Chantal Blouin

The political origins of health inequity: prospects for change

Ole Petter Ottersen, Jashodhara Dasgupta, Chantal Blouin, Paulo Buss, Virasakdi Chongsuvivatwong, Julio Frenk, Sakiko Fukuda-Parr, Bience P Gawanas, Rita Giacaman, John Gyapong, Jennifer Leaning, Michael Marmot, Desmond McNeill, Gertrude I Mongella, Nkosana Moyo, Sigrun Møgedal, Ayanda Ntsaluba, Gorik Ooms, Espen Bjertness, Ann Louise Lie, Suerie Moon, Sidsel Roalkvam, Kristin I Sandberg, Inger B Scheel

Trade and social determinants of health

The effects of trade and trade liberalisation on the social determinants of health are not well known. Here, we outline a conceptual framework of links between trade liberalisation and health outcomes, and review existing evidence for these by focusing on four key factors: income, inequality, economic insecurity, and unhealthy diets. Even though trade liberalisation seems to have positive effects on economic growth, it is not sufficient to boost growth. In several countries, trade reforms have not translated into enhanced economic expansion because complementary policies are needed. Trade liberalisation and openness are associated with greater wage inequality and raised economic insecurity. Trade liberalisation has facilitated availability of highly processed, calorie-rich, nutrient-poor food in developing countries, but further research is needed to better understand the effects of trade on unhealthy diets. Policymakers and health professionals need to be aware that the global economy affects the health of populations and understand how risks associated with trade liberalisation can be mitigated.

International Trade in Health Services and the GATS: Current Issues and Debates

Health ministries around the world face a new challenge: to assess the risks and respond to the opportunities of the increasing openness in health services under the World Trade Organizations (WTO) General Agreement on Trade in Services (GATS). This publication addresses this challenge head-on by providing analytical tools to policymakers in health and trade ministries alike who are involved in the liberalization agenda and, specifically, in the GATS negotiations. This book informs and assists policymakers in formulating trade policy and negotiating internationally. There is ongoing and animated international debate about the impact of GATS on public services in general and health in particular. In response, the book offers different perspectives from more than 15 leading experts. Some of the authors stress opportunities linked to trade in health services, others focus more on the risks. The book offers: Detailed legal analysis of the impact of the agreement on health policy; an overview of trade commitments in health-related services; new empirical evidence from nine country studies; and a simple 10-step explanation on how to deal with GATS negotiations.

Trade and Health

Human societies have long histories of trade with each other, although it is one marked by conflict as much as by equanimity; witness the forced opening of the closed economies of China (by the British in the 19th century) and Japan (by the USA in the early 20th century). Competition since the rise of capitalism has been the theoretical underpinning of trade, albeit one that gives frequent rise to monopolies and oligopolies which undermine the very market principles — and the win-win efficiency of comparative advantage — upon which trade is supposed to work its economic magic. Disease, too, has long followed trade routes, from the infectious pandemics of past (and now future recurrent) times, to the chronic ills associated with the global diffusion of unhealthy lifestyles and health destructive products.

Global health diplomacy for obesity prevention: lessons from tobacco control.

AbstractTo date the global health diplomacy agenda has focused primarily on infectious diseases. Policymakers have not dedicated the same level of attention to chronic diseases, despite their rising contribution to the global burden of disease. Negotiation of the Framework convention on tobacco control provides an apt example from global health diplomacy to tackle diet-related chronic diseases. What lessons can be learned from this experience for preventing obesity? This article looks at why a global policy response is necessary, at the actors and interests involved in the negotiations, and at the forum for diplomacy.

From policy coherence to 21st century convergence: a whole-of-society paradigm of human and economic development

The 20th century saw accelerated human and economic development, with increased convergence in income, wealth, and living standards around the world. For a large part, owing to the well‐entrenched Western‐centric linear and siloed industrialization pattern, this positive transformation has also been associated with complex societal challenges at the nexus of agricultural, industrial, and health sectors. Efforts at cross‐sectoral policy coherence have been deployed with limited success. To go beyond what has been possible thus far, the whole‐of‐society (WoS) paradigm for human and economic development proposes a 21st century convergence where, instead of the rest (of the world) converging with the West, sectoral and cross‐sectoral efforts converge in their single and collective policy and action on a common target of human and economic development. In this paper, we first review and discuss contributions and limitations of policy coherence approaches. We then elaborate the institutional foundation of the WoS paradigm, taking as an anchor the well‐established model of polycentric governance that views individuals, and state, market, and community, forming society as part of the same complex adaptive system. Actors within such systems self‐organize into nested hierarchies that operate at multiple scales and move toward 21st century convergence of human and economic development.

