lobal patent law, which discourages investment in the diseases of poverty and makes existing drugs prohibitively expensive. So the WHO proposes a global treaty which would weaken patents and put research under official control. But a look at India, which has both a lot of poor people and weak patents, shows the diagnosis and the cure are wrong. With per capita income under US$800, Indians are certainly poor. The current economic boom means far fewer people are poor and hungry than before but, despite swelling coffers, India is still failing on healthcare. Some parts of India have worse rates of infant mortality, maternal mortality and immunization than much poorer parts of sub-Saharan Africa or neighboring Bangladesh.
Despite all this, India is often held up as a model of healthcare delivery in Asian countries such as the Philippines. This is largely because of the widely-held perception -- supported by the WHO -- that breaking patents automatically translates into health improvements.
Try telling that to an Indian. The most significant determinants of health in India -- like every other developing country -- are improved drinking water, sanitation, sewage treatment and immunization. In many parts of India, however, simple technology such as sewerage is simply not available: an estimated 400,000 Indian children under five die each year from medieval diseases such as preventable diarrhea.
Partly to blame is the insistence that health-related goods such as water and electricity be provided by state monopolies, which restricts choice and encourages waste. Similarly, Indian state governments remain adamant that they should be the only provider of healthcare to the poor. The resulting state monopolies are riddled with corruption and rarely provide decent services. According to a 2005 report by Transparency International, the health system is the most corrupt service sector in India.
At the same time, the government maintains bureaucratic barriers that prevent the development of medical insurance. So the majority of people are forced to pay for all their medicines out of pocket, making them reluctant to take drugs when they fall ill, so ill health is guaranteed.
Clearly, in India, at least, the real problem lies not in patents but in state failure and bad governance. These problems have been thoroughly documented but they are barely mentioned by the WHO -- but if the developing world is to significantly improve its health, this is the main problem that needs to be addressed. These failures disproportionately affect the poor, because the wealthy can buy clean water, sewage, power, medicines and healthcare. The poor have no such choices.
