F ood systems, which are at the heart of pressing societal challenges including malnutrition and climate change, are heavily influenced by trade-related changes to domestic policy and product environments-in both positive and negative ways. This interaction between trade, malnutrition and climate change has been amplified in the last decades by the shift towards industrial food systems, with global supply chains owned and operated by large or transnational agribusinesses, manufacturers, retailers and food service chains 1 . If global malnutrition and climate change are to be addressed, it is vital to understand their link with trade agreements and how these can be improved to support a nutritious, equitable and environmentally sustainable food system. While there is a growing body of evidence related to trade, food systems and malnutrition, what remains absent from the literature is an examination of the current understanding of the ways in which the technical and political aspects of trade agreements interact with food systems to affect malnutrition and climate change. Here, we review the literature connecting trade and food systems to show how major technical and political aspects of such relationships may affect malnutrition and climate change ( Fig. 1). We aim to elucidate how the technicalities of trade, through different types of agreements and provisions, sit alongside the political economy of trade policy. In doing so, we also highlight the opportunities and challenges of creating nutrition-and climate-sensitive trade policy.The Review starts with an overview of the global food trade regime and the technicalities of how trade agreements interact with policies aimed at improving malnutrition and climate change. It then focuses on the political and policy processes surrounding trade agreements that can enable or constrain attention to malnutrition and climate change. Global and national policy windows for connecting trade, nutrition and climate change mitigation are highlighted at the end, as well as how public interest actors must work to ensure policy coherence towards those goals. The global trade regimeEstablished in 1995, the World Trade Organization (WTO) governs the multilateral trade rules among its 164 member countries 2 and presides over 24 multilateral trade agreements. These agreements cover a wide range of binding obligations on issues including trade in services (General Agreement on Trades in Services; GATS), Trade-Related aspects of Intellectual Property rights (TRIPS), Technical Barriers to Trade (TBT), agriculture (the Agreement on Agriculture; AOA) and a dispute settlement system 3 .Through these trade agreements, member states are required to open their markets, including agri-food markets, by reducing tariffs and non-tariff barriers to imports, reducing subsidies for exports and reducing domestic agricultural support. WTO rules promote the global integration of markets and provide a favourable operating environment for the private sector. These liberalization policies and agreements hav...

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BackgroundTrade and investment agreements negotiated after the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) have included increasingly elevated protection of intellectual property rights along with an expanding array of rules impacting many aspects of pharmaceutical policy. Despite the large body of literature on intellectual property and access to affordable medicines, the ways in which other provisions in trade agreements can affect pharmaceutical policy and, in turn, access to medicines have been little studied. There is a need for an analytical framework covering the full range of provisions, pathways, and potential impacts, on which to base future health and human rights impact assessment and research. A framework exploring the ways in which trade and investment agreements may affect pharmaceutical policy was developed, based on an analysis of four recently negotiated regional trade agreements. First a set of core pharmaceutical policy objectives based on international consensus was identified. A systematic comparative analysis of the publicly available legal texts of the four agreements was undertaken, and the potential impacts of the provisions in these agreements on the core pharmaceutical policy objectives were traced through an analysis of possible pathways.ResultsAn analytical framework is presented, linking ten types of provisions in the four trade agreements to potential impacts on four core pharmaceutical policy objectives (access and affordability; safety, efficacy, and quality; rational use of medicines; and local production capacity and health security) via various pathways.ConclusionsThe analytical framework highlights provisions in trade and investment agreements that need to be examined, pathways that should be explored, and potential impacts that should be taken into consideration with respect to pharmaceutical policy. This may serve as a useful checklist or template for health and human rights impact assessments and research on the implications of trade agreements for pharmaceuticals.

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