Policy Tag: Access to Care

Adopted by the 200th WMA Council Session, Oslo, April 2015,
and adopted, with amendments by the 72nd WMA General Assembly (online), London, United Kingdom, October 2021 

 

PREAMBLE

Trade agreements are treaties between two or more countries which include provisions addressing trade in goods and/or services. Trade agreements are tools of globalization and typically seek to promote global wealth through trade liberalization. They can have significant implications for the social, commercial, political and ecological determinants of health as well as the delivery of health care. 

International trade contributes significantly to increases in national wealth which is a key factor in building strong health care systems.  

While trade agreements are designed to produce economic benefits and global wealth, it is fundamental to identify public health implications that may arise from these agreements.  

Negotiations should take into account broad impact to ensure that the right to health and to a healthy natural and social environment are well-prioritized. Trade agreements should be directed at contributing to global health and equity. 

Trade agreements may have the ability to promote the health and wellbeing of all people when they are well-designed to protect health and preserve the ability of governments to legislate, regulate and plan for health promotion, health care delivery and health equity. 

Recent trade agreement negotiations have sought to establish a new global governance framework for trade and have been unprecedented in their size, scope and secrecy. A lack of transparency and the selective sharing of information with a limited set of stakeholders are anti-democratic. 

There must be recognition of the importance of innovation sharing in public health. This is particularly important during health emergencies. Access to medicines and medical supplies is essential to address the major public health problems such as pandemics and trade agreements must not act as a barrier to that access. 

Investor-state dispute settlement (ISDS) provides a mechanism for investors to bring claims against governments and seek compensation, operating outside existing systems of accountability and transparency. ISDS in existing trade agreements has been used to challenge evidence-based public health measures including tobacco plain packaging. Inclusion of a broad ISDS mechanism could threaten public health actions designed to support evidence-based tobacco control, alcohol control, healthy and safe food consumption including regulation of obesogenic foods and beverages, access to medicines, health care services, environmental protection/climate change and occupational / environmental health protections. Efforts by industry to challenge domestic public health laws and regulation have targeted nations with limited access to legal resources and some of the world’s most vulnerable populations. 

Access to affordable medicines is critical to controlling the global burdens of communicable and non-communicable diseases. The World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) established a set of common international rules governing the protection of intellectual property including the patenting of pharmaceuticals. TRIPS safeguards and flexibilities including compulsory licensing seek to ensure that patent protection does not supersede public health. 

The WMA Statement on Patenting Medical Procedures states that patenting of diagnostic, therapeutic and surgical techniques is unethical and “poses serious risks to the effective practice of medicine by potentially limiting the availability of new procedures to patients.” 

Trade agreements should not pose a new difficulty in accessing medicines, especially for developing countries and for the most vulnerable populations. 

There must be a fair balance established between the prices of medicines and the protection of intellectual property through patents. 

The WMA considers that patenting on medicines/vaccines must be regulated in accordance with the ethical principles and values of the medical profession in order to ensure effective and global action for public health and therefore recognizes that it may be necessary to temporarily waive patents in times of public health emergencies.  Moreover, to produce fast and comprehensive results, sustainable solutions for patent issues must be supplemented by the transfer of technology, knowledge, and manufacturing expertise, global investment in manufacturing sites, training of personnel, and quality control. 

The WMA Resolution on Medical Workforce states that the WMA has recognized the need for investment in medical education and has called on governments to “…allocate sufficient financial resources for the education, training, development, recruitment and retention of physicians to meet the medical needs of the entire population…” 

The WMA Declaration of Delhi on Health and Climate Change states that global climate change has had and will continue to have serious consequences for health and demands comprehensive action. 

The WMA Declaration on Fair Trade in Medical Products and Devices states that purchasing policies for medical goods should be fair and ethical, working conditions should be safe and modern slavery should be eradicated throughout supply chains. Health product manufacturers should establish a plan for continuity of supply of vital and life-sustaining products to avoid production shortages whenever possible. This plan should include establishing the necessary resiliency and redundancy in manufacturing capability to minimize disruptions of supplies. 

