax exposure -Threatened to buy generic drugs from India if the pharmaceutical companies didn't reduce the price of the patent drug - Because Ugandan government allowed generic drugs from India to be let in the country based on what western countries did -The cost of ARVs went down and people dying went down The U.S. response to the Global Fund's plan to purchase generics - Us government said if they bought generic drugs with that money the US would pull out its commitment - They said they would reduce access to these drugs - But in 2003 Clinton said he would commit 15 million dollars to turn the tide against AIDS in Africa and the Caribbean but they bought high branded expensive drugs which meant far fewer lives were saved by the program
selective primary health care
an approach to health care that focuses on using specific interventions to target specific health problems, cost-effectiveness -Growth monitoring -Oral rehydration therapy -Breast feeding -Immunizations
Mission of WHO
attainment by all peoples of the highest possible level of health
latent TB
bacteria lives in your body but doesn't make you sick, its dormant, you cant spread it to others
primary health care
emphasizes health promotion for all , and includes prenatal and well-baby care, nutrition counseling, and disease control. is based on a sustained partnership between client and provider. examples include office or clinic visits and scheduled school/work centered screenings (vision, hearing, obesity) o access to basic care o equitable distribution of resources o local participation § community health workers who are trained in basic health care delivery o achieve level of health that enables productive live § all based on a horizontal approach
universal health coverage (UHC) by the WHO
ensuring that all people have access to needed health services of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship.
AIDS
having 200 or less CD4 cells or having opportunistic infection and being HIV positive
HIV
human immunodeficiency virus detected in blood
the international committee of the red cross
impartial, neutral, and independent organization whose independently humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance." -Focuses on war zones -Does more than just medical care strict doctrine with neutrality and distraction -necessary to operate on the battlefield, problematic during the holocaust -defends the interests of those afflicted by war, cooperation from both sides of war
- know how global health efforts were initially funded (WHO vis member state contributions) and how the emergence of Gavi and the Global Fund marked a shift in that approach
initially funded by the UN WHO gets most of their funds from US, UK, and the Bill & Melinda gates foundations - it marked a shift towards a separate fund that was specifically focused on AIDS, TB and malaria
co-payments
like a user fee, an individual pays part of the cost, but it is a flat fee
Structure of World Bank
made up of 5 instituions mainly 2 tho (International Bank for Reconstruction and Development (IBRD) and International Development Association (IDA)
mutuelle health insurance plan
mandated by the government so every citizen has to buy health insurance
UK health system
o Strengths: government pays for health care via NHS o Challenges: don't prioritize non-life threatening conditions
Switzerland health system
o Strengths: high copays, system that is humane o Challenges: have to have a job, strict, its enforced, its expensive ???
Cuba Health System
o Strengths: prevention, high immunization rates, they do field visits o Challenges: difficult to get medication o Their health system is a model for the world
private health system
paid for or run by groups other than the government
health care is a right reading: Americans agree broadly on one topic about who the rules should apply to--who should they apply to
people who contribute to health care costs and contribute to society
Mission of the World Bank
promote general economic development provides loans to developing countries
examples of horizontal approach
rural doctors of India and the "barefoot doctors" of the People's Republic of China bc - its community based medicine, relied on grassroots participation
critiques of TRIPS
sets only minimum standards, lets countries decide, its vague, allows evergreening, Aims at extending the stricter patenting laws previously used in industrialized countries to developing countries, regardless of their radically different social and economic conditions -Life-saving medicines are considered the same as mere consumer goods and lifestyle drugs - The danger is that TRIPS extends high drug prices and worsens the crisis of access to medicines
horizontal approach
tackle the overall health problems on a wide front and on a long term bases through the creations of a system of permanent institutions commonly known as general health services
co-insurance
the individual pays part of the cost, but it is a % of the cost
two metrics the WHO is using to measure UHC
the proportion of a population that can - access essential quality health services that spends a large amount of household income on health
health care is a right reading: What two values does he state are in tension? (What do we want to reward and who do we want to protect?)
whether the government should step up or back down regarding health care rights. reward those who work. protect those who are disabled or mentally ill
successes/benefits of the ACA
• Ambulatory patient services (outpatient services) • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services and devices (those that help patients acquire, maintain, or improve skills necessary for daily functioning) • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care • More than 20 million people gained health insurance under the ACA according to the Dept of Health & Human Services (as of March 2016)
