The threat of a UK-US trade deal to managing non-communicable diseases

McNamara, Courtney L.

doi:10.1136/bmj.n1630

Cited by 4 publications

(3 citation statements)

References 24 publications

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“…US and EU Free Trade Agreements (FTAs) create opportunities for the large, multinational tobacco, food, and alcohol companies headquartered in these jurisdictions to oppose unhealthy commodity policies, as summarised in Fig 2 [ 11 – 13 ]. FTAs are important instruments of foreign economic integration that are designed to reduce cross-border trade and investment costs [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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US and EU Free Trade Agreements and implementation of policies to control tobacco, alcohol, and unhealthy food and drinks: A quasi-experimental analysis

Barlow

Allen

2023

PLoS Med

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Background Identifying and tackling the factors that undermine regulation of unhealthy commodities is an essential component of effective noncommunicable disease (NCD) prevention. Unhealthy commodity producers may use rules in US and EU Free Trade Agreements (FTAs) to challenge policies targeting their products. We aimed to test whether there was a statistical relationship between US and EU FTA participation and reduced implementation of WHO-recommended policies. Methods and findings We performed a statistical analysis assessing the probability of at least partially implementing 10 tobacco, alcohol, and unhealthy food and drink policies in 127 countries in 2014, 2016, and 2019. We assessed differences in implementation of these policies in countries with and without US/EU FTAs. We used matching to conduct 48 covariate-adjusted quasi-experimental comparisons across 27 matched US/EU FTA members (87 country-years) and performed additional analyses and robustness checks to assess alternative explanations for our results. Out of our 48 tests, 19% (9/48) identified a statistically significant decrease in the predicted probability of at least partially implementing the unhealthy commodity policy in question, while 2% (1/48) showed an increase. However, there was marked heterogeneity across policies. At the level of individual policies, US FTA participation was associated with a 37% reduction (95%CI: −0.51 to −0.22) in the probability of fully implementing graphic tobacco warning policies, and a 53% reduction (95%CI: −0.63 to −0.43) in the probability of at least partially implementing smoke-free place policies. EU FTA participation was associated with a 28% reduction (95%CI: −0.45 to −0.10) in the probability of fully implementing graphic tobacco warning policies, and a 25% reduction (95%CI: −0.47 to −0.03) in the probability of fully implementing restrictions on child marketing of unhealthy food and drinks. There was a positive association with implementing fat limits and bans, but this was not robust. Associations with other outcomes were not significant. The main limitations included residual confounding, limited ability to discern precise mechanisms of influence, and potentially limited generalisability to other FTAs. Conclusions US and EU FTA participation may reduce the probability of implementing WHO-recommended tobacco and child food marketing policies by between a quarter and a half—depending on the FTA and outcome in question. Governments negotiating or participating in US/EU FTAs may need to establish robust health protections and mitigation strategies to achieve their NCD mortality reduction targets.

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Section: Introductionmentioning

confidence: 99%

“…A substantial body of scholarship documents the various ways that firms can and have used FTA clauses to influence policies targeting their products, summarised in Box 1 and Fig 2 [ 11 – 13 , 19 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

US and EU Free Trade Agreements and implementation of policies to control tobacco, alcohol, and unhealthy food and drinks: A quasi-experimental analysis

Barlow

Allen

2023

PLoS Med

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“…As such, many provisions, and even entire chapters, of the CPTPP are near carbon copies of other free trade deals negotiated by the US. But despite how much alarm was raised over the potential health effects of a free trade agreement with the US,1 there has been little discussion of the public health implications of the UK’s accession to this new deal.…”

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confidence: 99%

The CPTPP trade deal is a major threat to public health and warrants a health impact assessment

McNamara

Green

Barlow

et al. 2023

BMJ

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Assessing public health implications of free trade agreements: The comprehensive and progressive Trans‐Pacific Partnership Agreement

Green,

Ashton,

Silva

et al. 2024

Global Policy

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In 2016, the United Kingdom voted to exit the European Union, which was surrounded by political and social uncertainty. The United Kingdom now negotiates its own trade agreements, and in March 2023, it agreed to join the Comprehensive and Progressive Trans‐Pacific Partnership Agreement (CPTPP). A health impact assessment (HIA) was undertaken in 2022–23 to predict the potential impact of the CPTPP on the health and well‐being of the Welsh Population. This paper explores the HIA findings and highlights the value of the approach in engaging with stakeholders and informing policymakers. This HIA followed a standard five‐step approach which involved a literature review to identify potential health impacts, qualitative interviews with cross‐sectoral stakeholders and the development of a community health profile. The HIA identified potential impacts across the wider determinants of health and specific vulnerable population groups. Investor state dispute settlement mechanisms, economic uncertainty and loss of regulatory policy space were identified as key pathways for health impacts. The findings have been beneficial in informing decision‐makers to prepare for the CPTPP in Wales using an evidence‐informed approach. This work has demonstrated the value of a HIA approach that uses a transparent process to mobilise a wide range of evidence, resulting in transferrable learning.

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The threat of a UK-US trade deal to managing non-communicable diseases

Abstract: Courtney McNamara argues that a trade deal between the UK and US could limit the UK’s ability to manage non-communicable diseases unless the agreement includes public health safeguards

Cited by 4 publications

References 24 publications

US and EU Free Trade Agreements and implementation of policies to control tobacco, alcohol, and unhealthy food and drinks: A quasi-experimental analysis

US and EU Free Trade Agreements and implementation of policies to control tobacco, alcohol, and unhealthy food and drinks: A quasi-experimental analysis

The CPTPP trade deal is a major threat to public health and warrants a health impact assessment

Assessing public health implications of free trade agreements: The comprehensive and progressive Trans‐Pacific Partnership Agreement

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