‘Choices in Global Health: whom do we choose to ignore?’

Access to basic healthcare is a human right. According to Prof. Hans Hogerzeil, withdrawing provisions such as modern contraceptives for young women aged 21 to 25 from the basic healthcare package is a violation of the Human Rights agreements which the Netherlands has signed. Hogerzeil was appointed professor of Global Health at the University Medical Center Groningen (UMCG) and held his inaugural lecture on 19 March 2013.

Global Health involves several disciplines working together to identify and expose the consequences of policy. To illustrate his point, Hogerzeil cites the withdrawal of contraceptives from the basic healthcare package for women aged 21 to 25. ‘Economists argue that women are in a position to pay for it themselves. Although this may be true of some of the 500,000 women in this group, have we really considered the consequences for those who cannot afford it?’ Hogerzeil points to young women living at home with no money of their own, because they bring all their income to the family, or students who get pregnant and are unable to complete their studies. ‘If we ignore these women, we are undermining their chances for empowerment and interfere with their right to self-determination.’

Drugs market

Access to medicines is an important theme within Global Health. ‘In some countries, people spend half of their income on medicines,’ explains Hogerzeil. ‘The free market is reinforcing inequality in access to essential medicines in low- and middle income countries. Research has shown that governments are often able to provide essential medicines to an entire population within existing budgets by opting for unbranded, generic drugs, which are 3-6 times cheaper than branded products.’ Hogerzeil argues that governments can stop reimbursing more expensive branded medicines for some people in the interests of the right to basic healthcare facilities for the population as a whole.

Challenge

‘We are currently facing the enormous challenge of trying to realize global healthcare for an ever-increasing number of people with chronic illnesses such as diabetes, asthma and cardiovascular disease. Along with cancer, these are the fastest-growing illnesses among people in countries with low- and middle incomes. They account for approximately 80% of all deaths in these countries,’ says Hogerzeil. Many patients with these diseases need life long treatment, which they are unable to afford. A lot of them find themselves bankrupt before they eventually die.

Insulin

Hogerzeil uses insulin to explain the importance of generic drugs. People with type 1 diabetes need a daily dose of insulin because their bodies are unable to produce it. ‘In some countries, insulin is only available via the free market, making it 7 times more expensive than a generic equivalent, which could be prescribed via public healthcare provisions.’ Hogerzeil stresses that insulin can be made affordable for poor people by introducing targeted policy. ‘Why do you think there are so few adults in Africa with insulin-dependent (type 1) diabetes?’ His conclusion: ‘Because they’ve never had the chance to become adults. By opting for a free market, you are excluding poor people. And by opting for a free market, the number of poor people will grow. The number of poor people in the world increases yearly by 150 million. Many of these people have gone bankrupt because of the medical costs they are forced to pay. They have already sold off their livestock and land and have no other way of generating income.’

Policy

An international group of researchers headed by Hogerzeil recently put forward a case in the leading journal The Lancet, stating that the access to life-saving medicines for people with chronic illnesses in countries with low- and lower middle incomes could be seriously improved. Governments should make well-considered decisions about purchasing these medicines and actively target high-risk patients. ‘This requires strong governments wanting to pursue policies in line with the interests of the population. In Groningen, we educate our medical students to become aware of such issues; and some of them may be able to make a difference in the future.’ Hogerzeil has noticed that governments in developing countries are standing up for their rights and interests, and refuse to accept that wealthy countries are defining the global healthcare strategies.

Training

Four years ago, the UMCG launched a unique, English programme in Medicine with an international Bachelor’s programme in Medicine, Global Health Profile. ‘We are training some 80-90 international medical students per year, all with a special Global Health profile,’ explains Hogerzeil. ‘This is the first University of Groningen programme in which the students work and learn together as a learning community. More learning communities will be set up for medical students in Groningen as from 2014.’ Hogerzeil has been given the task of further developing the programme and promoting scientific research into Global Health in Groningen.

Curriculum Vitae

Hogerzeil started his career as a missionary doctor in India and Ghana. After writing a thesis on essential medicines in Ghana, he went on to spend more than 25 years working for the World Health Organization (WHO). During this period, he advised governments in more than 40 countries on devising their drug policies. Between 2004 and 2011, he was Director of Essential Medicines in Geneva, a post in which he was responsible for all WHO quality standards relating to medicines, and for the WHO’s technical assistance with policy, quality and distribution of medicines in more than 100 developing countries.