Deborah Gleeson

Emerging threats to public health from regional trade agreements

The decision by Australia’s High Court to uphold the constitutionality of the country’s ground-breaking tobacco plain packaging laws has been heralded as a victory for national sovereignty over vested interests. However, the ability of governments worldwide to introduce and im plement public health policies and laws is increasingly threatened by trade and investment treaties that privilege investors over governments and provide avenues for international corporations to challenge democratically enacted public health policies in diff erent countries. The risks are clearly shown by Philip Morris Asia’s challenge to Australia’s plain packaging laws under the investor–state dispute settlement (ISDS) provisions set out in an investment treaty between Australia and Hong Kong. The action by Philip Morris Asia seems to be part of a global strategy by the tobacco industry to use international trade and investment dispute mechanisms to undermine tobacco control measures. Other such disputes include investor-state actions by tobacco companies against Uruguay and Norway and challenges within the dispute mechanisms of the World Trade Organisation (WTO) brought against both the USA and Australia by other countries. Through the ISDS mechanism, Philip Morris Asia is seeking the suspension of enforcement of Australia’s plain packaging legislation, or millions of dollars in compensation on the grounds that the value of its investment has been aff ected by the supposed expropriation of its trademarks and related branding. Australia, however, has a strong case, in part because Philip Morris Asia acquired its holdings in Philip Morris Australia in February, 2011, after the Australian Government had announced its intention to introduce plain packaging. But the costs of such litigation can amount to millions of dollars, the ISDS process is without many of the safeguards and the transparency of domestic legal systems, and the mere threat of legal action can have a powerful deterrent eff ect on governments considering the introduction of new laws to regulate industry in ways that protect public health. On a global scale, the most recent trade-related threat comes from the negotiations for the Trans Pacifi c Partnership Agreement (TPP), a large regional trade agreement consisting of 11 countries around the Pacifi c Rim—Australia, Brunei, Canada, Chile, Malaysia, Mexico, New Zealand, Peru, Singapore, USA, and Vietnam. Together these countries account for almost 10% of the world’s population. They include some of the biggest economies in the world, accounting for more than 30% of the world’s gross domestic product (with a combined value of US

A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement.

20 734 billion in 2011), in a region that represents 40% of global trade. More countries are likely to accede in future: Japan, Thailand, and the Philippines have already expressed interest in potentially joining. Arguably a geopolitical manoeuvre on the part of the USA—which is seeking to stake its claim in the region as a counter to China—the TPP might tilt the axis of economic power towards this region of the world, and, by setting an ambitious precedent, reset global trade rules. Negotiations for the TPP began in March, 2010, and the 16th negotiating round will begin on March 4, 2013, in Singapore. Negotiations are held under conditions of confi dentiality and draft texts are not publicly available. The agreement includes 29 chapters or negotiating areas, ranging from traditional trade issues such as trade in goods and technical barriers to trade, to areas in which unprecedented commitments have been proposed, such as regulatory coherence as well as stronger intellectual property rights and investor protections than those provided by previous trade agreements. Regional trade agreements such as the TPP are emerging in the context of countries being unable to gain the terms they want through the multilateral trading system generally overseen by the WTO. During the past decade, the WTO has been progressively abandoned by wealthy countries in favour of bilateral and regional trade agreements, leading to multiple overlapping trade commit ments of increasing complexity. The capacity for regional agreements such as the TPP to create and exacerbate health inequities derives, in part, from their inherent power imbalances. Wealthy countries have more bargaining power to negotiate advantageous trade rules, and tend to use this power to gain concessions that they are unable to obtain through the WTO. Large corporations also hold disproportionate power in such agreements, and are the benefi ciaries of their rules, which they are able to enforce through new dispute settlement mechanisms. These asymmetries are com pounded by the lack of accountability and transparency measures compared with the formal rules and dispute settlement procedures of the multilateral system. Such power dynamics can exacerbate inequities in the benefi ts from trade. The TPP is a prototype of a new style of regional trade agreement that presents profound new threats to global health and health equity. Unlike older trade agreements, 21st century trade is no longer about selling goods produced in one nation to customers in another: it is a complex mix of trade in goods, services, and investments. The TPP will deepen global economic integration by reaching much further into the regulation of Published Online March 1, 2013 http://dx.doi.org/10.1016/ S0140-6736(13)60312-8

Negotiating Tensions in Developing Organizational Policy Capacity: Comparative Lessons to be Drawn

