The first wealth is health, wrote American thinker Ralph Waldo Emerson. Indeed, history has taught us (even before Emerson)
that health and wealth are inextricably linked—the more money one has, the healthier one is likely to be.
Charles Conrad Uy
But the economic gains and growing wealth of the middle classes in countries like Brazil, Russia, India, and China (BRIC)
don't seem to fit into that equation. A growing body of research shows that, in these countries, economic gains don't translate
evenly into health benefits. Rather, the rapid confluence of industrialization, increased economic wealth, and shifting demography
means that these emerging countries' disease burden isn't going away—it's just changing.
Consider this: From 2005 to 2030, improvements in sanitation, pediatric care, and the treatment of communicable diseases will
increase projected life expectancy by about four years in Brazil, Russia, and China, and seven years in India. On the other
hand, the impact of chronic diseases—such as cardiovascular disease, cancer, respiratory disease, and type 2 diabetes, which
are more commonly associated with wealthier developed nations—is already taking its toll. The World Health Organization (WHO)
now estimates that 80 percent of global mortality due to chronic disease occurs in low- and middle-income countries. In Russia,
for example, more than half (51.8 percent) of total deaths in 2002 are from cardiovascular and cerebrovascular disease, according
to the European Health Report 2005.
However, of all the chronic diseases that are on the rise in BRIC, diabetes may be considered the most pernicious. WHO has
outlined a three-step framework for governments to help reduce the burden of diabetes. Yet given both the commercial and public
health opportunities, the question remains, what role can the pharmaceutical industry play?
Diabetes Rising—Opportunities and Challenges
In 2000, Brazil, Russia, India, and China alone accounted for 34.8 percent of the total global prevalence of diabetes. According
to WHO, BRIC's share of the global diabetes burden is set to increase to 37.8 percent by 2030. Though a three-percentage-point
increase may not sound like a lot, it translates to a more than doubling of BRIC's diabetic population, from 61.5 million
patients to 138 million patients.
2030: Global Incidence of Diabetes
These markets are ripe for investment—personal income is on the rise, and it's expected to spur utilization of drugs. In Russia,
wages tripled from 2001 to 2006, and the introduction of $1.35 billion in public money for the reimbursement of medicines
has helped to create a $9 billion pharmaceutical market. In India, the drug market is expected to grow 12 percent year on
year from 2005 to 2009, according to WHO. China's market for healthcare services is also expected to skyrocket, with drug
sales set to exceed $46 billion by 2010, according to Business Monitor's China Pharmaceuticals Report.