Globalization and Its Impact On Health•Health care, education, water and sanitation ... Health as...
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Globalization and Its Impact on Health Ellen R. Shaffer, PhD MPH and Joe Brenner, MA, Co-Directors, Center for Policy Analysis on Trade & Health San Francisco, CA August, 2007 Prepared as part of an education project of the Global Health education Consortium And collaborating partners
Transcript of Globalization and Its Impact On Health•Health care, education, water and sanitation ... Health as...
Globalization and Its Impact on Health
Ellen R. Shaffer, PhD MPH and Joe Brenner, MA, Co-Directors, Center for Policy Analysis on Trade & Health
San Francisco, CA
August, 2007
Prepared as part of an education project of the
Global Health education Consortium
And collaborating partners
Page 2
Learning Objectives
• Understand changes in the global economy that affect health
• Identify global public health priorities and conflicts with prevailing economic and trade policies
• Articulate how trade agreements can restrict access to affordable health-related services and medicines, public health regulations that protect health such as tobacco and alcohol control measures, health professional workforce, and food supply
• Provide examples of campaigns to bring public health’s voice into global economic policy
Page 3
Introduction: Public Health And Global Trade
• Global trade agreements address public health
concerns
• Public Health not generally involved
• Sustainable economic development is a public
health issue
• Trade negotiations are at a crossroads: we can
make a difference
Page 4
Outline: GLOBALIZATION & PUBLIC HEALTH
1. Context: Economic Globalization
2. Trade Agreements and Public Health
– Public Health’s Right to Regulate
– Environment, Tobacco Control
– Services
– Affordable Medicines
3. Public Health Representation in U.S. Trade Negotiations
4. Prospects for Progress: Bringing Public Health Voice to
Sustainable Development
Page 5
1. Context: Economic Globalization
• Threats to Global Health
• Global Economic Trends
• Barriers to Development
• Sustainable Development: Prevailing Economic
View Vs. Public Health View
• The Trade Landscape
• Trade Policy at a Crossroads
Page 6
Threats to Global Health
• Widespread threats to global health persist
– AIDS, TB, Malaria
– Infectious diseases
– Chronic illnesses: Hypertension, diabetes
– Environmental: Cancer, respiratory
• Coexisting with both unprecedented wealth and
economic inequality
– Americas have greatest income inequalities
Notes on Threats to Global Health
Country Gross National
Income Per
cap. Current
U.S.$1
Expenditures
Per cap. On
Health
Services,
Latest Year,
Current U.S.$3
Health
Expenditures
% of GDP2
Infant Mortality
Per 1,000
Births
Developed
Canada 21,130 1,847 9.3 6
United States 34,100 4,055 12.9 7
Developing
Antigua &
Barbados 9,440
498 1.9 17
Argentina 7,460 667 8.4 19
Bahamas 14,960 778 4.3 18
Belize 3,110 170 2.7 35
Bolivia 990 53 6.5 66
Brazil 3,580 320 6.5 36
Chile 4,590 369 5.9 11
Columbia 2,020 226 9.4 25
Costa Rica 3,810 245 6.7 14
Cuba * 138 9.1 7
Dominican
Republic
2,130 126 4.8 43
Ecuador 1,210 59 3.6 30
El Salvador 2,000 164 7.2 30
Guatemala 1,680 78 4.4 41
Guyana 860 45 5.4 58
Haiti 510 16 4.2 91
Honduras 860 56 8.6 33
Jamaica 2,610 159 5.5 10
Mexico 5,070 234 5.3 28
Nicaragua 400 53 12.5 39
Panama 3,260 255 7.3 18
Paraguay 1,440 120 5.2 27
Peru 2,080 100 6.2 43
St. Kitts and
Nevis
6,570 349 5.8 30
St. Vincent &
Grenadines
2,720 170 6.3 (not available)
Suriname 1,890 140 6.3 28
Trinidad &
Tobago
4,930 248 4.3 16
Uruguay 6,000 697 9.1 16
Venezuela 4,310 200 4.2 21
Threats to Global Health
Data on inequalities in income and health status among and within nations, continents
Table 1. Income, Expenditures on Health, Infant Mortality in the Americas, 1998.
