Public Health Association of Australia: Policy-at-a-glance Trade Agreements & Health Policy

Transcription

1 Public Health Association of Australia: Policy-at-a-glance Trade Agreements & Health Policy Key message: 1. Trade agreements should not limit or override a nation s ability to foster and maintain systems and infrastructure that contribute to the health and well-being of its citizens by detracting from a nation s ability to legislate and regulate in the national interest. 2. Policy space needs to be preserved in trade agreements for national governments to regulate to protect public health. 3. PHAA advocates a fairer regime of trade regulation which addresses sustainability issues as well as economic development and which prioritises equity within and between countries as a necessary condition for global population health improvement. Summary: The Australian Government s Trade Policy Statement released in April 2011 included significant commitments to protect public health in trade agreements but increasingly the Government is under pressure renege on these commitments in negotiating trade agreements. PHAA will advocate at the national and international levels to promote and protect public health within international trade agreements and limit adverse impacts of trade agreements on health and well-being, both within Australia and in other countries. Audience: Responsibility: Australian Government, policy makers and international public health organisations. PHAA s Political Economy of Health Special Interest Group (SIG) Date policy adopted: September 2011 Contact: Dr Deborah Gleeson, Convenor, Political Economy of Health SIG d.gleeson@latrobe.edu.au 1

2 TRADE AGREEMENTS AND HEALTH POLICY The Public Health Association of Australia notes: 1. Trade agreements regulate international trade in goods, services and intellectual property. They include the agreements administered through the World Trade Organisation (WTO) such as the GATT (General Agreement on Tariffs and Trade), GATS (General Agreement on Trade and Services) and TRIPS (Trade Related Aspects of Intellectual Property Rights). They also include bilateral and regional trade agreements concluded outside the WTO such as the Australia US Free Trade Agreement (AUSFTA) and two regional trade agreements involving Australia which are currently being negotiated: the Pacific Agreement on Closer Economic Relations (PACER) and the Trans- Pacific Partnership Agreement (TPPA). 2. The establishment of the WTO, and the various trade agreements which it administers, was based on the need for a rules-based trading regime to contain the tendency to unilateral trade restrictions adopted for short term national advantage but carrying the risk of wider instability. However, the goal of establishing a rules-based trading regime has become increasingly linked to the goal of free trade ; aiming for the progressive reduction in barriers to trade in manufactured goods. As currently promoted, free trade refers mainly to liberalising trade in manufactured goods. It does not include the free movement of labour nor liberalisation of agricultural trade but paradoxically does include the protection of technological monopolies (easy patents but tight policing). 3. While a rules-based trading regime makes sense generally, the drive towards free trade has different implications for different countries; it is generally beneficial for developed economies but has very mixed implications for economies which do not have a strong manufacturing base. The pressure on developing countries to reduce barriers to the import of manufactured goods while the developed countries maintain high levels of protection with respect to agriculture has serious implications for the health and development of developing countries including small farmers livelihoods (jeopardised by agricultural protection and dumping) and industrial development (jeopardised by inflow of cheap manufactured products). The experience of the Asian tigers (Japan, South Korea, Taiwan, Singapore) and Europe and the USA before them suggests that industrialisation can be facilitated by protection and that blanket liberalisation is not necessarily beneficial for all. 4. Since 1999 the drive to promote free trade through the WTO has met with increasing resistance from developing countries. In response to this resistance the USA and the European Union have embarked on a campaign to develop bilateral and regional trade agreements with explicit commitment to progressive liberalisation of trade. 2

3 5. The current focus of trade negotiation within the WTO has been on the Doha Round which is currently deadlocked. The main focus of the Doha negotiations has been on the demands of the developed countries for developing countries to reduce the barriers to the import of manufactured goods and the demands of developing countries for access to rich world markets for their agricultural products. In addition the GATS agreement is being renegotiated, with pressure to move from the present opt-in approach regarding services to be subject to the Agreement to an opt-out approach which would require countries to explicitly identify those services to which the Agreement would not apply. This opens the prospect of many additional service industries being exposed to foreign competition. 6. Beyond the WTO there are several bilateral and regional free trade agreements under consideration, two of which are particularly relevant to Australia: the TPPA and the proposed PACER Plus Agreement. 7. Major concerns from a public health point of view regarding the TPPA concern the Pharmaceutical Benefits Scheme and the prospect of Australia agreeing to investor state dispute resolution provisions. Over many years US pharmaceutical manufacturers have sought to force Australia to discontinue the use of cost effectiveness criteria in the listing and pricing of new drugs on the PBS. 8. The inclusion of investor state dispute resolution procedures would allow companies to sue the Australian Government in relation to any policy initiative which affected the profits of a foreign corporation, including tobacco companies suing for loss of revenue arising from plain packaging. 9. The Australian Government s Trade Policy Statement released in April 2011 included significant commitments to protect public health in trade agreements, including ensuring the sustainability of the Pharmaceutical Benefits Scheme (PBS) and excluding investor-state dispute resolution processes. However, US trade negotiators are known to be applying a great deal of pressure to persuade the Australian Government to renege on these commitments in relation to the TPPA. 10. PACER Plus is a new trade agreement being negotiated between Australia, New Zealand and the Pacific island countries. This agreement has the potential to damage the health of Pacific Islanders in a number of ways, including: loss of government revenues with reduced tariffs; increasing exposure to cheap junk food, alcohol and tobacco; increasing foreign investment in health care; increasing the cost of medicines; and exacerbating the brain drain of health workers (Morgan, 2010). The Public Health Association of Australia believes: 11. In evaluating proposed new trade agreements public health advocates need to have regard to the following criteria: The quality and distribution of any increased economic activity associated with new trading arrangements; Unrestricted scope for policy makers to implement policies for health and well being and other policy goals in the national interest. 12. New trading rules could increase aggregate economic activity but still lead to widening income inequalities with predictable consequences for health outcomes. New trading 3

