To Have and to Have Not

Investing in public health for all

Your baby is sick. He lies tiny in a large hospital bed with an intravenous tube feeding him the medicine he needs. Though you’ve been consumed by worry since his fever started, he is going to be fine.

In another part of the world, another baby is also sick. His mother cuddles him, her worry mounting to terror. She has no medicine. Though a remedy may exist, there may be no local producer or supplier. Or the price may simply be beyond this mother’s ability to pay.

Across our global village, this drama plays out every day. Some people recover from illnesses that are well known and treatable. Others get the same bug and die. Lucky ones contract illnesses that afflict wealthy populations and have thus attracted medical research. Unlucky ones contract illnesses that afflict only the poor, and therefore fixing them isn’t economically viable.

The question, as we come to grips with the “village” aspect of our world, is why we continue to tolerate such fundamental unfairness. (Perhaps we have been overtrained on inequity. I am of a generation that grew up with regular admonishments about perpetually starving children in India. Yes, we learned to appreciate our food. But did we learn to share it?)

The answers are not easy. Private companies invest in drug treatments as they invest in new entertainment technology or new communications services: they put capital at risk, develop new products, and seek to make a return. The difference is that medical products hold potential returns far beyond financial; human lives hang in the balance. The ethics of which illnesses are targeted for research, the way drugs are marketed and priced, and the way drug companies conduct themselves vis-à-vis government policy, are far different from those in industries less invested in human suffering and survival.

Access to Medicine Foundation offers a navigational path through this tricky landscape. Based in the Netherlands, the three-year-old foundation partnered with a variety of development agencies, as well as socially responsible investment organizations, to produce the Access to Medicine Index. The index evaluates and ranks pharmaceutical companies’ performance on issues such as equitable pricing of drugs, lobbying governments, drug donations, research into neglected diseases, and commitment to providing access. The first index was published in June. You can browse through an interactive web version at atmindex.org .

The index provides impartial, independent assessments of the way companies handle the prickly issues between the haves and the have-nots. It provides, for the first time, a standardized set of metrics to help us shift from simply appreciating what we have (“eat everything on your plate!”) to ensuring everyone has a fair chance to share it.

The foundation carried its work a step further by inviting major international investors to sign a pledge supporting both the index and pharmaceutical company transparency. Twelve international investors with assets totalling well over US$1 trillion have signed. They believe a company that is proactive on these issues is a better investment bet. Meanwhile, you can be sure the companies—especially those that scored poorly—are having to think differently about which side their bread is buttered on.

You may have investments in pharmaceutical companies, and you may feel committed to seeing medical care reach people—all people—who need it. Now you can put the two together, and choose to invest in those that help advance public health around the globe. We know one of the things that makes us feel the most wealthy is good health. Even better is having the tools to share it.

Nina Winham is principal of New Climate Strategies (newclimate.ca), helping clients build value through sustainability practices and positive change. She’s never understood how eating too much would help anyone else.