From: The FTAA: Health Hazard For The Americas? Shaffer, Brenner, Yamin, 2003.
1. Developing countries – Economic Policy – 2001. World Bank. http://devdata.worldbank.org/external/dgcomp.asp?rmdk=110&smdk=473880&w=0
2. http://who.int./whr/2001/main/en/annex/Annex5-en-WEB.xls. 1998
3. http://www.socwatch.org.uy/indicators/query.htm. 1998
* GNI per cap is not presented for Cuba in the World Bank’s table, Developing countries – Economic Policy – 2001. No explanation is provided for this missing information. http://www.socwatch.org.uy/indicators/query.htm.%201998
From Michele Barry, MD, FACP
(Former) Director of the Office of International Health
Yale University School of Medicine:
•The gap in per capita income between the wealthy and poor countries has tripled from 1960 – 19931 •100/174 countries per capita income is lower than 15 years ago •1.2 billion people live on < $1 a day 2
1 United Nations Development Programme (UNDP). Human Development Report 2002. New York: Oxford University Press, 2002. 2 Crunching the Numbers. Global Issues 2006 http://www.global-issues.net
Inequalities: Health Care Expenditure Gap
89% of all global expenditures on health care goes to
16% of the world’s population
World expenditure on healthcare = $2.2 trillion
U.S. expenditure on healthcare = $1.1 trillion
% Gross National Product spent on health care
U.S. = 14.1%
SubSaharan Africa = 1.6%
Benatar SR. Ethics and Tropical Diseases: Some global considerations. In: Cook G, Zumla A,
editors. Manson’s Tropical Diseases, 21st Edition. Edinburgh: Elsevier Sciences. 2002:Pp 85-93;
from Michele Barry, Yale
Page 9
Which Comes First: Wealth or Health?
Higher Income Growth Lower Income Growth
Better IMR* Many East Asian countries Many Latin American
Countries
Worse IMR Many South Asian countries Many African countries
Nishan de Mel, Trinity College, Oxford Health Without Wealth
*IMR = Infant Mortality Rate, or deaths <1 year of age/1000 live births
Page 10
Barriers to Development
• Imbalance of wealth and power
• Legacy of colonialism
• History of Cold War politics
Page 11
Global Economic Trends
• Manufacturing, agriculture growth in
low/middle income countries
• Growth of services sector in
wealthier nations
• Greater quantity and accelerated
pace of cross-border financial
transactions and exchanges
Page 12
Economic Globalization
• The integration of economic and political
systems across the globe
• Who will control and benefit?
Page 13
Sustainable Economic Development : Competing Views
Prevailing Economic View
• Facilitate trade to increase the wealth of corporations and the
general population, including the poor.
• Deregulation. By reducing laws and regulations:
– Facilitate faster flow of capital, with Foreign Direct Investment
• Privatization:
– Turn public entities into private enterprises
– Save public funds, increase access
Page 14
Public Health Views: Sustainable Alternative
• Countries determine mix of foreign investment and
local development
• Accountable, democratic governments
• Strong social institutions and infrastructure
– Assure access to affordable vital services
• Health care, education, water and
sanitation
– Promote equity
• Privatization shifts costs to individuals
Notes on Public Health Views: Sustainable Alternative
Public Health Views: Sustainable Alternative
Health as a Public Good; Other Health Consequences of Globalization - Graham Lister, Judge Business School
Health as a Global Public Good
A global public good is one all can share and from which none can be excluded
Global Public health goods include:
Health knowledge
Drugs and treatments
Health systems that protect global health
Globalization may increase public goods
By supporting global health solutions, sharing knowledge and enabling common action but
It also leads to a reduction in public goods
By taking health resources from where they are needed
By privatizing health knowledge and resources
Health and Trade
Selected health impacts related to trade by 500 Trans National Companies which account for 50% of
international trade and 90% of foreign direct investment
Financial instability: Reduced resources, depression
Agriculture subsidies in rich countries reduce farm income in poor countries
Patent laws raise drug prices, restrict supply of drugs
Pharmaceutical research 90% is spent on 10% of people
Trade and tourism: spread 0f Hepatitis B and BSE/ nvCJD (New variant Creutzfeldt-Jakob Disease)
Investment: can produce “sweat shops” and poor health as countries reduce environmental protection
measures to attract investment
Page 16
The Trade Landscape
Page 17
Key Multilateral Trade Agreements
• General Agreement on Trade and Tariffs (GATT). Part of Bretton Woods accords at end of World War II. Reduced tariffs as financial barriers to trade.
