Abstract:Twenty-first-century trade policy is complex and affects society and population health in direct and indirect ways. Without doubt, trade policy influences the distribution of power, money, and resources between and within countries, which in turn affects the natural environment; people's daily living conditions; and the local availability, quality, affordability, and desirability of products (e.g., food, tobacco, alcohol, and health care); it also affects individuals' enjoyment of the highest attainable standa… Show more
“…The framework focuses on three main intermediate mechanisms linking RTAs to health outcomes: production, consumption, and health-services and policy. This builds on previous identification by Labonte and Schrecker (2007), Blouin et al (2009), and Friel et al (2015) [13, 22, 23]. Fig.…”
BackgroundRegional trade agreements are major international policy instruments that shape macro-economic and political systems. There is widespread debate as to whether and how these agreements pose risks to public health. Here we perform a comprehensive systematic review of quantitative studies of the health impact of trade and investment agreements. We identified studies from searches in PubMed, Web of Science, EMBASE, and Global Health Online. Research articles were eligible for inclusion if they were quantitative studies of the health impacts of trade and investment agreements or policy. We systematically reviewed study findings, evaluated quality using the Quality Assessment Tool from the Effective Public Health Practice Project, and performed network citation analysis to study disciplinary siloes.ResultsSeventeen quantitative studies met our inclusion criteria. There was consistent evidence that implementing trade agreements was associated with increased consumption of processed foods and sugar-sweetened beverages. Granting import licenses for patented drugs was associated with increased access to pharmaceuticals. Implementing trade agreements and associated policies was also correlated with higher cardiovascular disease incidence and higher Body Mass Index (BMI), whilst correlations with tobacco consumption, under-five mortality, maternal mortality, and life expectancy were inconclusive. Overall, the quality of studies is weak or moderately weak, and co-citation analysis revealed a relative isolation of public health from economics.ConclusionWe identified limitations in existing studies which preclude definitive conclusions of the health impacts of regional trade and investment agreements. Few address unobserved confounding, and many possible consequences and mechanisms linking trade and investment agreements to health remain poorly understood. Results from our co-citation analysis suggest scope for greater interdisciplinary collaboration. Notwithstanding these limitations, our results find evidence that trade agreements pose some significant health risks. Health protections in trade and investment treaties may mitigate these impacts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-017-0240-x) contains supplementary material, which is available to authorized users.
“…The framework focuses on three main intermediate mechanisms linking RTAs to health outcomes: production, consumption, and health-services and policy. This builds on previous identification by Labonte and Schrecker (2007), Blouin et al (2009), and Friel et al (2015) [13, 22, 23]. Fig.…”
BackgroundRegional trade agreements are major international policy instruments that shape macro-economic and political systems. There is widespread debate as to whether and how these agreements pose risks to public health. Here we perform a comprehensive systematic review of quantitative studies of the health impact of trade and investment agreements. We identified studies from searches in PubMed, Web of Science, EMBASE, and Global Health Online. Research articles were eligible for inclusion if they were quantitative studies of the health impacts of trade and investment agreements or policy. We systematically reviewed study findings, evaluated quality using the Quality Assessment Tool from the Effective Public Health Practice Project, and performed network citation analysis to study disciplinary siloes.ResultsSeventeen quantitative studies met our inclusion criteria. There was consistent evidence that implementing trade agreements was associated with increased consumption of processed foods and sugar-sweetened beverages. Granting import licenses for patented drugs was associated with increased access to pharmaceuticals. Implementing trade agreements and associated policies was also correlated with higher cardiovascular disease incidence and higher Body Mass Index (BMI), whilst correlations with tobacco consumption, under-five mortality, maternal mortality, and life expectancy were inconclusive. Overall, the quality of studies is weak or moderately weak, and co-citation analysis revealed a relative isolation of public health from economics.ConclusionWe identified limitations in existing studies which preclude definitive conclusions of the health impacts of regional trade and investment agreements. Few address unobserved confounding, and many possible consequences and mechanisms linking trade and investment agreements to health remain poorly understood. Results from our co-citation analysis suggest scope for greater interdisciplinary collaboration. Notwithstanding these limitations, our results find evidence that trade agreements pose some significant health risks. Health protections in trade and investment treaties may mitigate these impacts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-017-0240-x) contains supplementary material, which is available to authorized users.
