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French Version

Diseases of the poor, Medicine for the rich : How can inequality be reduced ?

I - World health: the paradoxes

There are ever-widening inequalities in terms of access to healthcare. The sick are in the South and the medication is in the North. Infectious diseases are now the primary cause of mortality in the world. Africa and South Asia are the two areas of the planet with the most health problems. Two-thirds of the 35 million people who suffer from AIDS are in Africa (Laurence Ferrari; Bernard Kouchner). In the South, out of the 30 million people with AIDS only 50,000 are currently undergoing treatment. These figures include 13,000 patients in Africa, each of whom is allocated 440 dollars annually for treatment, compared with thousands of dollars for patients in Europe (Kouchner).

Life expectancy has fallen by 15 years in Africa, but continues to rise in developed countries (Michel Kazatchine). 80% of the world’s population consumes 20% of the world’s drugs. Developing countries devote 7 dollars per person per year to health spending (Ali Sedrati).

II – Health and globalisation

The question of health in developing countries should not be reduced to the problem of AIDS, even though it is a threat to their survival. Diseases that are today considered as curable in the North continue to decimate the populations of developing countries (Kouchner, Jean-François Girard). The question of health must be examined from a wider perspective. The success of globalisation depends on how health problems are tackled (Sedrati, Kouchner and Girard). This is where the real challenges of globalisation lie. In today’s world, diseases know no borders. International opinion is increasingly aware of the problem and means are being mobilised to meet the challenge (Kazatchine). However, this mobilisation often takes time, as was shown in the case of the International Therapeutic Solidarity Fund (Hakima Himmich). Despite certain self-centred attitudes, France’s actions in Morocco should be praised (Hakima). The clash of poverty versus wealth is far more serious than the clash of civilisations, religions and cultures (Sedrati).

III - Possible solutions

Twinning hospitals and North-South solidarity
One of the possible solutions to the problem is to twin hospitals in the North and South. This fosters exchanges and mutual support, as reflected in the work of Médecins du Monde (Kouchner).

The countries of the North must show more solidarity and generosity towards those of the South. The problems of sick poor people in the South can only addressed by having access to money in the North. Treatment is of course expensive, but we cannot afford not to spend money to save human lives. It is up to the leaders in the North to find the money to relieve people’s suffering in their countries and elsewhere in the world (Kouchner; Jean-François Girard). If we are unable to give a ray of hope to those who are condemned to die, we hasten their death. The indifference of countries in the North to the misery and suffering in the South can only lead to humanitarian catastrophes (Hakima), hence the need for the right to intervention in healthcare (Kouchner).

Lowering drug prices and access to healthcare
All the speakers agreed that efforts still need to be made to make drugs cheaper and more accessible. The WTO agreements on generic drugs should be extended to allow countries not only to make generic drugs but also to export them.

We must build a new system to improve transparency in setting drug prices (Kazatchine).

Increasing investment in research
We must do away with a certain number of generally accepted ideas about the relevance of financing research. Research is one of the engines of development. There is a definite correlation between research and development (Girard).

Focus on prevention
Prevention must be at the centre of all health strategies, simply because it is less costly (Simon-Xavier Guerrand-Hermès).

Jean-François GIRARD, President of the Institut de recherche pour le développement
Simon Xavier GUERRAND-HERMES, President of the Guerrand-Hermès Foundation for Peace
Hakima HIMMICH, professeur de médecine, spécialiste des maladies infectieuses
Michel KAZATCHKINE, President of the Agence nationale de recherche sur le Sida
Bernard KOUCHNER, former Minister of Health
Ali SEDRATI, President of the Association marocaine de l'industrie pharmaceutique

Paris,03 08 2004
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