• World Trade Organization (WTO). Established as formal trade organization in 1995. Assumed administration of GATT, added 9 new trade agreements, including agreements on services, intellectual property, and agriculture for the first time.
Page 18
WHAT DO TRADE AGREEMENTS DO?
“Liberalize” trade:
Facilitate global corporate transactions
Page 19
Reduce barriers to trade
• Barriers to trade in steel & other
goods = tariffs
• Barriers to trade in services =
“measures”
• Regulations
• Laws
• Administrative rulings
Page 20
Stalemate
• The major countries have sought “liberalizing” measures for their competitive sectors (services, goods) but have been unwilling to make offsetting concessions in their noncompetitive sectors (e.g., unwilling to reduce subsidies for agriculture).
•
• Popular opposition at conferences: Seattle, Cancun, Hong Kong, Guatemala, Thailand
• Deadlock at World Trade Organization (WTO) meetings: 1999, 2003, 2005, 2006
Page 21
Carnegie: Trade and Wealth
• It has been fashionable to state that trade can do
more than development aid to lift people out of
poverty in developing countries.
• But trade is only one policy mechanism among
many that must be pursued to achieve economic
growth and rising incomes.
Page 22
Trade Policy at a Crossroads: Trade Gains Modest
Recent studies* by Carnegie Corp. and the World Bank show a one-time global income gain of less than $60 billion under any realistic new WTO trade scenario.
That is 0.146 percent (about one-seventh of one percent) of current global gross domestic product (GDP).
*Kym Anderson, William J. Martin, and Dominique van der Mensbrugghe, Global Impacts of the
Doha Scenarios on Poverty, September 18, 2005. In Poverty and the WTO: Impacts of the Doha
Development Agenda, ed. Thomas W. Hertel and L. Alan Winters (Washington: World Bank, 2006),
Sandra Polaski, Winners and Losers: Impact of the Doha Round on Developing Countries.
Carnegie Endowment for International Peace, 2006.
Page 23
Carnegie Policy Proposals
1. Reject proposed trade policy changes that are
likely to worsen poverty
2. Reject trade policy changes likely to produce
benefits for only small numbers of firms and
households while inflicting economic harm on
larger numbers
3. Sequence liberalization
4. Strengthen trade adjustment assistance.
Page 24
CURRENT U.S. PROPOSALS: Regional, Bilateral Agreements
• Since failure of large international trade
negotiations at WTO in 2003 and 2006, US is
focusing on individual countries and smaller
regions.
– Australia
– CAFTA (Central America Free Trade Agreement,
also including the Dominican Republic)
– Andean Region, Korea
Page 25
2. Trade Rules vs. Public Health Priorities
• Right to regulate trade
• Trade dispute resolution
• Tobacco control
• Services
• Intellectual property (IP) and access to medicines
• Agriculture
Page 26
What Do Trade Agreements Do? Review
• “Liberalize” trade:
– Facilitate global corporate transactions
• Reduce tariff & other barriers to trade
– Barriers to trade in steel = tariffs
– Barriers to trade in services = regulations
Page 27
Trade Rules Vs. Public Health Right to Regulate
Trade rules threaten to pre-empt a wide range of
laws, regulations, policies, and programs
designed to prevent disease and promote health.
