Health, Health Care and Pharmacy in India

David Taylor
Professor of Pharmaceutical and Public Health Policy, The School of Pharmacy, University of London Introductory presentation for the conference on Health and Biomedical Research in India, Barcelona, November 25th, 2005

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This presentation
Introduces some concepts relating to global health development and the role of pharmacy and pharmaceuticals Offers some information about modern India, and pharmacy today Outlines a proposal for enhancing collaboration between pharmacists and other health care providers in India and the EU, aimed at contributing to better (global) public health in the future

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Initial points
This presentation relates to work still in progress It is not based on a neocolonialistic philosophy, or one which fails to understand the interests of Europeans who happen to have south Asian or other non-Caucasian ethnic backgrounds It is in the first instance suggested that an EU/India pharmacy collaborative should be established. But initiatives involving nations such as Pakistan and the countries of Africa ought also to be considered

Demographic Transition
DEATHS

BIRTHS

RATE

INCREASE

TIME
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Demographic transition (population increase and ageing)

Epidemiological transition (from acute infection to chronic potentially disabling illness)

Care transition?
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Dimensions of Care Transition include

Increasingly assertive consumerism in health care Decreased social distance between health professionals and service users Increased recognition of the role of self care in health improvement
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Stages of public health improvement

1. Improving sanitation and water macro environmental progress 2. Improving homes and child care micro environmental progress 3. Improving lifestyles 4. Understanding genetically mediated risks and pathologies, and tailoring biomedical interventions to fit the requirements of specific phenotypes
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In western Europe pharmaceuticals played only a very limited role in improving health until the later stages of demographic and epidemiological transition. But they are central to care transition in Europe today, and are of much more potential importance in all stages of current emergent economy development

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Challenges for Pharmacy, in Europe and Globally

A partial profession, threatened with collective redundancy? As dispensing is delegated and mechanised, can pharmacists develop a cost effective clinical role? As societies change and regulatory strategies evolve, can pharmacys professional structures move on from the defence of sectional interests to the positive pursuit of the (global) publics interests in better treatment and better health?
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King James 1 granting the British Apothecaries their first Royal Charter in 1617

Population growth in India

Population (Census 1901-91 & Projected 1996-2016) 1,400,000
Population (thousands)

1,200,000 1,000,000 800,000 600,000 400,000 200,000 0

19 01 19 11 19 21 19 31 19 41 19 51 19 61 19 71 19 81 19 91 19 96 20 01 20 06 20 11 20 16

Year

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Health and ill-health in India

Infant mortality rate still ten times the EU average Over a third of the annual global total of maternal deaths occur within India Infections such as TB and HIV are prevalent Rural health care facilities are often very limited Death rates from suicide and violence are notably high in young women Overall cancer rates are low, but rising India already has more people with type 2 diabetes that any other country on earth
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Key points about India and its pharmaceutical sector

Despite a strong heritage of centralised authority India is highly diverse. Its states are in widely differing stages of development Indias public spending on health care is low, at about 0.9% of GDP (~ $600 per capita in exchange rate terms) India has recently re-introduced patents for pharmaceutical products. This should encourage investment. India is already the worlds fourth largest volume producer of medicines Presently, the domestic market is characterised by tens of thousands of competing brands Pharmacy is not well established as a health care profession in India. Pharmacy graduates frequently work in industrial research, production and sales settings. Community pharmacies are normally staffed by less qualified individuals There are opportunities to build on tradition approaches such as Ayurvedic medicine, and also to improve modern pharmaceutical care in the community and hospitals
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Opportunities for Pharmacy?

To improve the health of the Indian public, and meet shared moral responsibilities at an international level To further develop clinical and public health pharmacy in both the EU and India To secure the interests of Europe and India in the future of the knowledge based pharmaceutical industry
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The Proposal
To establish an EU/India pharmacy and medicines use collaborative, aimed primarily at sharing educational opportunities and promoting the development of pharmacy as a fit for purpose twenty first century health care profession To fund and build this collaborative in ways which help enable Indian and global pharmaceutical companies fairly to access national and international markets, and invest in research that can contribute to improved global health
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David.Taylor@ulsop.ac.uk