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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?
The School of Pharmacy, University of London
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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