Page 28
Vectors of Pre-Emption: Trade Agreement Rules
• Example: Domestic Regulation Rules
• Laws and regulations that are “more burdensome than necessary to ensure the quality of a service” can be challenged as barriers to trade.
• Public health officials may view a regulation as “necessary,” but trade officials may view the same regulation as an “unnecessary barrier to trade.”
.
Page 29
Laws and Regulations At Risk
• Public subsidies for “safety net” health services
• Affordable medications
• Food safety/foods that are Genetically Modified Organisms
• Quality standards for health care services and products & allocation based on need
• Clinician licensing
• Health insurance & patient protection
• Distribution of alcohol, tobacco, firearms
• Occupational safety & health
• Public administration of water & sanitation
Page 30
Enforcing Trade Rules: WTO Dispute Resolution
• 3 WTO-appointed trade “experts”
decide in closed session if a
WTO policy has been violated
• They can impose economic sanctions
on losing country
• These rules challenge domestic
sovereignty to regulate and protect
health and access to vital human
services
Page 31
Right to Regulate Vs. Corporations’ Right to Sue
Bilateral/regional agreements like NAFTA*
provide a unique “investor’s rights” mechanism.
– Foreign corporations can directly challenge national
government actions.
– Grounds: the loss of current or future profits, even if
caused by a government agency prohibiting the use
of a toxic substance.
*North American Free Trade Agreement – covers Canada, U.S., Mexico
Page 32
NAFTA Challenge to Health: Metalclad • State of San Luis Potosí - permission
to re-open waste disposal facility denied.
• Geological audit - waste disposal site would contaminate local water supply. Community opposed re-opening.
• Metalclad Company - local decision was an expropriation of its future potential profits.
• Metalclad successfully sued Mexico.
In 2000, Metalclad awarded $16.7 million.
Page 33
Does Public Health Ever Win? Rarely and Barely
• 2 cases in 10 years upheld public health
• Global trade dispute panels: no concept of
public health
• Decisions set poor precedents, delayed
public health protections
Page 34
World Health Organization/PAHO on Tobacco and Trade
“Transnational tobacco companies…have been among the strongest proponents of tariff reduction and open markets. Trade openness is linked to tobacco consumption.”
D. Woodward, N. Drager, R. Beaglehole, D. Lipson. Globalization, global public goods, and health. In: Trade in Health Services: Global, Regional and Country Perspectives. N. Drager and C. Vieira, Eds. Washington, DC: Pan American Health Organization (PAHO), 2002. pp 6-7.
Page 35
CHILLING EFFECT ON PUBLIC HEALTH REGULATIONS
• Canada proposes "plain" packaging for cigarettes
• American tobacco companies threaten NAFTA
suit for "expropriation" of their intellectual property
- their trademarks
• Canada withdraws proposal
Page 36
WHO Framework Convention for Tobacco Control
• Bans sales to minors
• Promotes agricultural diversification
• Bans advertising promotion & sponsorship
• Rotates pack health warnings at 30-50% size
• Eliminates illicit trade in tobacco
• Violates WTO Rules?
Michele Barry, MD FACP, Yale
Page 37
Bargaining Away Services: GATS
• General Agreement on Trade in Services (GATS)
• A WTO agreement that entered into force in 1995.
• Extends the multilateral trading system to vital human services such as health care, education and water supply, as well to commercial services such as finance and banking.
