Ashley Schram

The Trans-Pacific Partnership: Is it Everything We Feared for Health?

BACKGROUND Negotiations surrounding the Trans-Pacific Partnership (TPP) trade and investment agreement have recently concluded. Although trade and investment agreements, part of a broader shift to global economic integration, have been argued to be vital to improved economic growth, health, and general welfare, these agreements have increasingly come under scrutiny for their direct and indirect health impacts. METHODS We conducted a prospective health impact analysis to identify and assess a selected array of potential health risks of the TPP. We adapted the standard protocol for Health impact assessments (HIAs) (screening, scoping, and appraisal) to our aim of assessing potential health risks of trade and investment policy, and selected a health impact review methodology. This methodology is used to create a summary estimation of the most significant impacts on health of a broad policy or cluster of policies, such as a comprehensive trade and investment agreement. RESULTS Our analysis shows that there are a number of potentially serious health risks associated with the TPP, and details a range of policy implications for the health sector. Of particular focus are the potential implications of changes to intellectual property rights (IPRs), sanitary and phytosanitary measures (SPS), technical barriers to trade (TBT), investor-state dispute settlement (ISDS), and regulatory coherence provisions on a range of issues, including access to medicines and health services, tobacco and alcohol control, diet-related health, and domestic health policy-making. CONCLUSION We provide a list of policy recommendations to mitigate potential health risks associated with the TPP, and suggest that broad public consultations, including on the health risks of trade and investment agreements, should be part of all trade negotiations.

Urbanization and international trade and investment policies as determinants of noncommunicable diseases in Sub-Saharan Africa.

There are three dominant globalization pathways affecting noncommunicable diseases in Sub-Saharan Africa (SSA): urbanization, trade liberalization, and investment liberalization. Urbanization carries potential health benefits due to improved access to an increased variety of food imports, although for the growing number of urban poor, this has often meant increased reliance on cheap, highly processed food commodities. Reduced barriers to trade have eased the importation of such commodities, while investment liberalization has increased corporate consolidation over global and domestic food chains. Higher profit margins on processed foods have promoted the creation of ‘obesogenic’ environments, which through progressively integrated global food systems have been increasingly ‘exported’ to developing nations. This article explores globalization processes, the food environment, and dietary health outcomes in SSA through the use of trend analyses and structural equation modelling. The findings are considered in the context of global barriers and facilitators for healthy public policy.

Policy coherence, health and the sustainable development goals: a health impact assessment of the Trans-Pacific Partnership

Abstract The international community, comprised of national governments, multilateral agencies and civil society organisations, has recently negotiated a set of 17 sustainable development goals (SDGs) and 169 targets to replace the Millennium Development Goals, which expired in 2015. For progress in implementing the SDGs, ensuring policy coherence for sustainable development will be essential. We conducted a health impact assessment to identify potential incoherences between contemporary regional trade agreements (RTAs) and nutrition and health-related SDGs. Our findings suggest that obligations in RTAs may conflict with several of the SDGs. Areas of policy incoherence include the spread of unhealthy commodities, threats to equitable access to essential health services, medicines and vaccines, and reduced government regulatory flexibility. Scenarios for future incoherence are identified, with recommendations for how these can be avoided or mitigated. While recognising that governments have multiple policy objectives that may not always be coherent, we contend that states implementing the SDGs must give greater attention to ensure that binding trade agreements do not undermine the achievement of SDG targets.

Shaping the discourse: What has the food industry been lobbying for in the Trans Pacific Partnership trade agreement and what are the implications for dietary health?

