illustration for the drivers of inequality

Driver Category 1.7

Lack of regulation of health practitioners and companies whose activities compromise public health

This driver captures diverse aspects related to corporate behaviours that are harmful to public health. This could be the promotion of tobacco products or food and beverages implicated in the obesity crisis. It also captures activities by ‘big pharma’ where excessive profits are achieved at the expense of the affordability of drugs for public health systems.

The lack of regulations - whether of advertising, product development and manufacturing, or in relation to patents – that prioritise public health concerns above company profits is a key factor captured here. The political capture aspect – related to corporate lobbying in these areas – also come out in analysis of this driver category.

Another important aspect captured by this driver category is the lack of regulation of ‘alternative therapies’ which both play a role in high and middle-income countries but particularly important in rural areas of low-income countries. The least advantaged, lower educated are more likely to seek medical assistance from these practitioners.

Guiding Questions

Regulation of health practitioners

  • Is there evidence that health practitioners are operating without regulation?
  • Are some times of health practitioner allowed to practice without regulation?
  • Is there evidence that the practice of unregulated health practioners is related to premature mortality?

Regulation of related industries and products

  • In what areas is there evidence of corporate behaviour that has harmful impacts on public health in your country?
  • Is it relevant to look at the manufacturing and sale of products such as tobacco and/or unhealthy food and beverages?
  • Are there concerns in relation to the affordability of drugs for public health systems?
  • Or are there concerns about the impacts on public health from environmental pollution?
  • Is there any existing analysis in these areas that looks at how poorly regulated corporate behaviour is a problem?
  • Are there significant knowledge gaps?
  • What legislation is in place related to the food industry’s manufacturing standards with the aim of tackling obesity?
  • Are there regulations to stop companies manufacturing ultra-processed foods?
  • What standards exist limiting the salt, saturated fats, artificial trans-fats and sugar in processed foods and soft drinks?
  • What response have food and drinks companies had to the policy debates and any new standards or regulations being put in place to prevent obesity?
  • Are companies lobbying the government or undertaking legal challenges to overturn new legislation?
  • Are sales of tobacco products increasing or decreasing in your country?
  • What steps is the government taking to reduce the impact of tobacco consumption on public health?
  • Does tobacco product packaging have to display health warnings?
  • What restrictions apply to tobacco advertising, promotion and sponsorship?
  • Is the promotion of sales to young people particularly restricted?
  • Is regulation adequate in this area?

Essential medicines: availability, expenditure and pricing

  • Does the government have an updated national Essential Medicines List (EML)?
  • How does the public sector availability of essential medicines compare to those available in the private sector?
  • How do the prices of essential medicines compare between the public and private sectors?
  • What is the level of public health expenditure on medicines?
  • What is the national per capita expenditure on medicines and how is expenditure varying from year to year?
  • What essential medicines are available free (or at very low cost) in the public sector?
  • Is availability of these increasing or decreasing from year to year?
  • What prices is the public sector paying to access essential medicines?
  • Are the lowest-priced generic medicines between purchased or is the government procuring high-priced originator brands?
  • Are any ‘differential pricing agreements’ in place with manufacturers to guarantee lower costs to public health systems in developing countries?
  • How do the prices the government is paying for essential medicines compare to the International Reference Prices of the World Health Organisation?

Regulation of the pharmaceutical industry

  • Does the government have an adequate national pharmaceutical policy that ensures essential medicines, of appropriate quality, safety and efficacy, are available?
  • Are there appropriate processes of licensing and registration?
  • Are there procedures for counterfeit or dangerous medicines to be taken off the market and sanctions applied against those responsible?
  • What regulations are in place to ensure rational use of medicines and to prevent resistance and over-consumption?

Environmental regulation

  • What are the most polluting industries/sectors about which there is highest public concern?
  • Is information available on the risks to public health from different kinds of environmental pollution (e.g from pollution of drinking water, air pollution, solid waste pollution, soil pollution, hazardous and industrial waste handling, environmental noise)?
  • Where are the biggest problems in your country?
  • Where are the biggest knowledge gaps?
  • What regulatory agency/ies is/are charged with designing and enforcing environmental regulations related to public health?
  • What information is available on the activities of the regulatory agency – its investigations, violations identified and sanctions applied?
  • Is the regulator able to properly enforce standards and hold companies accountable?

Indicators

Potential indicators to monitor the drivers of inequalities in this main driver category

  • Annual tobacco sales (volume and value)
  • Nutritional content of typical (widely available, unhealthy, cheap) food
  • Amount of public procurement prices for essential medicines compared to international reference prices for same medicines
  • % of generic medicines vs % of originator brands, of same medicine, distributed
  • Amount of public procurement prices for essential medicines compared to patient prices for same medicines
  • Number/value of compulsory licences issued for production, or importation, of lower-priced generic versions of patented products
  • Number of companies breaching clean air and other standards
  • Number of staff employed by the environmental standards regulator and annual budget of the regulator
  • Number of violations recorded in relation to environmental standards that protect human health

Candidate Policies

To see related Candidate Policies in this main driver category please click here.