Although the country is the world’s largest generic medicines exporter, 400-600 million Indian citizens live in severe poverty and lack of free access to drugs is going to have a devastating effect both globally and locally.

That is the key point of a study published by University College London's School of Pharmacy, which notes that life expectancy in India has doubled from 30-35 years to over 65 years since 1947. In the same period the population has grown from around 300 million to over 1.20 billion and despite some important successes, "high residual rates of infection in poorer communities combined with an increasing prevalence of disabling chronic diseases mean that healthy life expectancy in India is only about 55 years".

The analysis estimates that non-communicable diseases already cost India the equivalent of 12.5% of the nation’s GDP in lost welfare terms. Co-author David Taylor states that the country currently spends only a little over 1% of its GDP on publicly funded health care, "and only about 0.1% of GDP on publicly funded medicines for the Indian people". He adds that "it would be tragic if plans for extending universal health coverage and increasing the supply of free generic medicines for those who lack the resources to purchase even minimal cost modern treatments for common conditions such as high blood pressure and type 2 diabetes are not taken forward as an urgent priority".

Prof Taylor goes on to say that "some people wrongly believe that steps like reducing the prices of new anticancer drugs that can only be used effectively in high technology settings to commodity levels will significantly improve public health in India. But this is not the case". He argues that "measures like imposing compulsory licences on such medicines are mainly likely to benefit well-off individuals [while] the mass of the population will gain from better day to day access to low cost but highly effective treatments that are already available as off-patent generics".

The UCL report concludes that, without enhanced universal access to essential medicines and other forms of cost effective care, "health improvement and social transition in poorer parts of India may stall. Given the size and importance of the Indian population this could in future have harmful global impacts".

The study suggests a range of solutions to the problem including internationally-agreed tiered or differential pricing arrangements and promoting greater individual and local community involvement in healthcare through, for example, "establishing confidential SMS texting based systems for reporting corrupt practices like charging for treatments that should be supplied free of charge".

The report concludes by saying that if in the coming decades "India’s people and their leaders give investing in better health care and better health outcomes higher political priority, India could once again become one of the world’s healthiest and wealthiest nations".