Abstract The Trans Pacific Partnership agreement (TPP), emblematic of the new generation of free trade agreements, is a regional agreement among 12 Pacific Rim countries. This paper reports on a study into how the food industry has framed issues in an effort to influence the TPP. We undertook a thematic analysis of the issues raised in publicly available submissions by the food industry to the trade negotiating bodies of four TPP countries: Australia, New Zealand, Canada and the United States of America (USA). The food industry is an active player in trade negotiations, mainly through food industry associations and other business associations. The submissions assumed that trade liberalization would result in more exports and investment, as well as raise living standards and benefit the economy and country. There was little mention of food as anything other than a commodity, focusing on types and quantities of food traded and what this meant for revenue generation, with no connection to nutritional health. The TPP could affect food systems and population health in ways that are not readily apparent to governments, policy makers or the public. The written submissions mechanism is one way in which the food industry could have shaped the agreement by framing the issues, influencing the content and direction of the TPP negotiations and agreement itself. If coherence between trade and health goals is to be strengthened, the public health community needs to engage with industry arguments and build a strong counter-argument that gives more prominence to health concerns.

A conceptual framework for investigating the impacts of international trade and investment agreements on noncommunicable disease risk factors

We developed a conceptual framework exploring pathways between trade and investment and noncommunicable disease (NCD) outcomes. Despite increased knowledge of the relevance of social and structural determinants of health, the discourse on NCD prevention has been dominated by individualizing paradigms targeted at lifestyle interventions. We situate individual risk factors, alongside key social determinants of health, as being conditioned and constrained by trade and investment policy, with the aim of creating a more comprehensive approach to investigations of the health impacts of trade and investment agreements, and to encourage upstream approaches to combating rising rates of NCDs. To develop the framework we employed causal chain analysis, a technique which sequences the immediate causes, underlying causes, and root causes of an outcome; and realist review, a type of literature review focussed on explaining the underlying mechanisms connecting two events. The results explore how facilitating trade in goods can increase flows of affordable unhealthy imports; while potentially altering revenues for public service provision and reshaping domestic economies and labour markets-both of which distribute and redistribute resources for healthy lifestyles. The facilitation of cross-border trade in services and investment can drive foreign investment in unhealthy commodities, which in turn, influences consumption of these products; while altering accessibility to pharmaceuticals that may mediate NCDs outcomes that result from increased consumption. Furthermore, trade and investment provisions that influence the policy-making process, set international standards, and restrict policy-space, may alter a states propensity for regulating unhealthy commodities and the efficacy of those regulations. It is the hope that the development of this conceptual framework will encourage capacity and inclination among a greater number of researchers to investigate a more comprehensive range of potential health impacts of trade and investment agreements to generate an extensive and robust evidence-base to guide future policy actions in this area.

The Trans-Pacific Partnership Agreement and health: few gains, some losses, many risks

BackgroundIn early October 2015, 12 nations signed the Trans-Pacific Partnership Agreement (TPPA), promoted as a model ‘21st century’ trade and investment agreement that other countries would eventually join. There are growing concerns amongst the public health community about the potential health implications of such WTO+ trade and investment agreements, but little existing knowledge on their potential health impacts.Methods and resultsWe conducted a health impact review which allows for a summary estimation of the most significant health impacts of a set of policies, in our case the TPPA. Our analysis shows that there are a number of potentially serious health risks, with the following key pathways linking trade to health: access to medicines, reduced regulatory space, investor-state dispute settlement (ISDS), and environmental protection and labor rights. We also note that economic gains that could translate into health benefits will likely be inequitably distributed.ConclusionOur analysis demonstrates the need for the public health community to be knowledgeable about trade issues and more engaged in trade negotiations. In the context of the COP21 climate change Agreement, and the UN Sustainable Development Goals, this may be an opportune time for TPPA countries to reject it as drafted, and rethink what should be the purpose of such agreements in light of (still) escalating global wealth inequalities and fragile environmental resources—the two most foundational elements to global health equity.

The Trans-Pacific Partnership Agreement: Trading away our health?

