TPP affecting health policies?

The present debate on the TPPA in Malaysia is part of the global discussion on how trade and investment treaties are affecting health, including access to medicines and tobacco control.

ARE big companies making use of trade and investment agreements to challenge health policies? Evidence is building up that they do so, with medicine prices going up and tobacco control measures being suppressed.

This issue came up in Parliament last week when International Trade and Industry Minister Datuk Seri Mustapha Mohamed said the Government would not allow the Trans-Pacific Partnership Agreement (TPPA) to cause the prices of generic medicines to go up.

He added he would defend existing policies on patents and medicines and if we don’t agree with some of the terms, we can choose not to sign it.

Trade agreements and health concerns are linked because some companies selling tobacco, medicines and food are using these agreements to sue governments that introduce new regulations to safeguard public health.

Malaysia will host the next round of the TPPA negotiations this month, so the debate on these issues can be expected to continue.

The World Health Organisation’s Director-General Dr Margaret Chan recently noted that corporate interests are preventing health measures.

The cost of non-communicable diseases are shooting up. The costs for advanced cancer care are unsustainable, even in rich nations and some countries spend 15% of the health budget on diabetes.

“In the developing world, the cost of these diseases can easily cancel out the benefits of economic gain,” she said. It is harder to get people to adopt healthy lifestyles because of opposition by “unfriendly forces”.

“Efforts to prevent non-communicable diseases go against business interests. These are powerful economic operators. It is not just Big Tobacco anymore. Public health must also contend with Big Food, Big Soda and Big Alcohol. All of these industries fear regulation and protect themselves by using the same tactics,” said Dr Chan.

Those tactics include “front groups, lobbies, promises of self-regulation, lawsuits and industry funded research that confuses the evidence and keeps the public in doubt”.

Many studies show how trade agreements with the United States or Europe have raised the prices of medicines because of the constraints placed by the FTA’s strict patent rules on the sale of cheaper generic medicines. Patients have had to switch to costlier branded medicines.

One study estimated that Colombia would need to spend an extra US$1.5bil (RM4.74bil) a year on medicines by 2030 or people would have to reduce medicine consumption by 44% by that year.

“Data exclusivity”, one of the features of the FTA, has delayed the introduction of cheaper generic versions of 79% of medicines launched by 21 multinational companies between 2002 and mid-2006 and, ultimately, the higher medicine prices are threatening the financial sustainability of government health programmes.

The tobacco industry is also making use of trade and investment agreements to challenge governments’ tobacco control measures.

According to an article by Prof Mathew Porterfield of Georgetown University Law Centre, the company Philip Morris has asked the US government to use the TPPA to limit restrictions on tobacco marketing.

In comments submitted to the US trade representative (USTR) , Philip Morris argued that Australia’s plain packaging regulations would be “tantamount to expropriation” of its intellectual property rights, and complained of the broad authority delegated to Singapore’s Health Minister to restrict tobacco marketing.

In order to address these “excessive legislative proposals”, Philip Morris urged USTR to pursue both strong protections for intellectual property and inclusion of the investor-state dispute settlement mechanism in the TPPA.

The company has instituted legal cases against Uruguay and Australia for requiring that cigarette boxes have “plain packaging”, with the companies’ names and logos disallowed.

These cases are under bilateral investment agreements. The company claims that the packaging regulations violate its right to use its trademark, and also violate the agreement’s principle of “fair and equitable treatment”.

It claims that a change in government regulation that affects its profits and property is an “expropriation” for which it should be compensated.

Under such agreements, companies have sued governments for millions or even billions of dollars.

The provisions in the bilateral investment treaties are also present in trade agreements including the TPPA. Companies can directly sue the governments in an international court, under an investor-state dispute system.

Having been sued by the tobacco company for its health measure, the Australian government has decided not to enter any more agreements that have an investor-state dispute system.

In the TPPA negotiations, Australia has asked that it be granted an exemption from that agreement’s investor-state dispute system. So far, such an exemption has not been agreed to.

The controversies over how trade and investment agreements are threatening health policies will not go away, because the rules are still in place and new treaties like the TPPA are coming into being.

A “Google search” on this issue will yield hundreds, in fact, many thousands of documents. And the number will go up as long as the controversy continues.

Global Trends
By MARTIN KHOR

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No time to be patient

Can we, Malaysians, not see the changes we so long for in our lifetime?

NELSON Mandela is dying. The world waits sombrely and respectfully for what seems to be inevitable. He has lived to a good age – he turns 95 on July 18 – and it is time to let him go. What’s more, this great man’s place in history is assured.

He is in the same league as Mahatma Gandhi and Abraham Lincoln, for what he did for his country.