Trade in health services: Can it improve access to health care for poor people?:

trade from different viewpoints, with Qadeer bringing the argument back from national concerns and legislation to the necessity of international ethical debate and action. I hope these forum contributions, together with the articles in this issue, help to make the case for further focus on ethical and global regulatory context in this area, which extends from addressing poverty and destitution and the necessities of health systems to fundamental ethical problems inherent as part of this trade. If poverty and regulatory differences between countries are the driving force for this trade, it is unlikely that a solution will be reached without a further focus and assessment of the ethical and normative basis on which current efforts to promote health care tourism and trade in health services reside.

Whole-of-society approach for public health policymaking: a case study of polycentric governance from Quebec, Canada

In adopting a whole‐of‐society (WoS) approach that engages multiple stakeholders in public health policies across contexts, the authors propose that effective governance presents a challenge. The purpose of this paper is to highlight a case for how polycentric governance underlying the WoS approach is already functioning, while outlining an agenda to enable adaptive learning for improving such governance processes. Drawing upon a case study from Quebec, Canada, we employ empirically developed concepts from extensive, decades‐long work of the 2009 Nobel laureate Elinor Ostrom in the governance of policy in nonhealth domains to analyze early efforts at polycentric governance in policies around overnutrition, highlighting interactions between international, domestic, state and nonstate actors and processes. Using information from primary and secondary sources, we analyze the emergence of the broader policy context of Quebecs public health system in the 20th century. We present a microsituational analysis of the WoS approach for Quebecs 21st century policies on healthy lifestyles, emphasizing the role of governance at the community level. We argue for rethinking prescriptive policy analysis of the 20th century, proposing an agenda for diagnostic policy analysis, which explicates the multiple sets of actors and interacting variables shaping polycentric governance for operationalizing the WoS approach to policymaking in specific contexts.

Trade Policy and Health: Adding Retrospective Studies to the Research Agenda Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?"

Prospective studies of the potential health consequences of trade and investment treaties, such as the Trans-Pacific Partnership, are critical. These studies can make visible to trade policy-makers the potential negative impacts associated to such treaties and can influence the outcomes of such negotiations. However, few researchers have examined retrospectively the consequences of trade agreements. With more than 400 trade agreements and more than 2000 investment treaties currently in force, researchers have a large corpus of agreements to analyse in order to assess not only their potential impacts on health system and population health, but also their actual impacts. This comment suggests some research questions that would benefit from retrospective inquiry.

The how: a message for the UN high-level meeting on NCDs

This September’s UN General Assembly high-level meeting (HLM) on noncommunicable diseases (NCDs) provides a strategic opportunity to propel the response—from “where do we want to be” to “how do we get there”. The WHO Independent High-Level Commission on NCDs made a number of solid proposals to inform HLM negotiations. These include a call for governments to enhance regulatory frameworks to protect health, for example, through a code on the marketing of some health–harming products and a full–cost accounting of these products. The draft of the HLM’s political declaration prioritises universal health coverage, including affordable treatment, and promotion of mental health but falls short on the primary prevention of NCDs and promot ing healthy societies as per Agenda 2030. The transition from health-harming to health-enhancing products and processes requires action across multiple sectors and strengthened public institutions. We propose an agenda for member state HLM negotiators (panel). First, accountability must be assigned at the highest political levels. The WHO NCD Commission called on heads of government to lead the NCD response, as was the case with effective AIDS responses. This will ultimately empower ministers of health by ensuring all government departments are accountable to national leadership and are enabled to manage political opportunities, barriers, and trade-offs for NCD prevention. Rather than create new vertical structures, the NCD agenda should be integrated into national Sustainable Development Goal (SDG) plans. The declaration must commit to distributed ownership, impact assessments, policy coherence, and accountability across ministries. Second, improving fiscal policies should be prioritised. Countries should implement a synergistic approach to taxing sugar (not just sugarsweetened beverages but also sugary snacks), tobacco and alcohol, as well as unhealthy nutrients. The international community should provide technical advice on taxation and removing subsidies for processed foods, alcohol, and fossil fuels, and for divesting from tobacco, alcohol, and fossil fuels; governments should also support healthy local food systems. Third, additional financial resources must be mobilised. The declaration should call for dramatic financial increases for NCDs over the US