Bitter Pills:Medicines & The Third World Poor | Page 25

In the same year, thirty-four of the poorest nations, with almost double that
population (1,317 millions) consumed just 3%. (3) The Third World as a whole
has three-quarters of the world's population, but today accounts for little more
than 20% of world drug sales, and nearer 15%, when China is excluded. <4)
Drug expenditure each year in the poorest countries averages less than 50p a head.
In some industrialised nations it exceeds £35.(51 These figures underline the lack
of purchasing power of the Third World poor. Essentially, they reveal more about
wealth than health. It is, for example, highly debatable whether the level of drug
consumption in much of the rich world represents a particularly 'healthy' state
of affairs. But one conclusion is inescapable: whereas rich countries can afford
to be extravagant with medicines without risking acute social consequences, poor
people and their governments cannot. Because they have so little money, it is crucial
that it is spent only on essential drugs.
In most countries drugs are distributed both through organised health services,
either government or voluntary, and by private pharmacies and retailers. Patients
in industrialised countries can usually obtain treatment through governmentsubsidised services or health insurance schemes. For example, in Britain anyone
in need of medicine is entitled to a prescription subsidised by the National Health
Service. In many developing countries medicines are also, in theory, available
free of charge through the health services. In practice, only a privileged minority
has easy access to treatment, mostly because they can afford to pay for drugs
prescribed by private doctors, rather than relying on the desperately inadequate
health services.
Drug distribution cannot be looked at in isolation from health care systems. The
stark fact is that throughout most of the Third World almost three-quarters of
the population has no access to basic health services. <6) This lack of a primary
health care infrastructure to meet the needs of the majority is the single major
obstacle to the safe and effective distribution of drugs in poor countries.
But the Third World poor face a double deprivation. In the absence of organised
health services, they are particularly vulnerable to pressures from the expanding
commercial drug market which is subject to a minimum of controls. There are
of course exceptions. A few developing countries have succeeded in providing
basic health services for the majority of their people and have introduced controls
on private drug distribution to safeguard health.<7) However, in this chapter we
concentrate on the problems of public and private drug distribution common to
many very different developing countries.

LIMITED HEALTH BUDGETS
Much of the problem of people not getting health care or drugs is straight
economics. Governments of poor countries lack resources not just to buy
medicines, but to balance all the conflicting demands generated by
underdevelopment. The deficien cies of the health infrastructure are, after all, just
one problem area. Food production, transport and other sectors may present more
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