KUALA LUMPUR, Malaysia – The healthcare sector in India produced 32 billionaires in 2022 – more than any other sector in an extraordinary demonstration of corporatisation, according to Abhay Shukla, co-convenor of Jan Swasthya Abhinyan, the People’s Health Movement in India.

Massive investment in healthcare by private companies since the 1990s, particularly in “corporate, profit-driven hospitals”, has sent non-essential procedures and treatments skyrocketing. 

For example, 48% of births in private hospitals are now Caesarian sections, in comparison to 14% in public health in India, said Shukla. The World Health Organization (WHO) recommends a rate of 10-15%.

“Two out of three Caesareans taking place in India are medically unnecessary. This is huge. We’re talking about hundreds of millions of women,” said Shukla, addressing a symposium on the growing influence of powerful private actors (PPAs) on global health, convened by the United Nations University International Institute for Global Health (UNU-IIGH) and Third World Network in Kuala Lumpur.

Unnecessary thrombolysis for stroke patients, additional cancer treatments and getting higher-paid consultants to perform basic procedures that could be done by frontline ER physicians to enable higher billing, are other examples of what the corporatisation of health has done to Indian healthcare.

Private equity and venture capital (PEVC) investment in Indian healthcare (as a percentage of PEVC total investment in India) doubled from 5% during 2017-2019 (pre-Covid years) to almost 10% during 2020-2023, with a record 18% in 2023.

Initially focused on pharmaceutical investment, investment in healthcare services has boomed since 2006, when the government made it easier for foreign direct investment in Indian companies. Healthcare investment boomed during COVID-19, rising to $413 million in 2021 (vs $160 million in 2019/20).

“The treating doctors are like spare parts in a big machine. They can be replaced at will by the corporate management. If they fulfil targets and if they are generating profits, they stay. If they are not generating profits, they go,” said Shukla.

Deaths driven by four industries

While India provides a jarring example of how corporate interests are subverting health services, the negative impact of a range of industries on health is better known.

One-third of global mortality is caused by four industries: tobacco, fossil fuel (air pollution) alcohol, and big food, said Dr Monika Kosinka, WHO lead on the economic and commercial determinants of health.

“For the region that we are in, the Western Pacific, the figure goes up to 48% mortality  attributable to these four interests,” she added.

“While businesses and private markets play a key role in producing and supplying the goods and services we consume every day, powerful corporations with commercial interests have also played a key role in driving consumption of health-harming products, blocking regulations to protect health or the environment and aggravating health inequalities between and within countries,” said Kosinka.

WHO Malaysia Representative Dr Rabi Abeyasinghe added that many corporate interests wanted the WHO to focus narrowly on medical concerns rather than taking a holistic view of health.

“They want us to be the World Medical Organization not the World Health Organization,” said Abeyasinghe.

Concentrated power and health

“Looking at powerful private actors in global health governance and accountability is both important and necessary,” stressed conference co-convenor Dr David McCoy of UNU-IIGH. 

“Many people working in global health will perhaps find it odd that we’re looking at powerful private actors and accountability. They’re more used to having conferences that talk about HIV or universal health coverage, or global health financing. 

“But what you’ll be hearing throughout this symposium is the evidence that demonstrates the link between concentrated power and wealth and its impacts on health and health governance,” stressed McCoy 

“Whether it’s about the unethical and deceitful marketing of commercial milk formula or challenging the abuse of intellectual property rights to keep essential medicines out of the reach of millions of people with HIV, or the truth around the causal relationship between fossil fuels and global warming, there is a long history of public health having to engage with the politics of the world,” said McCoy.

The growing influence of private actors, including big philanthropy, on the UN and its organisations was also raised.

Barbara Adams pointed to how the increase in voluntary contributions by countries and donors, rather than member states’ assessed contributions, has slanted financial allocations to earmarked issues rather than core funding.

UNU-IIGH director Dr Revati Phalkey emphasized the urgency of the situation: “This symposium comes at a critical juncture. While painful budget cuts are being made to the WHO and many vital health programmes, private entities with commercial interests appear to be gaining more influence in the health sector. This raises urgent questions about accountability.”

‘Tax the rich’

“The extreme concentration of wealth in the hands of so few in today’s global economy is itself an existential threat to good global health governance,” said Oxfam’s Anna Marriott.

She pointed out that taxing the ultra-wealthy appropriately would provide enough money to address global health and poverty needs.

“In 2022, the 10 richest men in the world doubled their fortunes during the pandemic while the incomes of 99% of humanity fell,” said Marriott.

“In 2023, the richest 1% grabbed nearly twice as much new wealth as rest of the world put together, while poverty increased for the first time in 25 years,” she said. This year, billionaire wealth has “surged three times faster in 2024”.

“This much wealth and power in the hands of so few is intolerable,” Marriott stressed, urging participants to support “global movements’ and multilateral efforts from the global South to tax extreme wealth to raise urgently needed revenue for health”.

The symposium concluded with a powerful call for accountability in the system of global health governance, demanding that systems be established to prioritise public interest and hold powerful private actors responsible for their impact on health. 

Suggestions include greater transparency, stronger regulatory frameworks, more monitoring of private actors and greater collaboration between governments, civil society, and international organisations.