Trade poses risks and opportunities to public health nutrition. This paper discusses the potential food-related public health risks of a radical new kind of trade agreement: the Trans Pacific Partnership agreement (TPP). Under negotiation since 2010, the TPP involves Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the USA, and Vietnam. Here, we review the international evidence on the relationships between trade agreements and diet-related health and, where available, documents and leaked text from the TPP negotiations. Similar to other recent bilateral or regional trade agreements, we find that the TPP would propose tariffs reductions, foreign investment liberalisation and intellectual property protection that extend beyond provisions in the multilateral World Trade Organization agreements. The TPP is also likely to include strong investor protections, introducing major changes to domestic regulatory regimes to enable greater industry involvement in policy making and new avenues for appeal. Transnational food corporations would be able to sue governments if they try to introduce health policies that food companies claim violate their privileges in the TPP; even the potential threat of litigation could greatly curb governments’ ability to protect public health. Hence, we find that the TPP, emblematic of a new generation of 21st century trade policy, could potentially yield greater risks to health than prior trade agreements. Because the text of the TPP is secret until the countries involved commit to the agreement, it is essential for public health concerns to be articulated during the negotiation process. Unless the potential health consequences of each part of the text are fully examined and taken into account, and binding language is incorporated in the TPP to safeguard regulatory policy space for health, the TPP could be detrimental to public health nutrition. Health advocates and health-related policymakers must be proactive in their engagement with the trade negotiations.

Aboriginal health policy: is nutrition the 'gap' in 'Closing the Gap'?

Abstract This article explores how organizational policy capacity can be developed, drawing on a study conducted in a large human services agency in Australia. Building policy capacity within government agencies is widely acknowledged as important for successfully responding to complex policy problems. The existing literature suggests a range of strategies for building organizational capacity. Findings from interviews with policy workers support the principles for building policy capacity identified in the literature but uncovered a surprising degree of scepticism pointing to significant barriers to their realization. These barriers are identified as emerging out of the tensions between policy capacity and two other domains of governing capacity: administrative capacity and state capacity. These tensions however are highly contingent and dynamic; managing them requires a degree of discretion and judgement, in brief, policy leadership. A focus on developing policy leadership at the level of policy units and teams may present a strategic approach to building organizational capacity for policy work.

Challenges to Australia's national health policy from trade and investment agreements

Objective: To examine the extent to which nutrition has been prioritised in national Aboriginal and Torres Strait Islander health policy.

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

Recent federal trade policy commitments could protect Australia’s tobacco control legislation and the Pharmaceutical Benefits Scheme in the Trans-Pacific Partnership Agreement negotiations.

Is health impact assessment useful in the context of trade negotiations? A case study of the Trans Pacific Partnership Agreement

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.

The Trans Pacific Partnership Agreement and Pharmaceutical Regulation in Canada and Australia

Objective The Trans Pacific Partnership Agreement (TPP) is a recently concluded free trade agreement involving Australia and 11 other Pacific-rim nations, which has the potential for far-reaching impacts on public health. A health impact assessment (HIA) was carried out during the negotiations to determine the potential future public health impact in Australia and to provide recommendations to mitigate potential harms. This paper explores the findings and outcomes of the HIA, and how this approach can be used to provide evidence for public health advocacy. Design A modified version of the standard HIA process was followed. The HIA was led by technical experts in HIA, trade policy, and health policy, in collaboration with advocacy organisations concerned with the TPP and health. The HIA reviewed the provisions in leaked TPP text in order to determine their potential impact on future health policy. As part of this process, researchers developed policy scenarios in order to examine how TPP provisions may affect health policies and their subsequent impact to health for both the general and vulnerable populations. The four policy areas assessed were the cost of medicines, tobacco control, alcohol control and food labelling. Results In all areas assessed, the HIA found that proposed TPP provisions were likely to adversely affect health. These provisions are also likely to more adversely affect the health of vulnerable populations. Conclusions The HIA produced relevant evidence that was useful in advocacy efforts by stakeholders, and engaging the public through various media platforms.

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?

The Trans Pacific Partnership Agreement (TPP) is a large regional trade agreement involving 12 countries. It was signed in principle in February 2016 but has not yet been ratified in any of the participating countries. The TPP provisions place a range of constraints on how governments regulate the pharmaceutical sector and set prices for medicines. This article presents a prospective policy analysis of the possible effects of the TPP on these two points in Canada and Australia. Five chapters of relevance to pharmaceutical policy are analyzed: chapters on Technical Barriers to Trade (Chapter 8), Intellectual Property (Chapter 18), Investment (Chapter 9), Dispute Resolution (Chapter 28), and an annex of the chapter on Transparency and Anti-Corruption (Chapter 26, Annex 26-A). The article concludes that the TPP could have profound effects on the criteria these countries use to decide on drug safety and effectiveness, how new drugs are approved (or not) for marketing, post-market surveillance and inspection, the listing of drugs on public formularies, and how individual drugs are priced in the future. Furthermore, the TPP, if ratified and enforced, will reduce future policy flexibility to address the increasing challenge of rising drug prices.

The Trans Pacific Partnership Agreement: Exacerbation of inequality for patients with serious mental illness

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.