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L’ATLAS DU MONDE DIPLOMATIQUE I 37
access to health care
and future investment in medical
research. But steeply rising expendi-
ture in this field above all focuses on
more “profitable” diseases. Through
active lobbying the drug firms have
convinced the US administration, sup-
ported to a large extent by the European
Union, to exert considerable pressure
on countries, such as India, Brazil and
South Africa, to discourage them from
using generic drugs. Supplies of free
medicine must comply with market
rules. In its determination to prevent
India from producing generic drugs,
the North literally bought it off with
trade concessions in other fields.
Second, political and religious
considerations may condition the
allocation of international aid. The
quite substantial US contribution to
combating Aids is linked to President
Bush’s pro-life policies.
Last but not least, with public
funds in increasingly short supply due
to the structural adjustment policies
imposed by international donors, it is
difficult to retain the health workers
needed to provide a proper service.
The governments of poor, debt-ridden
countries are under pressure to cut
welfare spending and limit public-sec-
tor pay packets, whereas rich coun-
tries are busy attracting staff trained
elsewhere at no cost to them. More
than 23% of doctors working in the
US trained in foreign countries where,
in the vast majority of cases (86%)
salaries are much lower.
If the average life expectancy in
Zimbabwe is only 36 years it is also
because three quarters of the doctors
trained there emigrate at the end of
their studies, fleeing Aids, pitiful pay
and political persecution. This brain
drain is equivalent to poor countries
paying almost $500m in aid to rich
countries every year. It also increases
inequality at home, between people
living in the country (with no chance
of finding a doctor) and city dwellers,
between the poor obliged to make do
with a totally inadequate public service
and the rich who can afford private
treatment.
Sources: World Population Prospect,
the 2002 Revision(2003);Population,
Development and HIV/AIDS With
Particular Emphasis on Poverty: The
Concise Report(2005), United Nations
Department of Economic and social
Affairs, Population Division, New York;
United Nations Children´s Fund
(UNICEF), Joint United Nations
Programme on Aids (UNAIDS), 2004
(2003 figures).
1955 1965 1975 1985 1995 2005
65
55
35
45
40
50
60
30
in years
Countries where Aids
caused more than half
the orphans 11 to 15%
16 to 20%
under 11%
g Treatment Action Campaign (TAC) :
g Médecins sans frontières (MSF) :
g Medact, Global Health Watch :www.medact.
org/hpd_global_health_watch.php
g Consumer Project on Technology (CPTech) :
g Réseau médicaments et développement
(ReMeD) :
g Organisation mondiale de la santé (OMS) : www.
Sur la Toile
Décimés par le sida
Source: Rogers and Randolph, The global spread of malaria in a future, warmer world, Science (2000: 1763-1766). Based
on a map by Hugo Alhenius, UNEP/GRID-Arendal, Norway.
PACIFIC
OCEAN
ATLANTIC
OCEAN
INDIAN
OCEAN
PACIFIC
OCEAN
Possible extension by 2050 in line with the upper range forecast of
the HadCM2 model, produced by the Hadley Centre in the UK
Existing
Le changement climatique pourrait favoriser l’extension du paludisme