There is long-standing interest by the public health community in the potential implications of trade and investment agreements for public health. Our commentary highlights the main pathways by which the Trans-Pacific Partnerships (TPP), a comprehensive trade and investment agreement currently under negotiation, might undermine population health (based on analysis of and commentary about leaked chapters of the TPP), and calls for a more transparent and health-sensitive TPP negotiation process. We argue that use of comprehensive health impact assessments could be helpful in identifying how the potentially serious health consequences of the TPP and similar future international trade and investment agreements can be avoided, minimized or mitigated.RésuméLe milieu de la santé publique s’intéresse depuis longtemps aux répercussions possibles des accords commerciaux et d’investissement sur la santé publique. Notre commentaire souligne les principales voies par lesquelles le Partenariat transpacifique (PTP), un accord commercial et d’investissement complet en voie de négociation, pourrait miner la santé de la population (selon l’analyse et les commentaires sur les chapitres divulgués du PTP) et exige un processus de négociation plus transparent et sensible sur le plan de la santé. Nous affirmons que le recours à une évaluation complète des répercussions sur la santé pourrait être utile pour cerner comment les conséquences sur la santé, peut-être graves, du PTP et de tout accord commercial et d’investissement semblable à venir pourraient être évitées, minimisées ou atténuées.

When evidence isn’t enough: Ideological, institutional, and interest-based constraints on achieving trade and health policy coherence:

Trade and investment policy has the capacity to support or undermine global action on rising noncommunicable disease (NCD) rates. This article will employ a political science approach to explore how ideology, institutions and interests within the trade and investment policy space may constrain policy recommendations made in the World Health Organization’s Global Action Plan (GAP) on NCDs. Specifically, it details how neoliberal ideology may constrain public health values, how the new constitutionalism may constrain public health legitimacy and how disparities in money, power and resources between elite economic actors and public policy actors may constrain the capacity of public health to influence trade and investment agreement negotiations. The implications of these constraints on the implementation of the GAP-NCDs are discussed.

Trade, investment and the global economy: Are we entering a new era for health?:

Although officially dead due to US withdrawal from agreement, the Trans-Pacific Partnership agreement (TPP) is now in a ‘zombie’ state being resurrected in different ways by most of its remaining 11 member countries. This renders the analysis of its health implications both current and timely. This article, drawing on our own health impact assessment of the TPP and other analyses and commentaries, critically reviews some of the major ways in which the TPP, as a representative of so-called 21st-century regional trade agreements, poses a threat to global health equity. Four specific ways are identified and reviewed: (1) It increases restrictions on public health regulations (despite the tobacco partial carve-out) specifically through changes in the Technical barriers to Trade (TBT) and Sanitary and Phytosanitary Measures (SPS) chapters, and its new Regulatory Chapter. (2) Its flawed Investor–State Dispute Settlement (ISDS) system (with several cases affecting health services/insurance and indirectly health through cases challenging environmental protection) continues to benefit investor over public health and sustainability. (3) Its labour and environmental chapters are largely hortatory and concerned with ensuring increased trade by TPP rules, and not stronger labour rights or environmental protection per se. (4) There is little aggregate economic benefit, but disequalizing income distributions, and no accounting for public costs (e.g. trade adjustment compensation for negatively affected economic sectors, increased patent drug costs).The article concludes by locating the content and implementation of agreements as the TPP as a form of international law that entrenches a discredited neoliberal economic model of enormous benefit to capital and limited benefit to most of the world’s peoples.

Media and neoliberal hegemony: Canadian newspaper coverage of the Trans-Pacific Partnership agreement

Abstract This article presents findings from a media analysis of mainstream newspaper coverage of the Trans-Pacific Partnership Agreement (TPP). We conducted a broad search of articles published from January 2010 through to June 2014 in the major English-language Canadian daily newspapers, analyzing a total of 404 articles. We found limited substantive discussions about this comprehensive trade and investment treaty, and explain this lack of attention to the TPP by invoking Gramscian political economy theory and the role of media in the production of neoliberal hegemony.