Economic Globalization, Trade Liberalization and Health

1. Economic Globalization, Trade Liberalization and Health Canadian Society for International Health (CSIH) Paper prepared by Ron Labonte with assistance from Mathhew Sanger and Pam Thompson

2. An issue requiring advocacy: The response by CSIH • In the Spring of 2000, CSIH identified the area of Trade and Health as a priority area for advocacy • An issue paper was commissioned and developed in collaboration with the Advocacy Committee of the Society which will be circulated to members in the next month

3. An issue requiring advocacy: The response by CSIH • The paper focused on the recent developments in economic globalization, trade agreements and public governance and the implications for health and human/social development

4. An issue requiring advocacy: The response by CSIH Summary Points: • Globalization connects and creates interdependencies among people and organizations around the world • Not all forms of globalization promote health Key Questions: 1) What is known about the relationship between economic globalization, trade, governance and health? 2) What are the real and potential health effects of a number of trade agreements?

5. An issue requiring advocacy: The response by CSIH • Important to consider the inter-related types of globalization: 1. Economic 2. Environmental 3. Communicative

6. An issue requiring advocacy: The response by CSIH • Economic globalization is characterized by increased trade and investment liberalization (free trade), privatization of former public services and de-regulation of many former government powers • Economic globalization is also associated with increasing disparities in wealth and power both between nations and between different groups within nations and between public and private sectors

7. An issue requiring advocacy: The response by CSIH • New forms of public/private partnerships are arising in the wake of these shifts • New forms of global governance are occurring in the UN agencies, national governments, multilateral organizations such as the WTO and networks of civil society

8. An issue requiring advocacy: The response by CSIH • At issue is the relationship between increasing wealth-creating potential of more integrated markets globally and regulation of these very same forces to effect more equitable wealth distribution and the protection of ecological sustainability • Empirically the evidence is weak although there are many well documented negative effects associated with the current trend of liberalization, privatization and de-regulation • Current WTO processes and agreements favour the richer more developed countries and have failed to curb the growing inequities between and within countries

9. An issue requiring advocacy: The response by CSIH • Environmental globalization: Recognizes that an environmental incident or impact that happens in one region or country is not restricted to that area but has the potential to affect the entire world’s health and well being • Examples: Transport of PCBs, DDTs and heavy metals • Climate change due in part to the destruction of the rain forests • Global spread of infections due to misuse of antibiotics

10. An issue requiring advocacy: The response by CSIH • Communicative globalization: • Refers to the rapid growth of communications technology and the internet. • Capacity to link people, information and ideas around the globe • Impact on culture, positively and negatively • Instrument in increasing civil society engagement • Such technologies are not available or accessible on an equitable basis and will likely create a new technology/information economy

11. An issue requiring advocacy: The response by CSIH • Specific Trade Agreements and its impact on Canada • NAFTA:The Canadian Government let its plain packaging legislation die after representatives of the Philip Morris International and R.J. Reynolds Tobacco International argued that it constituted an expropriation of assets in violating NAFTA investment and intellectual property obligations • The reserve on health and social services may be open to commercial competition

12. An issue requiring advocacy: The response by CSIH • Five Specific WTO Agreements have implications for health: • GATT(General Agreement on Tariffs and Trade) • TRIPS (Trade Related Aspects of Intellectual Property Rights) • SPS ( Sanitary and Phytosanitary Measures) • TBT (Technical Barriers to Trade) • GATS (General Agreement on Trade in Services)

13. An issue requiring advocacy: The response by CSIH • Example of impact of TRIPS: • 20-year patent protection for pharmaceutical drugs. In September Canada lost its appeal which means that according to generic drug manufacturers it will cost Canadian consumers and governments $200 million per year in higher prescription drug prices • Example of impact of GATS (General Agreement on Trade in Services): • All services including health are covered which requires the same level of treatment for all foreign investors. If one province allows a foreign commercial provider, the rule could require similar treatment throughout Canada

14. An issue requiring advocacy: The response by CSIH • Key Challenges • The WTO remains a largely unaccountable and secretive organization • National government submissions to the dispute panels are kept secret • Hearings remain closed to the public, particularly ngo’s • Institutions, our form of governance have not kept up to these rapid and changing challenges

15. An issue requiring advocacy: The response by CSIH • The need for coordination and coherence • International health governance which includes ngos has been unable to provide a coordinated response (Kickbusch) • Conflicting and contradictory trade agreements, for example, at present several WTO agreements prevent national governments from complying with the terms of environmental and social good agreements such as Rio Agenda 21 which could have serious implications for health

16. An issue requiring advocacy: The response by CSIH • The need for coordination and coherence • One impediment to the World Health Organization enforcement of the international health regulations (IHR) is the impact of reporting outbreaks in regions dependent on tourism. This obstacle can be exacerbated when the IHRs conflict with members countries’ WTO trade obligations

17. An issue requiring advocacy: The response by CSIH • A Framework for Identifying Health Impacts of Trade and Investment Agreements • A population health framework developed in Canada provides a perspective that incorporates the determinants of health and allows for the inter-relationships of poverty, education, employment, living and working conditions, health services, etc. and health

18. An issue requiring advocacy: The response by CSIH • Conclusions • “Just as health is about more than wealth, trade agreements are of more than commercial significance.” • “Trade obligations which restrict governments’ capacities to achieve health goals through legislation or regulation may have very serious health impacts independent of any economic impact of liberalized trade.”

19. An issue requiring advocacy: The response by CSIH • An intersectoral framework and analysis could support collaboration among policy makers in health, trade and other fields to ensure that interventions acting on the direct determinants of health are not hampered b conflicting trade obligations and that appropriate policies are designed to address the indirect determinants of health and the impact of trade policy on inequities

20. An issue requiring advocacy: The response by CSIH • Next Steps • Resolutions to membership of CSIH for consultations • Reviewed and discussed at Annual General Meeting of CSIH in November 2000 • Resolutions on Economic globalization, trade liberalization, governance and health approved by AGM • Dissemination on CSIH web site • Letters to key national government departments and agencies as well as selected international agencies requesting response to the resolutions