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In order to achieve more ethical global health outcomes, health policies must be driven by health priorities and should take into account broader health policy requirements, including the needs of specific national health systems. It is thus important to recognize that the division of interests in key policy areas are not necessarily between the priorities of rich and poor countries, but between (1) pharmaceutical industry interests and health policy interests, and (2) national industrial and trade policy interests and public health policies. In this article I will focus on two broad common interests for health policy officials. Both have become important in the context of current global negotiations relating to access to medicines; pandemic influenza; and public health, innovation, and intellectual property rights. These are (1) ensuring access, availability, and the safety of pharmaceuticals, and (2) ensuring that research-and-development efforts respond to public health needs. I argue that these issues are not solely the concern of developing countries because the diminishing national policy space for health in pharmaceutical policies presents a challenge to all governments, including rich ones.