• Through the WTO, countries bargain with each other for concessions on services covered by GATS at the same time as they seek changes in other WTO agreements
• Countries can bargain away health “protections” for services in exchange for economic “protections” for goods, agriculture
Page 38
WTO Trade Disputes on Services
• Trade dispute panel banned Mexico telecommunications surcharges intended to fund wider access to phone services, because unfair to foreign companies
• U.S. internet gambling prohibitions overturned
– Intended to protect youth, the public, from online abuses related to gambling addiction
– Found to discriminate against online gambling companies in Antigua
From: Ellen R. Shaffer, Phd, MPH, Howard Waitzkin, MD, Phd, Joseph Brenner, MA, and Rebeca Jasso-Aguilar, MA,
Health Policy and Ethics In Public Health Research, Global Trade And Public Health, American Journal of Public Health,
Am JPublic Health. 2005;95:23–34. doi: 10.2105/AJPH.2004.038091,
http://www.cpath.org/sitebuildercontent/sitebuilderfiles/ajph_01_2005.pdf.
In the first trade dispute decided under GATS, a WTO tribunal rejected Mexico’s defense of its
telecommunications regulations. The tribunal found that charges including a contribution to the
development of Mexico’s telecommunications infrastructure were not “reasonable.” Mexico had
argued that GATS provisions appeared to give flexibility to governments in achieving development
objectives, including Mexico’s policy goal of promoting universal access to basic telecommunications services for its
population.
Page 39
HEALTH CARE PROFESSIONALS MIGRATION AND GATS
Page 40
Workforce RNs per 100,000 Population in Sending and Receiving Countries
So
uth
Afr
ica
Ph
ilip
pin
es
Zim
ba
bw
e
Nig
eri
a
Ind
ia
0
200
400
600
800
1000
1200
Sending
Un
ite
d S
tate
s
Un
ite
d K
ing
do
m
Ca
na
da
Au
str
ali
a
Ne
w Z
ea
lan
d *
0
200
400
600
800
1000
1200
Receiving
*New Zealand includes both RNs and midwives.
Jean Ann Seago, UCSF Julie Sochlaski, U Penn
Page 41
Should Countries Rely on GATS for Health Professionals? Proponents!
• Immigration resolves staffing shortages in richer countries
• Remittances are paid by migrants to poorer countries
• Some patients follow “temporary” MDs back to home
country when they return (e,g, for specialty care)
• Poor countries seek rules for easier emigration of unskilled
labor; willing to trade for rules that also make it easier for
their skilled professionals to emigrate
Page 42
Should Countries Rely on GATS for Health Professionals? Opponents!
• Temporary migration:
– Inefficient, unfair, hard to enforce
– Unsustainable model for development
• Rules for licensing, staffing, quality should not be determined in trade arena
• Human rights not addressed
– Migrant nurses often underpaid, isolated, unaware of their rights to fair treatment
• Infrastructure issues not addressed
– Use of migrant labor relieves pressure to provide health care workplaces that attract and retain nurses
Page 43
Nurse Migration: Some Proposed Solutions
• Protect nurses’ human rights
– Fair treatment: assure fair pay, working conditions
– Right to travel to advance global nurse expertise
• Invest in nursing education and higher pay
• Models:
– International Council of Nurses Code of Ethics
– PAHO Caribbean Managed Migration project
Page 44
INTELLECTUAL PROPERTY RULES AND ACCESS TO AFFORDABLE MEDICINES
Page 45
Global AIDS Pandemic
• 38 million people with HIV/AIDS
• 5.8 million could benefit now from effective drugs
• Generic antiretrovirals (ARVs) inaccessible to millions
• 3x5 plan (3 million on ARVs by 2005) failed
– ARVs increased 440,000 to reach 1M in the developing world receiving treatment.
Page 46
TRIPS
• Trade-Related Aspects of Intellectual Property
Rights = TRIPS
• WTO Agreement
• All WTO member countries must give patent
holders rights as stated in TRIPS
– Phased in: Least Developed Countries to implement by
2016
– Already in effect for most countries
Page 47
What Do Patents Do?