 

RECOMMENDATIONS 

 Therefore, the WMA calls on national governments and constituent member associations to: 

1.Call for transparency and openness in all trade agreement negotiations including public access to negotiating texts and meaningful opportunities for stakeholder engagement. 

2. Call for a proactive assessment of anticipated effects on health, human rights, and the environment for all trade agreements. 

3. Advocate for trade agreements that protect, promote and prioritize public health over commercial or political interests, and secure services in the public interest, especially those affecting individual and public health. This should include new modalities of health care provision including eHealth. 

4. Ensure that trade agreements do not have negative impacts on health systems, human resources for health and universal health coverage (UHC). Ensure trade agreements do not interfere with governments’ ability to protect and regulate health and health care, or to guarantee a right to health for all. Government action to protect and promote health should not be subject to challenge through an investor-state dispute settlement (ISDS) or similar mechanism.

5. Work to ensure that patents on medicines and vaccines are regulated in accordance with the principles of medical ethics, in order to protect public health in global emergency situations.  

6. Therefore, urge NMAs to promote the possibility of temporarily waiving patents on medicines and vaccines to protect public health in global emergency situations while ensuring fair compensation for the intellectual property of the patent holders, global investment in manufacturing sites, and knowledge transfer. Promote public health, equity, solidarity and social justice and protect countries and people who are weaker economically and health-wise, and therefore most vulnerable. 

7. Oppose any trade agreement provisions which would compromise access to health care services or medicines including but not limited to: 

  • Patenting (or patent enforcement) of diagnostic, therapeutic and surgical techniques; 
  • “Evergreening”, or patent protection for minor modifications of existing drugs; 
  • Patent linkage or other patent term adjustments that serve as a barrier to generic entry into the market; 
  • Data exclusivity for biologics; 
  • Any effort to undermine TRIPS safeguards or restrict TRIPS flexibilities including compulsory licensing; 
  • Limits on clinical trial data transparency. 

8. Oppose any trade agreement provision which would reduce public support for or facilitate commercialization of medical education. 

9. Oppose any trade agreement which would facilitate the inappropriate privatization of public services in areas such as conservation of natural environment, education, healthcare, and daily necessities such as energy and water. 

10. Ensure that trade agreements promote environmental protection and support efforts to reduce activities that cause climate change. 

 11. Ensure that trade agreements promote equity and human rights and include mechanisms for accountability following implementation. 

 

 

Adopted by the 60th WMA General Assembly, New Delhi, India, October 2009
and rescinded and archived by the 71st WMA General Assembly (online), Cordoba, Spain, October 2020

PREAMBLE

For over 150 years, the existence of health inequality has been acknowledged worldwide. The recently published Final Report of the WHO Commission on Social Determinants of Health  has highlighted the critical importance of health equity to the health, economy and social cohesiveness of all countries. It is clear that while there are major differences between countries, especially between the developing and developed countries, there are also substantial disparities within countries with respect to various measures of socio-economic and cultural diversity. Disparities in health can be defined as either disparities in access to healthcare, disparities in quality of care received, or both. The differences manifest themselves in a wide variety of health measures, such as life expectancy, infant mortality, and childhood mortality. Particularly disturbing is evidence of the gradual and ongoing widening of specific disparities.

At the core of this issue is the healthcare provided by physicians. National medical associations should take an active role in combating social and health inequalities in order to allow their physician members the ability to provide equal, quality service to all.

The Role of the Health Care System:

While the major causes of health disparities lie in the socio-economic and cultural diversity of population groups, there is a very significant role for the health care system in their prevention and reduction. This role can be summarized as follows:

  • To prevent the health effects of socio-economic and cultural inequality and inequity – especially by health promotion and disease prevention activities (Primary Prevention)
  • To Identify, treat and reduce existing health inequality, e.g. early diagnosis of disease, quality management of chronic disease, rehabilitation (Secondary and Tertiary Prevention).