Yet, I wonder: Mandela was in his Robben Island prison cell for 27 years. During that time, did he ever think he would not live to see the end of apartheid in his beloved South Africa. Perhaps he thought, “Not in my lifetime.”

“Not in my lifetime”, that’s what we say to denote the unlikelihood of something momentous or significant happening or coming to fruition within our life span.

I guess NIML (as those four words have been abbreviated in this Internet age) would have crossed the minds of cynics concerning the fight to end slavery or suffrage for women in centuries past.

“Freedom for slaves? Never, not in my lifetime?” “Vote for women? Balderdash! Surely not in my lifetime.”

In our more recent past, so many amazing things have changed or taken place that were thought quite impossible, at least NIML: The creation of the Pill that sparked the sexual revolution, men walking on the moon and the birth of the first test-tube baby.

I remember when “Made in Japan” was a byword for shoddily made products that didn’t last and China was an uptight communist state where its repressed people dressed in monochrome colours and were deprived of life’s little luxuries.

Today, Japanese-made products are synonymous with quality; Russia and China are practically unrecognisable from the USSR and China of, say, 1985.

So too South Korea, now east Asia’s poster nation. But it wasn’t too long ago it was under a repressive military dictatorship and it was only in May 1980 that the Gwangju Uprising began that nation’s transformation to liberal democracy.

Who would have thought back in the 1980s, that many Chinese nationals and Russians would become obscenely rich citizens living freely in various parts of the world; or that South Korea would rule with “soft” power through its pop culture.

Ironically, I found Korean music grating and unpleasant during the opening ceremony of the 1988 Seoul Olympic Games. Twenty-five years on, I can hum Arirang, Korea’s popular folk song, and have k-pop songs on my handphone, a Samsung Galaxy, of course.

All that in my lifetime. And I am not that old. Really.

Change is a constant throughout the ages but the current speed of it is what takes our breath away. We accept and even demand it when it involves technology, our devices and machines.

Japanese scientists are ready to send a talking robot called Kirobo into space that can communicate directly with astronauts on board the International Space Station.

Better still, researchers just announced that people with severe spinal cord injuries can walk again with ground-breaking stem cell therapy that regrows nerve fibres.

Dr Wise Young, chief executive officer of the China Spinal Cord Injury Network, was quoted as saying: “It’s the first time in human history that we can see the regeneration of the spinal cord.”

He further declared: “This will convince the doctors of the world that they do not need to tell patients ‘you will never walk again’.”

It is a pity quadriplegic Christopher Reeve, who will always be Superman to his fans, did not live to see it happen in his lifetime.

Yet, strangely enough, when it comes to change to create a better and safer society, change to weeding out corruption, change to needs-based policies, change to save our education system, change to end institutionalised racism, we seem willing to apply brakes and decelerate.

We tell ourselves, “slowly lah”, or “some things take time” and yes, even “not in our lifetime” because we believe the things we want changed are too entrenched or too rotten.

I refuse to accept that because, as I have repeatedly lamented, we don’t have the time to slow such things down. We need to change urgently and effectively or we will fall further behind other nations. What I think we need for effective change to happen is great statesmanship and selflessness from our leaders.

While Mandela is rightly honoured and revered, he could not have succeeded in ending apartheid without the support and courage of F.W. de Klerk, the now largely forgotten last white president of South Africa who freed Mandela.

Similarly, it was Mikhail Gorbachev, the last general secretary of the Soviet Union who brought political, social and economic reforms that ended both the USSR and the Cold War.

It is men in power like them who had the political will, the vision and steely courage to dismantle their untenable systems of government and set their nations on the path of a new future.

Do we have a de Klerk or Gorbachev among our leaders who will demolish race-based politics and policies, free our education system from politics and truly fight corruption and crime? A leader who will move our nation onto a new path of greatness by quickly harnessing all the talents that a multiracial Malaysia has to offer without fear or bias?

Can it happen in my lifetime? Since I have seen what was deemed impossible, NIML, the first black man elected US President, I want to believe the answer is yes, we can.

So Aunty, So What? By JUNE H.L. WONG

> The aunty likes this quote: Patience is good only when it is the shortest way to a good end; otherwise, impatience is better. Feedback: junewong@thestar.com.my or tweet @JuneHL­Wong

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Doing good well - there's greater impact in helping through informed giving

TWO weeks ago, I was on a flight back from Singapore. One of the newspapers had a poignant picture of a young boy in tears. I could practically feel him staring at me.

He had been rescued from a saree embroidery factory in Kathmandu. Child labour in the Kathmandu Valley is extensive and there are up to 80 such factories which employ more than 500 children, mostly below the age of 14, to make those sarees. And the sad part of the story is that many do not want to be rescued.