• Monopoly rights to originator who can then
sell product without competition
• Protection for originator’s “intellectual
property” (= IP)
Page 48
Role of Patent Policy for Drugs
• Key incentive to innovation
• Fairly compensates investments in Research &
Development (R&D)
• Assures timely access to new life-saving drugs
-- OR (a contrary view) --
• Props up exorbitant pharmaceutical company profits in
absence of actual innovation
• Perpetuates monopoly as long as possible by extending
patent terms and durations
• Discourages fair competition by generics
Page 49
Pharmaceutical Industry is one of the most profitable in the World
• Industry justifies profits in large part based on R&D costs. But….. – 15% Research and Development
– 37% Marketing and Administration
– 19% Profits
– With only ~29% as the Cost of Production
Sources: M. Angell, The Truth About the Drug Companies; Kaiser Family Foundation, Prescription Drug Trends, Nov. 2001
Page 50
Crisis in Innovation
• Fewer new drugs in research pipeline
• Business model stuck in vicious cycle
– Windfall of billions due to patent laws that
created mega-corporations with obligations to
investors, employees
– Driven to seek blockbuster, copycat drugs
Page 51
Pharma Political Strategy: Trade Agreements
A. Protect high prices in US market
– Block reimportation to US (“parallel importation”)
B. Seek higher prices in other developed countries
– Pharma argues that price controls harm quality, access, innovation
C. Maintain IP structure in regional trade agreements with low
and middle-income countries
– “TRIPS-Plus” trade rules extend patents
– Restrict production and sale of generics
– Market to small number of wealthy individuals
Page 52
TRIPS Challenge to ARVs in South Africa
• Clinton Administration threatened to cancel other trade benefits (Generalized System of Preferences) to force S. Africa to change laws providing affordable drugs
• Gore rescinds threat, 2000
• Pharma files TRIPS suit against SA drug law
• Pharma withdraws suit in 2001 due to international outcry
• Results led to Doha Declaration, 2001
Page 53
International Response to Crisis: Doha Declaration on the TRIPS Agreement and Public Health
• Addition to the TRIPS Agreement
• Establishes that countries can protect public health
• Paragraph 4. “We agree that the TRIPS Agreement
does not and should not prevent members from
taking measures to protect public health.”
– World Trade Organization Ministerial Meeting, Doha
– Adopted November 14, 2001
Page 54
Doha Declaration Allows Compulsory Licenses
• Government can issue a license to a producer other than the patent holder to market a drug
– Can authorize generic production of patented drugs
• Compulsory license can be issued for various reasons including – but not limited to - an emergency, eg, epidemic, humanitarian disaster
– License can let a country develop its own drug industry, and/or attain higher outputs and efficiencies
– License can be bargaining chip to lower brand name drug prices
• TRIPS Health Solution, 2003: Grants limited right to import/export generics for least developed countries that can’t produce own drugs
Page 55
What is “TRIPS-Plus?”
• Debate: Is TRIPS a Floor or Ceiling?
• Can bilateral and regional agreements give patent holders greater monopoly rights than they enjoy under TRIPS? – US says ‘Yes’, through bilateral/regional Free Trade Agreements
(FTAs)
– India, China, Brazil, South Africa say ‘No’, and urge use of WTO
• TRIPS-Plus provisions in bilateral/regional trade agreements give drug companies with patents greater monopoly rights than they have through TRIPS alone.
Page 56
U.S. Imposes TRIPS-Plus Rules
• CAFTA (Central American Free Trade Agreement)– enacted 2006
• Proposed since 2005: – Andean FTA: Peru, Panama, Colombia
– South Korea
– Thailand: withdrew from negotiations after coup, issued Compulsory Licenses
– Southern African Customs Union: withdrew from negotiations
Page 57
CPATH on Australia FTA: Trade Rules Prop Up Drug Prices:
• Trade rules protect brand-name pharmaceutical
companies from fair competition
• U.S.- Australia FTA: challenges effective
Australian program for controlling drug prices
• Forbids reimporting lower priced drugs from
Australia to US
– Real target is Canada
Page 58
U.S. Congress on Reimportation
• Appropriations bills, 2005 and 2006, respond to
misuse of trade agreements to set U.S. policy
• Appropriations bills state that trade agreements
cannot bar reimportation of drugs to U.S.
