Trade and Health Linkages

Health is impacted on by other sectors, including sectors related to trade and the economy. Apart from domestic health sector-specific policies and regulations, a variety of international commitments, rules and practices influence a country’s ability to provide effective health care coverage to the whole population. These cover, among others, trade and investment in health care services and products, including pharmaceuticals. They make a significant contribution to health systems, without being regulated or influenced by policies within the purview of the health sector. They, thus, act as broad determinants of health.

In order to make sustainable progress towards the provision of affordable access to drugs –the region requires coherent policies and practices that will assist it to overcome a number of supply- and demand-driven constraints. These include policies conducive to productive research and development pf pharmaceuticals and innovation in areas relevant to the region; balanced implementation of IPR regimes; fair competition; and Public-Private Sector Partnerships.

Similarly, trade in health services can also have an impact on performance of health systems and public health care delivery. The region has seen a considerable increase in international trade in health services. Cross border trade is still developing in the region, but rapid expansion of telecommunications and information technology have led to more widespread use of telemedicine across borders. Telemedicine has some way to go towards becoming a viable force for cross border health-care delivery, as issues related to licensing, liability and quality remain unresolved. Movement of patients abroad is becoming a major business for destination countries like India, Thailand, Malaysia, Singapore and some others in the region. Foreign participation is still limited in health care sector of ESCAP countries, but is growing. There is also outward investment by Thai, Singaporean, Malaysian and Indian entrepreneurs in the health sector overseas. Mode 4 covers temporary movement of natural persons. Migration of health workers is commonly seen in some ESCAP countries. The countries in the South and South-East Asian sub-regions serve as source countries of health workers moving to destination countries such as Australia, Canada, USA, UK and other European countries. Countries in the region also serve as a source of nurses for OECD and some middle-eastern countries. This migration of health workers, while having significant benefits in the form of remittances, have negative effects that include depletion of human resources and loss of vital investment in human capital made by developing countries. The policy options for countries include protective policies to ensure that trade in health services does not impact delivery of public health and facilitatory policies that optimize the economic benefits from such trade, while protecting public health

An Expert Group Meeting on “Development determinants of health: Regional trends in trade in health services and their impact on health systems performance in the region” was held on 9-11 October 2007. Details on the meeting are provided here.