When can Trade Policy be Hazardous to your Health?
A panel of experts on trade, development and health has warned that a new generation of trade and investment agreements threatens the future of health, and ‘requires a broad resistance from the health community’.
The warning, published on 7 November in The Lancet, comes from the Independent Panel on Global Governance for Health, established as a follow-up to the 2014 report of a Lancet commission on the topic. (Full disclosure: I am one of the panel’s members.) It comes on the heels of expressions of concern about the effects of trade agreement provisions on health by the UK’s Faculty of Public Health and by commentators in journals including New England Journal of Medicine and Journal of the American Medical Association.
The context is dominated by mega-regional trade agreements like the Transatlantic Trade and Investment Partnership (TTIP), now under negotiation between the US and the European Union, and the Trans-Pacific Partnership (TPP) that awaits ratification by its 12 Pacific signatory countries, including the high-income US and Canada and low-income Vietnam. Such agreements are widely viewed as the wave of the future in trade policy; in ways that go beyond the provisions of the World Trade Organization regime, they reach ‘behind the border’ to limit the policy space available to governments for reducing health inequalities and addressing their underlying economic drivers.
Perhaps the most familiar concern is whether expanded intellectual property protection for the pharmaceutical industry will constrain efforts to keep the cost of medicines affordable. The authors of the Lancet paper focus instead on the destructive potential of investor-state dispute settlement (ISDS) provisions, which are important elements of mega-regional trade agreements and of many of the more than 3,000 bilateral investment treaties now in force. ISDS provisions essentially create a separate, parallel justice system for foreign investors (in practice mainly transnational corporations) seeking to recover anticipated profits lost as a result of policies that may have a legitimate public purpose, such as reducing the attractiveness of smoking through plain packaging requirements. The number of cases brought by foreign investors against host governments under such provisions is growing rapidly; unlike many elements of the emerging trade policy architecture, they have been criticized by mainstream economists including Dani Rodrik, Joseph Stiglitz and Jeffrey Sachs and even in a leader in The Economist.
The interface of trade policy and health should be of special concern in the UK as it prepares to leave the European Union and negotiate a new set of trade agreements from a position of relative weakness, given the size of its economy relative to those of (most importantly) the United States, the EU, and China. What concessions on market access for for-profit health insurance firms, for example, will UK negotiators have to offer as the price of improving or maintaining today’s levels of access to US markets? What limits on ability to pursue a rational climate policy or restrict the marketing of ultra-processed foods, which are major contributors to the obesity epidemic, will lurk in the ISDS provisions they agree? The decision to expand Heathrow in the face of formidable counter-arguments has already shown what it means to appear open for business, whatever the health and social costs. This imperative is certain to metastasise into post-Brexit trade policy, at least without the resistance referred to in the Lancet article.
Ted Schrecker is Professor of Global Health Policy in the Centre for Public Policy & Health, Durham University.
Photo credit: stevendepolo via Foter.com / CC BY