– Trade agreements achieve corporate policy without
public debate
• Singapore and Australia provisions banning
reimportation cited
Page 59
Agriculture, Trade and Obesity
• Global agribusiness and transnational shifting of raw materials to processed foods, high calorie soft drinks and snacks
• Nutrition transition during globalization • Dietary convergence of low to high income country
patterns
• Consumption of foods high in fats and sweeteners
• Cultural change: urbanization, eating outside home, global supermarkets
Michele Barry, MD, Yale
Worldwide Obesity
1 billion adults are overweight (BMI > 25)
300 million adults are obese (BMI > 30)
22 million children are overweight
Michele Barry, MD, Yale
Page 61
Diabetes prevalence in people over 20 years of age in 2000 and predicted for 2030
Countries
(population >100 million)
Diabetes
prevalence in 2000 (>20 years of age as
percentage)
Estimated
prevalence in 2030 (>20 years of age as
percentage)
Developed 6.3% adults 8.4% adults
Developing 4.1% adults 6.0% adults
Worldwide 175 millions 353 millions
From: Yach et al. Epidemiologic and economic consequences of the global epidemics of
obesity and diabetes. Nature Medicine 2006;12(1):62-66. From Michele Barry, Yale University
Page 62
3. Democracy in Trade Policy: Who Decides?
Page 63
Democracy in Trade Policy Who Decides for U.S.?
• US Trade Representative (USTR) appointed by President
– Susan Schwab is USTR as of 2006
• Congress limited by “Fast Track” Rules:
– Congress cannot amend trade agreements, just vote yes or no
– Fast Track expired June 30, 2007
• Applies to agreements negotiated before 6/07 – Andean, Korea
– Congress could renew
• The public can speak up
Page 64
Campaign for Public Health Representation
• US Trade Representative Advisory Committees
• Mechanism for domestic input into trade negotiations
• Provide both formal and informal advice to Executive branch
• 110 meetings in 2001, per study by Govt. Accountability Office
Page 65
Access to Policy Making
• Govt. Accountability Office findings: Advisory Committee members feel they benefit from increased access to the US Trade Rep. and other government officials, and increased ability to influence trade negotiations and policy
• There are no public records of meetings
Page 66
Trade Advisory Committee members, 2005: Big Business Reps: 42 vs. Public Health: 0
Pharma reps. 20 Public Health 0
Tobacco reps. 7 Public Health 0
Alcohol reps. 6 Public Health 0
Food reps. 5 Public Health 0
Health Insurance reps. 4 Public Health 0
Page 67
Public Health Takes Action • Public health and medical groups file federal lawsuit for representation:
2005
• One tobacco control (public health) representative appointed, 2005
• USTR reports appointing a public health rep to each of
2 Committees: Pharmaceuticals, and Intellectual Property
– 1 of them comes from a pharma think tank
• Now 42 to ~ 2
• 2007: Congress demands greater transparency, accountability
Both public health representatives and members of Congress are demanding a greater
role in setting U.S. trade policy, and more fundamental changes in trade policy that
benefit individuals and communities as well as corporations. See www.cpath.org for the
latest developments.
Page 68
4. Prospects for Progress: Public Health Voice for Sustainable Development
Page 69
Alternative Models of Trade Alliances and Objectives
• MERCOSUL – Latin American trade/development alliance
• European Union
• Cash transfers to lower income neighbors
• Aim to eliminate inequalities among countries
• Bolster social programs
Page 70
Public Health Campaigns
• These campaigns…..
