Trade and Health

Introduction

Trade is potentially a far more significant avenue for raising living standards and for economic development in developing countries than development assistance. However, the current regime of global economic regulation is severely tilted against the interests of developing countries. There is a massive flow of value each year from the South to the North.

The rules which govern world trade are formalised in the 23 treaties and agreements which are negotiated and implemented under the aegis of the World Trade Organisation. Understanding the way unfair trade damages health requires an understanding of the formal rules of the WTO and how they are enforced.

Behind the WTO is a complex configuration of stakeholders jostling for advantage and beyond them various constituencies with different interets and perspectives. Analysing the relations of trade and health also requires certain assumptions about what is happening in the global economy generally. The WHO Commission for Macroeconomics and Health presented the links between health and economics in terms of a virtuous cycle, better health as an input to (and outcome of) economic development, and argued that development funding should be mobilised to address diseases such as AIDS and malaria because these are so obviously barriers to economic development. It is unfortunate that the CMH did not undertake a more broadly based analysis of the links between economics and health.

The implications of the WTO for public health did not attract much attention from the international public health community until 1997 when 28 international pharmaceutical companies sued the South African Government alleging that its arrangements for parallel importing of AIDS drugs contravened its commitments under the TRIPS Agreement. The pharmaceutical companies were finally forced to withdraw their case in early 2001 through the rising pressure of public opinion globally (driven by the TAC in South Africa and supported by MSF, CPTech and a range of other civil society organisations).

At the Doha meeting of the Ministerial Council of the WTO in December 2001 the WTO adopted the Doha Statement on Public Health which affirms that “the TRIPS Agreement does not and should not prevent members from taking measures to protect public health”.

While the international public health focus has been on the WTO agreements, which have direct implications for health (GATS, SPS, TRIPS), it is the Agreement on Agriculture (AoA) which may have had the most negative effect on the health of people in developing countries through the impact of protected markets and dumped product on small farmers’ livelihoods. See Via Campesina and the Institute for Agriculture and Trade Policy (IATP) for further discussion.

From Doha in 2001 to the Ministerial Council meeting in Cancun in 2003 there was a rising tide of resistance to the free trade agenda from developing countries and civil society globally. In the face of this resistance the USA and EU switched their trade policy focus from the multilateral arena to bilateral and regional trade agreements. See bilateral.org for a critical overview of the state of regional and bilateral negotiations.

The ACP (Africa, Carribean and Pacific) countries are involved in a particularly complex set of arrangements with Europe. The EU is now pushing to finalise Economic Partnership Agreements with the ACP countries. These are essentially bilateral trade and investment agreements and have profound implications for national and regional development and for health.

The accelerating pace of the bilateral and regional FTAs, including agreements with the notorious TRIPS Plus provisions (and investment provisions which greatly reduce national policy space), contributed to increased concern among the developing countries and civil society. In conjunction with this rising concern is the increase of pressure on the WHO to exercise some leadership in trying to ensure that trade agreements are supportive to health development rather than harmful.

In 2005 the WHO Secretariat submitted a report on International Trade and Health to the Executive Board which inter alia commented that:

Generally, ministries of health need the capability, in terms of expertise and access, to provide their colleagues in the trade and finance ministries with the best evidence on the potential impact of trade and trade agreements on health outcomes, so that ongoing multilateral, regional, or bilateral trade negotiations may be properly informed. This need creates demands on WHO’s Secretariat from Member States and from the international organizations involved in trade, including for guidance on international standards for health-related goods and services, advice on potential implications of trade rules from a public-health perspective, provision of tools and methodologies to assess the possible implications of trade and trade agreements on public health, and information on best practices in trade negotiations that might affect health.

In 2006 the World Health Assembly adopted a resolution on trade and health which:

1. URGES Member States:
(1)    to promote multi-stakeholder dialogue at national level to consider the interplay between international trade and health;
(2)    to adopt, where necessary, policies, laws and regulations that deal with issues identified in that dialogue, and to take advantage of the potential opportunities, and address the potential challenges that trade and trade agreements may have for health, considering (where appropriate) using their inherent flexibilities;
(3)    to apply or establish, where necessary, coordination mechanisms involving ministries of finance, health, and trade, and other relevant institutions, to address public-health related aspects of international trade;
(4)    to create constructive and interactive relationships across the public and private sectors for the purpose of generating coherence in national trade and health policies;
(5)    to continue to develop capacity at national level to track and analyse the potential opportunities and challenges of trade and trade agreements for health-sector performance and health outcomes;
2. REQUESTS the Director-General:
(1)    to provide support to Member States, at their request and in collaboration with the competent international organizations, in their efforts to frame coherent policies to address the relationship between trade and health;
(2)    to respond to Member States’ requests for support of their efforts to build the capacity to understand the implications of international trade and trade agreements for health and to address relevant issues through policies and legislation that take advantage of the potential opportunities, and address the potential challenges, that trade and trade agreements may have for health;
(3)    to continue collaborating with the competent international organizations in order to support policy coherence between trade and health sectors at regional and global levels,including generating and sharing evidence on the relationship between trade and health;
(4)   to report to the Sixty-first World Health Assembly, through the Executive Board, on progress made in implementing this resolution.

This resolution places particular responsibilities on ministries of health to work with ministries of trade. PHM has a particular role to support ministries of health in carrying out this responsibility.

WHO is currently developing a ‘diagnostic tool on trade and health’ ‘that will guide national policymakers in: (1) developing national policies and strategies related to trade and health; and (2) structuring their requests for capacity building in issues related to trade and health.

Learning objectives
Participants will:

• develop their understanding of the origins, structures and procedures of the WTO and of its main agreements; and the politics of WTO decision making;
• develop their understanding of the range of bilateral and regional trade agreements and of the distribution of costs and benefits, both between and within participating countries;
• in particular, develop their understandings of the specific agreements involving their country and operating in their region;
• develop their understanding of global trade, IP regulation and investment agreements and how these affect the health chances of different populations;
• develop their skills in analysing and explaining trade issues and their relations to population health;
• develop a strategic framework for planning activist work around the health implications of trade relations.

Presentations
Bretton Woods Family David Legge at Savar, Nov 2007
Trade regulation and public health (Lily Walkover at Atlanta, 2007) 
Readings  

• Institute for Agriculture and Trade Policy 
• Centrefor Policy Analysis on Trade and Health 
• South Centre 
• Amit Sen Gupta(2006). The WTO at the Cross Roads (The Marxist, 22(2-3)) 

Discussion questions
What is the role of health care activists in relation to political and economic issues such as trade?
Assignment topics
"Development assistance can only play a minor role in economic development compared with trade reform". Critically discuss this statement.
Other related topics

• Trips and big pharma
• GATS and health systems
• Food

Acknowledgements
This topic developed by: David Legge, Ellen Shaffer, Lily Walkover, Amit Sen Gupta
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