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Health Sector Discussion Paper: Background Paper for the Project on Innovation and Access to Technologies for Sustainable Development
Suerie Moon, Alyssa Yamamoto and John Arne Røttingen
This background paper describes the global innovation system for health technologies using the conceptual framework of the Project on Innovation and Access to Technologies for Sustainable Development. As recognized in the Rio+20 Declaration on the Future We Want, health is “a precondition for, an outcome of and indicator of sustainable development.” Knowledge has enabled many of the dramatic health improvements seen over the past century, including (though not limited to) the knowledge codified as technologies. A significant proportion of health spending is dedicated to the development and deployment of health technologies—nearly $1 trillion/year on pharmaceuticals alone. While a broad range of technologies can impact health, we define “health technologies” as those deployed with the primary intent to protect, restore, or promote health, such as drugs, vaccines, diagnostics, and intangible methods and practices. Furthermore, since a broad definition of “health technologies” can include essentially all of medicine and public health (including much of service provision), we narrowed the focus of the project and this paper to the tangible health technologies that have been particularly relevant in low- and middle-income countries, and where transnational actors or institutions have played an important role in the innovation process.
Section II of this paper articulates key global norms and goals, embedded in the right to health, that have influenced the evolution of the global innovation system for health technologies. While the right to health is well-established, specific norms regarding health technologies did not emerge until relatively recently. We discuss both norms regarding “invention” (often called “innovation”), and then turn to “widespread use” of health technologies (often called “access”); these two sets of norms largely evolved separately, but we examine how they have recently begun to merge. Section III describes the key actors in the global innovation system for health technologies, which include a range of international, national and local actors, spanning the public, private, and non-governmental sectors. It also describes the major institutions, ranging from informal norms to binding national and international law. Section IV explains how health technologies progress through seven stages of the innovation life-cycle: (1) invention; (2) selection; (3) production; (4) initial adoption; (5) widespread or sustained use; (6) adaptation; and (7) retirement. It describes the “mechanisms” that moves a technology from one stage to another, followed by an initial diagnosis of barriers or weaknesses in the system in Section V. Examples of systemic barriers include the high costs and risks, declining productivity, and inefficient approaches to invention, and inadequate attention to the needs of “neglected populations”; in the selection phase, inadequate access to information, expertise or data can all hinder appropriate choice of health technologies; furthermore, achieving widespread use of a technology is frequently hindered by unaffordable prices and weak health systems; finally, products are often poorly adapted for use in resource-poor settings, and some potential technologies (such as traditional medicine) are not adapted for broader use. Overall, the system is fragmented, ad hoc and insufficient to meet global health needs. There is a need for a more coherent global framework that would help to set priorities, coordinate actors, ensure sustainable financing and monitor results.
Keywords: global health; innovation; health technology; global innovation system; access to medicines