– Help reframe the debate on global trade and economic
development
– Have declared health care & water vital human rights
– Engage in dialogue and decision-making process to
protect health care services and promote public health
Page 71
Health Leaders Prescribe Caution on Trade Agreements
Drs. David Satcher, Joyce Lashof,
Victor W. Sidel, Anthony Robbins,
CPATH, APHA, ANA, Nov. 2003:
New trade rules
threaten ability of
nations to protect
public health
Issue Call for Public
Health Accountability
Page 72
Public Health Positions
American Medical Association: Collaborates with
interested members and other professional
organizations to advise the U.S.T.R. on trade
issues that involve the distribution and advertising
of alcohol and tobacco, and other pertinent public
health issues.
Page 73
States, Cities, Towns Concerned
• State and local officials are gravely concerned about the prospect of the trade dispute resolution mechanism… no provision remotely similar to NAFTA’s should be included in future agreements… – Executive Directors of National Conference of State
Legislators, National League of Cities, National Association of Towns& Townships
- Comments to USTR, Fed. Register, August, 2002, regarding the trade dispute mechanism in Singapore FTA
Page 74
U.S. Public Health Groups Support World Health Organization Trade Resolutions – May, 2006
• Resolution on Trade and Health: EB 117 R5
• Global Framework on Essential Health Research and Development: EB 117. R1
• Support by wide range of U.S. health groups: – American Cancer Society
– American College of Preventive Medicine
– American Nurses Association
– American Public Health Association
– Campaign for Tobacco-Free Kids
– Center for Policy Analysis on Trade and Health
– Physicians for Social Responsibility
– Tobacco-Free Kids Action Fund
Page 75
2007: New Views in Congress
• Freshmen members dubious on trade
• Re-negotiated Andean agreements
– Minimized TRIPS-Plus rules
– Stronger labor and environmental protections
• Resistance on Korea for health, other issues
– Restricts drug listing/pricing systems used in Korea and in US safety net
– Eliminates tobacco tariffs, threatens tobacco controls
– Controversy on auto, beef exports
• Democrats’ Statement of principles
– March 2007: Share benefits of trade more broadly
• Opposition to renewing Fast Track approval of trade agreements
Page 76
Getting Specific: Public Health Objectives for 2007 Major Public Health and NGO Groups
1. To assure democratic participation by public
health and transparency in trade policy
2. To develop mutually beneficial trade
relationships that create sustainable economic
development
3. To recognize the legitimate exercise of national,
regional and local government sovereignty to
protect population health
Page 77
Getting Specific: Public Health Objectives for 2007
4. To exclude tariff and non-tariff provisions in trade agreements that affect vital human services
5. To exclude tobacco and tobacco products from consideration
6. To exclude alcohol products from consideration
7. To eliminate intellectual property provisions related to pharmaceuticals from bilateral and regional negotiations….and promote trade provisions which enable countries to protect health per the Doha Declaration on Public Health
Notes on Getting Specific: Public Health Objectives for Global Trade
The objectives, and links to other public health groups concerned about
economic globalization, are online at the website for the Center for Policy
Analysis on Trade and Health: www.cpath.org
CPATH’s goals are:
• Increase visibility of public health leaders in the global trade debate.
• Education and mobilization on the threats of trade agreements for public
health.
• Develop alternative approaches.
• Assure that trade policy promotes and protects health.
• Network With CPATH
To subscribe to CPATH’s Globalization and Health listserv
Send a blank message to:
Contact information: www.cpath.org
Phone: 415-933-6204
Fax: 415-831-4091
Page 79
Summing Up
• Present rules for economic globalization threaten the
livelihood and health of people and communities
• Public health advocates can and must work to change
trade policies to assure sustainable development,
access to affordable health-related services, and the
right to improve and protect health
Page 80
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Credits
Ellen R. Shaffer, PhD MPH and Joe Brenner, MA Co-Directors, Center for Policy Analysis on Trade & Health
San Francisco, CA
Acknowledgements The Global Health Education Consortium gratefully acknowledges the support
provided for developing these teaching modules from:
Margaret Kendrick Blodgett Foundation
The Josiah Macy, Jr. Foundation
Arnold P. Gold Foundation
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0
United States License.
