Reassessing the health impacts of trade and investment agreements: a systematic review of quantitative studies, 2016–20

Barlow, Pepita; Sanap, Rujuta; Garde, Amandine; Mabhala, Mzwandile A.; Thow, Anne-Marie

doi:10.1016/s2542-5196(22)00047-x

Cited by 7 publications

(6 citation statements)

References 47 publications

(93 reference statements)

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“…The strong linkage between globalization, regional integration, and trade underscores the importance of trade in the development of regional integration. The dual impact of trade on health, particularly in regional trade scenarios, has led some regional organizations to establish health policies [ 14 , 64 , 65 ]. An increasing trade gap between member states can negatively affect regional integration and development, prompting regional organizations to focus on policy impact in social sectors like health.…”

Section: Discussionmentioning

confidence: 99%

Health policy competencies in regional organizations: a retrospective analysis for 76 regional organizations from 1945 to 2015

Wang,

Liang,

Dong

et al. 2024

Global Health

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Background Health policy competencies of regional organizations include mandates to create regional health laws and policies, as well as authorities that allow member states to undertake collective actions in the health field. The examination of the health policy competencies of regional organizations is essential, as it constitutes an important prerequisite for regional organizations to govern regional health. This study aims to map the development trajectory of health policy competencies in regional organizations worldwide and investigate their potential correlates. This will contribute to the enhanced promotion of both existing and new regional health cooperation. Methods This retrospective analysis utilized the health policy competencies of the 76 regional organizations worldwide from 1945 to 2015, as investigated in the Regional Organizations Competencies Database. By aggregating member state data from various sources such as the IHME Global Burden of Disease 2019, the World Bank, and the World Trade Organization, we extracted the mean values and coefficients of variation for the covariates in regional organization characteristics, socioeconomic and demographic factors, health status and health-system capacity. The correlation between changes in the health policy scope of regional organizations and independent variables was analyzed using Poisson pseudo-likelihood regression with multiple levels of fixed effects. Results From 1945 to 2015, the number of regional organizations with health policy competencies experienced a slow growth stage before 1991 and an explosive growth stage post-1991. By 2015, 48 out of the 71 existing regional organizations had developed their health policy competencies, yet 26 (54.2%) of these organizations possessed only 1–2 health policy competencies. An enhancement in the health policy scope of a regional organization correlated with its founding year, a greater number of policy fields, higher under-five mortality, and larger disparities in trade and healthcare access and quality indexes among member states. In contrast, larger disparities in population, under-five mortality and health worker density among member states, along with more hospital beds per capita, were negatively correlated with the expansion of a regional organization’s health policy scope. Conclusion Since 1991, there has been a surge of interest in health among regional organizations, although health remains a secondary priority for them. The health policy competencies of regional organizations are pivotal for promoting social equity within regional communities. Its establishment is also closely linked to the level and disparities among member states in aspects such as trade, population, child mortality rates, and health system capacity.

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Section: Discussionmentioning

confidence: 99%

Health policy competencies in regional organizations: a retrospective analysis for 76 regional organizations from 1945 to 2015

Wang,

Liang,

Dong

et al. 2024

Global Health

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“…A recent systematic review of FTAs and health did not identify any quantitative studies that systematically examined the relationship between participation in US and EU FTAs and unhealthy commodity policy implementation [ 22 ]. Previous small-N studies instead identified instances when food, tobacco, and alcohol companies threatened or initiated trade disputes about policies affecting their products [ 13 , 23 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

US and EU Free Trade Agreements and implementation of policies to control tobacco, alcohol, and unhealthy food and drinks: A quasi-experimental analysis

Barlow

Allen

2023

PLoS Med

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Background Identifying and tackling the factors that undermine regulation of unhealthy commodities is an essential component of effective noncommunicable disease (NCD) prevention. Unhealthy commodity producers may use rules in US and EU Free Trade Agreements (FTAs) to challenge policies targeting their products. We aimed to test whether there was a statistical relationship between US and EU FTA participation and reduced implementation of WHO-recommended policies. Methods and findings We performed a statistical analysis assessing the probability of at least partially implementing 10 tobacco, alcohol, and unhealthy food and drink policies in 127 countries in 2014, 2016, and 2019. We assessed differences in implementation of these policies in countries with and without US/EU FTAs. We used matching to conduct 48 covariate-adjusted quasi-experimental comparisons across 27 matched US/EU FTA members (87 country-years) and performed additional analyses and robustness checks to assess alternative explanations for our results. Out of our 48 tests, 19% (9/48) identified a statistically significant decrease in the predicted probability of at least partially implementing the unhealthy commodity policy in question, while 2% (1/48) showed an increase. However, there was marked heterogeneity across policies. At the level of individual policies, US FTA participation was associated with a 37% reduction (95%CI: −0.51 to −0.22) in the probability of fully implementing graphic tobacco warning policies, and a 53% reduction (95%CI: −0.63 to −0.43) in the probability of at least partially implementing smoke-free place policies. EU FTA participation was associated with a 28% reduction (95%CI: −0.45 to −0.10) in the probability of fully implementing graphic tobacco warning policies, and a 25% reduction (95%CI: −0.47 to −0.03) in the probability of fully implementing restrictions on child marketing of unhealthy food and drinks. There was a positive association with implementing fat limits and bans, but this was not robust. Associations with other outcomes were not significant. The main limitations included residual confounding, limited ability to discern precise mechanisms of influence, and potentially limited generalisability to other FTAs. Conclusions US and EU FTA participation may reduce the probability of implementing WHO-recommended tobacco and child food marketing policies by between a quarter and a half—depending on the FTA and outcome in question. Governments negotiating or participating in US/EU FTAs may need to establish robust health protections and mitigation strategies to achieve their NCD mortality reduction targets.

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“…In joining the CPTPP, the government hopes to boost trade, improve economic growth, and strengthen the UK’s strategic position as a global rule setter. Free trade deals, however, have serious and wide ranging implications for public health and policy making, as they commit countries to certain regulatory and legal obligations 2345. They can, for example, make it more difficult for governments to regulate for the benefit of health and increase industry influence in public health standard setting, as well as increase the cost of medicines.…”

mentioning

confidence: 99%

The CPTPP trade deal is a major threat to public health and warrants a health impact assessment

McNamara

Green

Barlow

et al. 2023

BMJ

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Reassessing the health impacts of trade and investment agreements: a systematic review of quantitative studies, 2016–20

Cited by 7 publications

References 47 publications

Health policy competencies in regional organizations: a retrospective analysis for 76 regional organizations from 1945 to 2015

Health policy competencies in regional organizations: a retrospective analysis for 76 regional organizations from 1945 to 2015

US and EU Free Trade Agreements and implementation of policies to control tobacco, alcohol, and unhealthy food and drinks: A quasi-experimental analysis

The CPTPP trade deal is a major threat to public health and warrants a health impact assessment

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