4 rules could increase economic activity but include the expansion of unhealthy industries such as gambling and junk foods. Privatisation and deregulation promoted as part of neoliberal economic policies and locked in by free trade agreements can contribute to increasing social and economic inequity and dysfunctional health systems, which adversely influences population health and well-being. 13. Trade agreements should not limit or override a nation s ability to foster and maintain systems and infrastructure that contribute to the health and well-being of its citizens by detracting from a nation s ability to legislate and regulate on such matters as: Water and sanitation; Control of tobacco, alcohol and firearms; Pricing of medications (e.g. price regulation in the PBS); Practitioner registration standards; Privacy rules; Distribution of services based on need; Health worker mobility; and Occupational Health and Safety standards. 14. Policy space needs to be preserved in trade agreements for national governments to regulate to protect public health (for example, by banning or restricting the availability of health damaging products) (Koivusalo et al, 2009). 15. Free Trade Agreements with any country (especially developing ones) must not be used to the detriment of public health. The application of this principle should include: Limiting the ability of private corporations to sue governments under indirect expropriation or investor state dispute settlement provisions; Ensuring the ability of the PBS (or similar programs in other countries), to use cost-effectiveness criteria in pharmaceuticals pricing; Preventing the patenting of medical procedures; Ensuring the bio-security of all local blood or organ products; Ensuring food safety and food security; Limiting the cost of medicines used for independent academic research; and Enabling governments to licence patents in public health emergencies, without prior consultation with the patent owners, if this is necessary to produce adequate supplies for urgently required treatments. 16. Moving towards a fairer regime of trade regulation which addresses sustainability issues as well as economic development and which prioritises equity within and between countries as a necessary condition for global population health improvement. The Public Health Association of Australia resolves that the Board, Executive and Political Economy of Health Special Interest Group will: 17. Advocate to appropriate Commonwealth officials and departments with a view to: Preserving the opt-in character of the GATS agreement; Excluding from any renegotiated GATS agreement any services that relate to or are likely to have an influence on population health and the provision of health care and welfare services; Supporting the continuing implementation of WHO Resolution which mandates WHO to provide advice to national governments regarding the implications of trade agreements for health; 4

5 Supporting moves within the WHO to reform global and national intellectual property protection rules to facilitate the development of pharmaceuticals for diseases of the developing world and to facilitate access to essential medicines; Ensuring that the PBS is not weakened and that investor-state dispute processes are not included in the TPPA negotiations. 18. Through the World Federation of Public Health Associations (WFPHA), the People s Health Movement and other international public health organisations, encourage the wider public health community to advocate at the national and international levels to promote and protect public health within international trade agreements. 19. Work with the Australian Fair Trade and Investment Network and with the People s Health Movement and other similar organisations nationally towards limiting adverse impacts of trade agreements on health and well-being, both within Australia and in other countries with which Australia has, or is negotiating, trade agreements. References: Blouin, C., Chopra, M. and van der Hoeven, R. (2009) Trade and social determinants of health. Lancet, 373 pp Koivusalo, M., Schrecker, T. and Labonte, R. (2009) Globalization and policy space for health and social determinants of health. In: Labonte, R., Schrecker, T., Packer, C. and Runnels, V. (eds). Globalization and Health: Pathways, Evidence and Policy. Routledge, New York. Labonté, R., C. Blouin, et al. (2007). Towards a Health-Equitable Globalisation: A Question of Rights, Regulation and Redistribution. Draft Final Report of the Globalisation Knowledge Network to the WHO Commission on Social Determinants of Health. WHO Commission on Social Determinants of Health Knowledge Network Reports. Ottawa, Institute of Population Health. Legge, D., Sanders, D. and McCoy, D. (2009) Trade and health; the need for a political economic analysis. Lancet, 373, pp Morgan, W. (2010). Public Forum on Trade and Health in the Pacific: PACER-Plus: Should we be Concerned? Final Report. Available from World Health Assembly (2006). International trade and health. Resolution 59.26, 27 May World Health Organisation Intergovernmental Working Group on Public Health (2007). Draft global strategy and plan of action on public health, innovation and intellectual property; Interagency work on the interface between trade, intellectual property and public health. Geneva, WHO. ADOPTED 2004, REVISED AND RE-ENDORSED IN 2008 AND 2011 First adopted at the PHAA Annual General Meeting held on 9 October 2004 following the IUHPE PHAA Policy forum in April Revised and re-endorsed as part of the 2008 and 2011 policy review processes. 5