“…From an evidence perspective, there is a growing literature showing the relationship between trade and health, for example (Bettcher et al., ; Blouin and Drager, ; Friel et al., ; Pollock and Price, ), but it is by no means widely considered in global public health. Normalising the connection between health and structural policy matters such as trade is vital.…”
Section: Many Regulatory Approaches To Creating Systems Of Hopementioning
The confluence of social and health inequities and global environmental degradation shines a light on fundamental ruptures in society. A systems view of humanity reminds us that this status quo is not static, and that the shifting political and economic sands provide an important window of opportunity to collectively change the system towards the public good, such that communities are able to live with good health, dignity and in an environmentally sustainable way. To enable this, global policy, and in particular global health policy must break out of the policy silos and refocus in a systems way. If the system is to adapt, an ambitious vision for the system is needed that is different to the status quo. No one regulatory model that can improve complex societal problems, rather we must use a plurality of approaches. Reorienting the system to achieve positive outcomes depends on reimagining the purpose of structural regulatory powers, and the releasing the agency of networks of concerned actors. In a hyper-connected world there are many partners to help create systems of hope.
“…For example, trade agreements have been largely negotiated without assessing their health and environmental effects on the Pacific peoples. 20 An integrated view of health development needs to be put into practice by both the countries themselves and the development partners.…”
Section: What Needs To Change Over the Next 15 Years?mentioning
Objective. Twenty years ago the Pacific's health ministers developed a 'Healthy Islands' vision to lead health development in the subregion. This paper reports on a review of health development over this period and discusses the implications for the attainmentof the health related Sustainable Development Goals.Methods. The review used qualitative and quantitative methods. The qualitative review included conducting semistructured interviews with Pacific Island Government Ministers and officials, regional agencies, health workers and communitymembers. A documentreview was also conducted. The quantitativereview consisted of examining secondary data from regional and global data collections.Results. The review found improvementin health indicators, but increasing health inequality between the Pacific and the rest of the world. Many of the larger island populations were unable to reach the health Millennium Development Goals. The 'Healthy Islands' vision remainedan inspirationto health ministersand senior officials in the region. However, implementation of the 'Healthy Islands' approach was patchy, under-resourcedand un-sustained. Communicable and Maternal and Child Health challenges persist alongside unprecedentedlevels of non-communicablediseases, inadequate levels of health finance and few skilled health workers as the major impedimentsto health development for many of the Pacific's countries.Conclusions. The currenttrajectory for health in the Pacific will lead to increasing health inequity with the rest of the world. The challenges to health in the region include persisting communicable disease and maternal and child health threats, unprecedentedlevels of NCDs, climate change and instability, as well as low economic growth. In order to change the fortunes of this region in the age of the SDGs, a substantial investment in health is required, including in the health workforce, by countries and donors alike. That investment requires a nuanced response that takes into account the contextual differences between and within Pacific islands, adherence to aid effectiveness principles and interventions designed to strengthen local health systems.What is known about the topic? It is well established that the Pacific island countries are experiencing the double disease burden, and that the non-communicabledisease epidemic is more advanced. What does this paper add? This paper discusses the review of 20 years of health development in the Pacific. It reveals that although progress is being made, health development in the region is falling behind that of the rest of the world. It also describes the progress made by the Pacific countries in pursuit of the 'Healthy Islands' concept. What are the implications for practitioners? This paper has significant implications for Pacific countries, donor partners and development partners operating across and within Pacific countries. It calls for a substantial increase in health resourcing and the way development assistance is organised to arrest the increasing inequities in healt...
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