China and Global Health: Partner or Problem

1
China and Global HealthPartner or Problem?

• Gerald Bloom
• Institute of Development Studies
• Co-Chair, China Health Development Forum
• February 11, 2009

2
Chinas rapid developmentglobal health
challenges and opportunities

• The emergence of new diseases and the spread of
  treatment resistant organisms
• Quality, safety and cost of drugs and other
  products
• Research and development of new products and
  treatment strategies
• Potential emergence of new types of health
  service delivery organisation
• Potential challenges to existing governance
  arrangements

3
Growing demand for health-related goods and
services

• Rapid rise in health spending
• Increasing use of diagnostic technologies and
  pharmaceuticals
• Growth of production of health-related
  commodities
• Development of pharmaceutical distribution
  network and wide variety of health service
  providers
• Demand for good quality and trustworthy health
  services

4
Crossing the river by feeling for the stones
The health sector has grown much faster than the
emergence of organisations and the institutional
arrangements to influence their performance. Many
health transactions take place in a largely
unorganised market
5
Problems and scandals

• Rising cost of medical care, concerns about its
  effectiveness and safety and about the quality of
  drugs (media, malpractice and political
  statements)
• Challenge of SARS and continuing threat of Avian
  Influenza
• Quality and safety of milk and other
  health-related products
• Growing role of the media and information and
  communications technology
• The government is investing a lot of political
  capital in addressing these issues and trying to
  build rules-based institutions

6
Institutions for effective health services
building rules-based arrangements

• Monitoring for unethical behaviour by
  accountability bodies and the courts
• Reduction of incentives to provide costly care
• Creation of Food and Drug Administration
• Strengthening disease surveillance by Centre for
  Disease Control
• Creation of urban and rural health insurance and
  measures to strengthen health facility management
  
• Major increase in public health budgets

7
China engages with global markets

• Pharmaceutical companies go global
• Major weaknesses in drug distribution networks
  (safety, branding and the challenge of
  counterfeits)
• Building regulatory agencies and the need for
  regulatory partnerships
• Reputation, competition and non-tariff barriers

8
Chinas segmented markets and the politics of
institutional development

• Urban areas linked to global markets
• Rural and peri-urban counties with incentive to
  produce and purchase low cost products
• Limited and unequal reach of regulatory system
  and effective public sector management
• Partnerships with international organisations,
  regulatory bodies, international firms and donor
  agencies (DFID engagement in rural health reform
  and response to HIV)

9
China innovates

• Research, development and new pharmaceuticals
  (search for the next artemesia)
• Insurance schemes make large-scale clinical
  trials possible
• Risk, regulation and the development of new
  technologies
• Possibilities for new types of production and
  service delivery organisation

10
China and global governance

• The rules of global trade and the development of
  local institutions
• Markets, aid and health sector programmes in low
  income countries
• Regional initiatives and epidemic outbreaks
• Engagement with international organisations (WHO,
  etc.)
• Potential reforms to global governance and
  international law

11
Co-operation and competitionnew order or
greater disorder

• Pharmaceutical markets, counterfeits,
  competition, the need for regulation and changes
  to value chain governance
• Transparency, surveillance and response to health
  threats
• New technologies and ethical research and
  development
• New markets and public health in low income
  countries
• Towards rules-based global governance?

12
Mutual learning for global healththe China
Health Development Forum

• Hosted by Ministry of Health think tank to
  organise informal exchanges between researchers,
  policy-makers and managers
• Building links with counterparts in Asia through
  research consortia and the establishment of
  inter-institutional relationships
• Bridging cultural, historical and linguistic
  divides with Latin America
• Changing understanding of links to European
  countries (from study tours and the important of
  organisational models to mutual exchanges and
  learning)

13
Mutual learning for global healthbuilding
Sino-British links

• Maintain UK engagement with Chinese Ministry of
  Health in support of rural heath reforms in other
  areas of inter-ministerial collaboration
• Build on experience of partnership in Western
  China Development to design new kinds of
  partnership for health in Africa
• Engage with WHO and other international agencies
  on shared global health agenda and international
  law
• Encourage Sino-British partnerships for research,
  innovation and development
• Engage with UK firms to assess future markets and
  regulation and global governance negotiations