Trade Agreements and Public Health: A Primer for Health Policy Makers, Researchers and Advocates (Palgrave Studies in Public Health Policy Research)

The need for policy coherence between trade and health has never been greater, yet few public health workers are equipped to navigate this complex field. This book aims to fill this gap, providing a focused and readable introduction to the topic. It introduces the principles underpinning trade treaties and examines the implications of trade rules for health services and access to medicines, unhealthy commodities, labour rights and the environment. It explores the trade policy making process, methods for trade and health research, and recommendations for strengthening policy coherence. Acknowledgements 7 Praise for Trade Agreements and Public Health 8 Contents 9 Abbreviations 13 List of Figures 16 List of Boxes 17 Chapter 1: Introduction 18 1.1 Overview of the Relationship Between Trade and Health 19 1.2 Purpose and Intended Audience of the Book 19 1.3 Structure and Content of the Book 20 1.4 Overall Approach and Disciplinary Basis 21 References 22 Chapter 2: Trade and Health: From Ancient Pandemics to the World Trade Organization and Beyond 23 2.1 Introduction 24 2.2 From World Wars to the World Trade Organization 24 2.3 Key Principles of Trade Agreements 27 2.4 From Principles to Practice: Key Health-Related WTO Treaties 29 2.4.1 General Agreement on Tariffs and Trade 1994 29 2.4.2 General Agreement on Trade in Services 29 2.4.3 Agreement on Trade-Related Intellectual Property Rights 29 2.4.4 Agreement on Technical Barriers to Trade 30 2.4.5 Agreement on Sanitary and Phytosanitary Measures 30 2.4.6 Agreement on Agriculture 30 2.5 Health in Dispute 31 2.5.1 Asbestos Versus Glass Fibres 33 2.5.2 Brazil’s Retread Tyres 33 2.5.3 Turkey Tails and Health in the Pacific Islands 34 2.5.4 Alcohol Product Labelling 35 2.6 Trickle-Down Health or Trickle-Up Wealth? 36 2.7 Enter the ‘Spaghetti Bowl’ 38 2.8 Investor-State Dispute Settlement Rules: Empowering Investors (Corporations) at the Expense of Governments? 42 2.9 Conclusion 47 References 49 Chapter 3: Health Services and Access to Medicines and Other Health Technologies 55 3.1 Introduction 56 3.2 Health Services 57 3.2.1 The General Agreement on Trade in Services 57 3.2.2 Benefits and Risks of the Four Modes of Trade in Health Services 59 3.2.3 Health Insurance 61 3.2.4 The Trade in Services Agreement 61 3.2.5 Potential Problems and Pitfalls in Negotiating Rules for Trade in Health Services 62 3.3 Access to Medicines and Other Health Technologies 63 3.3.1 Intellectual Property 63 3.3.2 The TRIPS Agreement 64 3.3.3 TRIPS-Plus Provisions in Trade Agreements Negotiated Outside the WTO 66 3.3.4 Empirical Evidence of the Impact of Trade Agreements on Access to Medicines 66 3.3.5 Attempts to Further Expand IPRs Through Large Regional Trade Agreements 68 3.3.6 Other Trade and Investment Rules with Implications for Pharmaceuticals and Access to Medicines 71 3.3.7 Vaccines and Medical Devices 72 3.4 Conclusion 73 References 75 Chapter 4: Commodities Harmful to Health 82 4.1 Introduction 82 4.2 Liberalisation of Trade and Investment in Tobacco, Alcohol and Processed Foods 83 4.2.1 Liberalising Trade and Investment in Tobacco 83 4.2.2 Liberalising Trade and Investment in Alcohol 84 4.2.3 Liberalising Trade and Investment in Food 85 4.3 The WTO Agreements and Their Implications for Tobacco, Alcohol and Food Policy 88 4.3.1 Tobacco 88 4.3.2 Alcohol 91 4.3.3 Food 92 4.4 Bilateral and Regional Trade and Investment Agreements: Implications for Tobacco, Alcohol and Food Policy 93 4.5 Achieving Policy Coherence 95 4.5.1 Careful Negotiation of Treaty Text 95 4.5.2 Counterbalancing Legal Instruments 96 4.5.3 Careful Design of Public Health Measures 98 4.6 Conclusion 98 References 100 Chapter 5: Trade, Labour Markets and the Environment 108 5.1 Introduction 109 5.2 Labour Standards 109 5.2.1 Do Labour Chapters Make a Difference? 113 5.2.2 Should Labour Chapters Make a Difference? 117 5.3 Environmental Protection 119 5.4 Conclusion 123 References 124 Chapter 6: The Politics of Trade Policy and the Trade Negotiating Process 128 6.1 Introduction 128 6.2 Actors and Institutions Involved in Trade Policy Making 129 6.2.1 Nation States 129 6.2.2 Industry 130 6.2.3 Civil Society 131 6.2.4 Academics 131 6.3 Trade Policy-Making Processes 132 6.4 The Role of Ideas and Framing in Agenda-Setting 136 6.5 Global Governance of Trade and Health 138 6.6 Power Asymmetries in Trade Policy Making 140 6.7 Advocacy for ‘Healthy Trade’ 141 6.8 Capacity Building to Strengthen Trade-Health Policy Coherence 145 6.9 Conclusion 147 References 148 Chapter 7: Methods and Approaches for Measuring the Impact of Trade Agreements on Public Health 153 7.1 Introduction 154 7.2 ‘Big Trade’ Studies1 154 7.3 Case Studies 157 7.4 Natural Experiments 158 7.4.1 Vietnam Versus the Philippines 158 7.4.2 Canada Versus ‘Synthetic Canada’ 159 7.5 Health Impact Assessments 160 7.6 Economic Impact Assessments 162 7.7 Qualitative Comparative Analysis 164 7.8 Legal Research 165 7.9 Conclusion 166 References 167 Chapter 8: Conclusion: Strengthening Trade and Health Policy Coherence 172 8.1 Introduction 172 8.2 Policy Incoherences Between Trade and Health 173 8.3 Flaws in the Trade Policy-Making Process 175 8.4 Towards Greater Policy Coherence 175 8.5 Conclusion 177 References 178 Index 180