Intended for healthcare professionals

Where Technology May Fail To Deliver

Political economy of technology transfer

BMJ 1999; 319 doi: (Published 13 November 1999) Cite this as: BMJ 1999;319:1298
  1. Anna Donald, lecturer (
  1. Department of Epidemiology and Public Health, University College London, London WC1E 6BT

    Every year, new health products and know-how become available: statins, new antibiotics, telemedicine, insurance know-how, imaging techniques, and genomics, to name a few. At the same time, major barriers to transferring information and technology between countries are falling with expansion of the internet and online health training programmes, the growth of information about the relative effectiveness of different technologies,1 and the liberalisation of trade. It might be reasonable to expect that global transfer of health technologies would take place more rapidly and in greater quantity to benefit “haves” and “have nots” alike. There is no evidence, however, that this is taking place. On the contrary, appropriate health technologies may become more unequally distributed than ever. Why?

    Summary points

    Less than 1% of global research and development is currently spent on technological innovations for poor countries

    The World Trade Organisation agreement enforcing trademarks and patents will increase the price poor countries pay to gain access to new, patented technologies

    It is unclear how such legislation will improve the health or wealth of impoverished countries, in the short or long term

    Active policies rather than passive diffusion are needed to distribute new technologies to people and countries unable to generate profit for suppliers

    Demand factors

    Economic demand for health technologies by individuals, governments, and insurers is determined by factors such as purchasing power, technological capability, purchaser priorities, and unequal information.

    Purchasing power

    One of the main reasons why people cannot get the health technologies they need is because they cannot afford them. For example, few African parents can afford the antibiotic ceftriaxone, the most effective treatment for one of the main causes of infant death each year, Streptococcus pneumoniae.2 Nor will most people be able to afford medicines for cardiovascular disease, the biggest projected killer in developing countries by 2020,3 as they exceed the …

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