Trade and health: an agenda for action

Abstract

The processes of contemporary globalisation are creating ever-closer ties between individuals and populations across different countries. The health of a population, and the systems in place to deliver health care, are affected increasingly by factors beyond the population and health system. The Lancet's Series on trade and health has provided an overview of these links between international trade, trade liberalisation, and health, and raised the key issues that face the health community. In this final paper in the Series, we call for a substantial and sustained effort by those within the health profession to engage with issues of trade, to strengthen institutional capacity in this area, and to place health higher on the agenda of trade negotiations. The rapid rise of trade agreements and treaties, as well as trade that occurs beyond these institutional boundaries, means that further action is required by a range of actors, including WHO, the World Bank, the World Trade Organization (WTO), regional agencies, foundations, national governments, civil society, non-governmental organisations, and academics. The stewardship of a domestic health system in the 21st century requires a sophisticated understanding of how trade affects, and will affect, a country's health system and policy, to optimise opportunities to benefit health and health care while minimising the risks posed though the assertion of health goals in trade policy. To acheive this will place a premium on all those engaged in health to understand the importance of trade and to engage with their counterparts involved in trade and trade policy. We hope that this Series has prompted the reader to become involved in these efforts.

Strengthening of accountability systems to create healthy food environments and reduce global obesity

“…25 Over the past few decades, the globalisation of food systems has meant that governance has become more complex with large transnational corporations, international trade and investment agreements, and international agencies, such as the World Trade Organization, reducing the policy space within which national governments, the traditional governance authority, can operate. 8,[26][27][28][29][30][31] Voluntary partnerships, such as the Public Health Responsibility Deal in England 32 and the USA's Healthy Weight Commitment Foundation, 33 have been embraced by industry and government leaders as a way to improve the healthiness of food environments in these countries, where food systems and diets are already dominated by…”

The relationship between international trade and non-nutritional health outcomes: A systematic review of quantitative studies

“…Thirdly, the separation of the evidence into three groups due to lack of comparability, although deemed to be necessary to derive important messages, illustrated the extent of heterogeneity in the evidence being assessed. Finally, there is a wealth of theoretical, descriptive, qualitative and case-study evidence on relationships between international trade and health which were outside the scope of our inclusion criteria Blouin et al, 2006;Fidler et al, 2009;Gerring & Thacker, 2008;Hawkes et al, 2009;Lee et al, 2009;Smith et al, 2009a;Smith et al, 2009c). Other types of evidence are unquestionably of importance to understanding the association between trade and population health.…”

“…Recently, the implications of international trade, or trade in capital, goods and services between nations, to health and health systems have received considerable attention Fidler et al, 2009;Hawkes, 2005;Hawkes & Thow, 2008;Lee et al, 2009;Owen & Wu, 2007;Smith et al, 2009c;Walls, 2013). Much of this has been in the form of reports and books from international bodies (Blouin et al, 2006;WHO, 2014), qualitative, and case-study evidence covering a broad range of possible associations between trade and health Hawkes et al, 2009;Smith et al;.…”

“…On the other hand, quantitative research has been chiefly focused on two areas. First has been the relationship between overall patterns of flows in international trade or Foreign Direct Investment (FDI), defined as the inflow of investment to acquire a lasting management interest in an enterprise operating in a different economy from the investor (World Bank, 2014), and levels of international trade in health-related services (Smith, 2004;Smith et al, 2009a;Smith et al, 2009b;Smith et al, 2009c). Secondly, some research has been focused toward associations between flows of FDI, nutrition and other health behaviours including smoking (De Vogli et al, 2014;Gilmore & McKee, 2005;Hawkes, 2005;Walls, 2013).…”

Trade Policy and Public Health

“…Proponents of trade liberalization maintain that there has been a net positive effect, with increased average per capita incomes and a global diffusion of knowledge, services, and technologies that have consequently improved health, labor, and other living conditions (8,88,141,142). Others argue that the attendant gains in income, goods, and services have been uneven, with net negative impact on social welfare and population health (4,13,71,79,121,124,126,127).…”