The Kathmandu operation was timed to coincide with World Against Child Labour Day which was on June 12. According to the International Labour Organisation, hundreds of millions of girls and boys throughout the world are involved in work that deprives them from receiving adequate education, health, leisure and basic freedoms.

More than half of these children are exposed to abuse because they work in hazardous environments where slavery, forced labour, illicit activities such as drug trafficking and prostitution, and armed conflict are common.

The plight of these children weighed heavy on my mind on this short flight back.

The following week, I was on the road listening to the radio and I learnt that World Refugees Day was on June 20. It is estimated that more than 45 million people worldwide have fled their homes due to conflict, persecution and other abuses.

In Malaysia, there are over 100,000 registered refugees in Kuala Lumpur alone, and one can imagine the actual figures nationwide, especially those not registered.

In looking at the two big issues here, we may wonder what we can do to make a difference in the lives of so many people.

Certainly there are many communities who will benefit from our giving and volunteer efforts – the aged, homeless, abused children and women, addicts, the poor,disabled, orphans, victims of human trafficking, etc to name a few. Then there are the sporadic needs in times of natural disasters.

And this is where the work of NGOs is significant. Many NGOs come about in response to a specific need and are small and limited in their operations. But there are an estimated 20,000 NGOs that operate globally because the causes they fight for transcend national borders.

And for the work they do, they need support. Some of these NGOs have a strong global presence and are able to draw funds and resources from many sources.

An executive from a large company once asked me what worthwhile organisation or group his company can contribute to.

I pointed them to a community in need of help for social change. They are children in estates who need assistance to enable them to stay in school. I told him that it would be better for him to visit the community in a somewhat remote area and understand their situation and needs.

The legwork proved to be a deterrent and so the company chose a children’s home in the Klang Valley instead. It was easier to arrange and provided ample photo opportunities for the company’s magazine.

There are many us who are willing to give and contribute. However, our giving can go further when it is done right.

For a start, we should go beyond being compassionate and generous, and instead be prepared to do due diligence to determine the deserving causes. This is called “informed giving” and it requires us to hold the organisation accountable so that the funds given are effectively used. It is not just giving, but following up for accountability and performance.

Sometimes it might be better to channel the funds raised to a reputable foundation to be administered instead of making the contributions direct. When I made this suggestion at a recent fundraising discussion, it was met with some laughter. Why would you give money to another organisation which already has so much money?

I know of trustees in a charitable foundation who diligently visit the communities they support. They want to see for themselves how the money is spent, whether the classroom has been built, and how the children who received financial aid were doing.

Just as the executive could not find the time to check out the community I recommended, many of us also do not have the time to do follow-up and accountability.

So we should consider those organisations which take the work of giving seriously. They are the ones that are managed professionally, with full transparency and accountability.

Companies and individuals can partner with such organisations which are more efficient and have a proven track record in helping others.

This is the reason why Warren Buffett gives such generous amounts to the Bill and Melinda Gates Foundation to pass on to the right people. Buffet knows that he should just continue to do what he does best, which is to make a lot of money, rather than rolling up his sleeves to manage the giving directly.

There are many practices in companies which can be applied to social work to transform lives.

Like businesses, charitable organisations need the best leaders and people to execute the programmes.

Many of the issues faced are complex. We need to understand the issues and provide insights on the right solutions to address the root causes of the problems.

Which is why simply doing good is not enough. We need to move to “doing good well”.

TAKE ON CHANGE By JOAN HOI

● Joan is inspired and influenced by the book, Doing Good Well. What does (and does not) make sense in the non-profit world by Willie Cheng.

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 About Doing Good Well 

 The way we see the world can change the world. In this book, Willie Cheng frames and explains the nonprofit world while providing fresh insights as to where and why it works - or not. 

He covers a spectrum of nonprofit paradigms including:

•	The structure of the marketplace - challenging whether a “marketplace” truly exists.

•	Concepts of nonprofit management - disputing why charities must follow corporate mantras of growth and reserves accumulation.

•	Philanthropy and volunteerism - questioning the motivations of givers.

•	New social models of social enterprises, social entrepreneurship and venture philanthropy - seeking to explain why these may not have worked as intended.

•	Nonprofit quirks - showing how the rules can result in the extension of the rich/poor divide into the charity world and make fundraising inefficient through an efficiency ratio.

In describing his ideas through an easy writing style and hearty anecdotes, Cheng engages and provokes the reader with a strategic review of the status quo as well as the enormous potential in the nonprofit world. After all, as Cheng describes it, charity is no longer simply about “Just Doing Good” but “Doing Good Well.”