1 DTaylor (India)

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Health, Health Care andPharmacy in India

David TaylorProfessor 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

The School of Pharmacy, University of London


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This presentation

Introduces some conceptsrelating to global healthdevelopment and the role of

pharmacy and pharmaceuticals

Offers some information about

modern India, and pharmacytoday

Outlines a proposal forenhancing collaboration

between pharmacists and otherhealth care providers in Indiaand the EU, aimed atcontributing to better (global)

public health in the future



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Initial points

This presentation relates towork still in progress

It is not based on a neo-colonialistic philosophy, or onewhich fails to understand theinterests of Europeans whohappen to have south Asian orother non-Caucasian ethnic

backgrounds

It is in the first instancesuggested that an EU/Indiapharmacy collaborative shouldbe established. But initiativesinvolving nations such asPakistan and the countries of

Africa ought also to beconsidered


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Demographic Transition

DEATHS

BIRTHS

INCREASERATE

TIME



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Demographic transition (population

increase and ageing)

Epidemiological transition (from acuteinfection to chronic potentially disabling

illness)

Care transition?



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Dimensions of Care Transition include

Increasingly assertiveconsumerism in healthcare

Decreased socialdistance betweenhealth professionalsand service users

Increased recognitionof the role of self carein health improvement



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Stages of public health improvement

1. Improving sanitation andwatermacroenvironmental progress

2. Improving homes andchild caremicro

environmental progress3. Improving lifestyles

4. Understandinggenetically mediatedrisks and pathologies, andtailoring biomedicalinterventions to fit therequirements of specific

phenotypes



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In western Europe pharmaceuticals played only avery 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 potentialimportance 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 pharmacistsdevelop a cost effective clinicalrole?

As societies change andregulatory strategies evolve, can

pharmacys professional

structures move on from thedefence of sectional interests tothe positive pursuit of the(global) publics interests in

better treatment and betterhealth?


King James 1 granting the British Apothecaries

their first Royal Charter in 1617


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Population

(Census 1901-91 & Projected 1996-2016)

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1901

1911

1921

1931

1941

1951

1961

1971

1981

1991

1996

2001

2006

2011

2016

Year

Population

(thousands)

Population growth in India



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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 maternaldeaths 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 notablyhigh in young women

Overall cancer rates are low, but rising

India already has more people with type 2 diabetesthat 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 ishighly diverse. Its states are inwidely differing stages ofdevelopment

Indias public spending onhealth care is low, at about

0.9% of GDP (~ $600 percapita in exchange rateterms)

India has recently re-introducedpatents for pharmaceuticalproducts. This should

encourage investment. India isalready the worlds fourthlargest volume producer ofmedicines

Presently, the domestic market

is characterised by tens ofthousands of competing brands

Pharmacy is not wellestablished as a health care

profession in India. Pharmacygraduates frequently work inindustrial research, productionand sales settings. Community

pharmacies are normally staffedby less qualified individuals

There are opportunities to build

on tradition approaches such asAyurvedic medicine, and alsoto improve modern

pharmaceutical care in thecommunity and hospitals



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Opportunities for Pharmacy?

To improve the health ofthe Indian public, andmeet shared moralresponsibilities at aninternational level

To further develop clinicaland public health

pharmacy in both the EUand India

To secure the interests ofEurope and India in thefuture of the knowledge

based pharmaceuticalindustry



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The Proposal

To establish an EU/India pharmacy and medicinesuse collaborative, aimed primarily at sharingeducational opportunities and promoting the

development of pharmacy as a fit for purposetwenty first century health care profession

To fund and build this collaborative in ways which

help enable Indian and global pharmaceuticalcompanies fairly to access national andinternational markets, and invest in research thatcan contribute to improved global health



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[email protected]

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