RECOMMENDATIONS

The members of the medical profession, faced with treating the results of this inequity, have a major responsibility and call on their national medical associations to:

  • Recognize the importance of health inequality and the need to influence national policy and action for its prevention and reduction
  • Identify the social and cultural risk factors to which patients and families are exposed and to plan clinical activities (diagnostic and treatment) to counter their consequences.
  • Advocate for the abolishment of financial barriers to obtaining needed medical care.
  • Advocate for equal access for all to health care services irrespective of geographic, social, age, gender, religious, ethnic and economic differences or sexual orientation.
  • Require the inclusion of health inequality studies (including the scope, severity, causes, health, economic and social implications) as well as the provision of cultural competence tools, at all levels of academic medical training, including further training for those already in clinical practice.

Adopted by the 50th World Medical Assembly, Ottawa, Canada, October 1998
and amended by the 60th WMA General Assembly, New Delhi, India, October 2009 and
rescinded and archived by the 70th WMA General Assembly, Tbilisi, October 2019

INTRODUCTION

Each country should have a health system with enough resources to attend to the needs of its population. However today, many countries across the world are suffering wide inequities and inequalities in health care and this is causing problems of access to health services for the poorer segments of society [the weak or underprivileged]. The situation is especially serious in low-income countries.

The international community has attempted to improve the situation. The 20/20 initiative of 1995, the 1996 Initiative for Heavily Indebted Poor Countries (HIPC), and Objectives for Millennium 2000 Development (MDGs) are all initiatives aimed at reducing poverty and dealing with poor health, inequities and inequalities between the sexes, education, insufficient access to drinking water and environmental contamination.

The objectives are formed as an agreement with acknowledgement of the contributions which developed countries can make, in the shape of trade relations, development assistance, reduction of the burden of debt, improving access to essential medication and the transfer of technology. Three of the eight objectives are directly related to health, which has a considerable influence on various other objectives that interact to support each of the others within a structural framework, these are designed to increase human development globally. The eight Millennium Development Objectives (MDO) foresee a development vision based on health and education, thus affirming that development does not only refer (allude) to economic growth.

Various reports from the World Health Organization have underlined the opportunities and skills [or techniques] which are currently involved in bringing about significant improvements in health, as well as helping to reduce poverty and encourage growth. Additionally, the reports highlight the fact that it is of fundamental importance to reduce limitations on human resources, in order to increase the achievements of the public health system, a situation which requires urgent attention. These limitations are related to work, training and payment conditions, and play a substantial role in determining capacity for sustained growth of access to health services.

RECOMMENDATIONS

The World Medical Association urges National Medical Associations to:

1. Advocate that their governments should adhere to and promote the proposals to increase investment in the health sector; and to adhere to and promote initiatives to reduce the debt burden for the poorest countries on the planet.

2. Advocate [defend] the inclusion of public health factors in all fields of policy provision, since health is mostly determined by factors that are external to the area of healthcare, for example, housing and education. [Health is not only medicine, it also depends on living standards].

3. Encourage and support countries in the planning and implementation of investment plans, which invest in health for the poor; guarantee that more resources be used for health in general, with greater efficiency and impact; and reduce limitations for the most effective use of the additional investments.

4. Maintain vigilance to ensure that the investment plans focus maximum attention on generating capacity, that they promote leadership skills and promote incentives to retain and place qualified personnel, whilst it is taken into consideration that the limitations in relation to the previous matter currently constitute the greatest obstacle for progress.

5. Urge international financial institutions and other important donors to: i) Adopt the necessary measures to help the countries that have already organised mechanisms to prepare their investment plans, and provide assistance to those countries that have begun to take the necessary steps, with the support and participation of the international community; ii) Help countries to obtain funds to develop and implement their investment plans; iii) Continue providing technical assistance to the countries for their plans.

6. Exchange information in order to coordinate efforts to change policies in these areas.