economic globalization, trade liberalization and health canadian society for international health...

Economic Globalization, Trade Economic Globalization, Trade Liberalization and HealthLiberalization and Health

Canadian Society Canadian Society

for for

International HealthInternational Health

(CSIH)(CSIH) Paper prepared by Ron Labonte with assistance from Mathhew Sanger and Pam Paper prepared by Ron Labonte with assistance from Mathhew Sanger and Pam

ThompsonThompson

An issue requiring advocacy:An issue requiring advocacy: The response by CSIH The response by CSIH

In the Spring of 2000, CSIH identified the In the Spring of 2000, CSIH identified the area of Trade and Health as a priority area area of Trade and Health as a priority area for advocacyfor advocacy

An issue paper was commissioned and An issue paper was commissioned and developed in collaboration with the developed in collaboration with the Advocacy Committee of the Society which Advocacy Committee of the Society which will be circulated to members in the next will be circulated to members in the next monthmonth


The paper focused on the recent The paper focused on the recent developments in economic developments in economic globalization, trade agreements and globalization, trade agreements and public governance and the public governance and the implications for health and implications for health and human/social developmenthuman/social development


Globalization connects and creates Globalization connects and creates interdependencies among people and interdependencies among people and organizations around the worldorganizations around the world

Not all forms of globalization promote healthNot all forms of globalization promote health

Summary PointsSummary Points::

Key QuestionsKey Questions::

1) 1) What is known about the relationship between What is known about the relationship between economic globalization, trade, governance and health?economic globalization, trade, governance and health?

2) What are the real and potential health effects of a 2) What are the real and potential health effects of a number of trade agreements?number of trade agreements?


Important to consider the inter-Important to consider the inter-related types of globalization:related types of globalization:

1. Economic1. Economic

2. Environmental2. Environmental

3. Communicative3. Communicative


Economic globalization is characterized by Economic globalization is characterized by increased trade and investment increased trade and investment liberalization (free trade), privatization of liberalization (free trade), privatization of former public services and de-regulation of former public services and de-regulation of many former government powersmany former government powers

Economic globalization is also associated Economic globalization is also associated with increasing disparities in wealth and with increasing disparities in wealth and power both between nations and between power both between nations and between different groups within nations and between different groups within nations and between public and private sectorspublic and private sectors


New forms of public/private New forms of public/private partnerships are arising in the wake of partnerships are arising in the wake of these shifts these shifts

New forms of global governance are New forms of global governance are occurring in the UN agencies, national occurring in the UN agencies, national governments, multilateral governments, multilateral organizations such as the WTO and organizations such as the WTO and networks of civil societynetworks of civil society


At issue is the relationship between increasing wealth-creating At issue is the relationship between increasing wealth-creating potential of more integrated markets globally and regulation of potential of more integrated markets globally and regulation of these very same forces to effect more equitable wealth these very same forces to effect more equitable wealth distribution and the protection of ecological sustainabilitydistribution and the protection of ecological sustainability

Empirically the evidence is weak although there are many well Empirically the evidence is weak although there are many well documented negative effects associated with the current trend documented negative effects associated with the current trend of liberalization, privatization and de-regulation of liberalization, privatization and de-regulation

Current WTO processes and agreements favour the richer Current WTO processes and agreements favour the richer more developed countries and have failed to curb the growing more developed countries and have failed to curb the growing inequities between and within countriesinequities between and within countries


Environmental globalization:Environmental globalization: Recognizes that an environmental incident or Recognizes that an environmental incident or

impact that happens in one region or country is impact that happens in one region or country is not restricted to that area but has the potential not restricted to that area but has the potential to affect the entire world’s health and well beingto affect the entire world’s health and well being

Examples: Transport of PCBs, DDTs and Examples: Transport of PCBs, DDTs and heavy metalsheavy metals

Climate change due in part to the Climate change due in part to the destruction of the rain forestsdestruction of the rain forests

Global spread of infections due to misuse of Global spread of infections due to misuse of antibioticsantibiotics


Communicative globalization:Communicative globalization: Refers to the rapid growth of communications Refers to the rapid growth of communications

technology and the internet. technology and the internet. Capacity to link people, information and ideas Capacity to link people, information and ideas

around the globearound the globe Impact on culture, positively and negativelyImpact on culture, positively and negatively Instrument in increasing civil society Instrument in increasing civil society

engagementengagement Such technologies are not available or accessible on Such technologies are not available or accessible on

an equitable basis and will likely create a new an equitable basis and will likely create a new technology/information economytechnology/information economy


Specific Trade Agreements and its impact on CanadaSpecific Trade Agreements and its impact on Canada NAFTA:The Canadian Government let its NAFTA:The Canadian Government let its

plain packaging legislation die after plain packaging legislation die after representatives of the Philip Morris representatives of the Philip Morris International and R.J. Reynolds Tobacco International and R.J. Reynolds Tobacco International argued that it constituted an International argued that it constituted an expropriation of assets in violating NAFTA expropriation of assets in violating NAFTA investment and intellectual property investment and intellectual property obligationsobligations

The reserve on health and social services The reserve on health and social services may be open to commercial competitionmay be open to commercial competition


Five Specific WTO Agreements have implications for Five Specific WTO Agreements have implications for healthhealth::

GATT(General Agreement on Tariffs and GATT(General Agreement on Tariffs and Trade) Trade)

TRIPS (Trade Related Aspects of Intellectual TRIPS (Trade Related Aspects of Intellectual Property Rights)Property Rights)

SPS ( Sanitary and Phytosanitary Measures)SPS ( Sanitary and Phytosanitary Measures) TBT (Technical Barriers to Trade)TBT (Technical Barriers to Trade) GATS (General Agreement on Trade in GATS (General Agreement on Trade in

Services) Services)


Example of impact of TRIPS:Example of impact of TRIPS: 20-year patent protection for pharmaceutical 20-year patent protection for pharmaceutical

drugs. In September Canada lost its appeal drugs. In September Canada lost its appeal which means that according to generic drug which means that according to generic drug manufacturers it will cost Canadian consumers manufacturers it will cost Canadian consumers and governments $200 million per year in and governments $200 million per year in higher prescription drug priceshigher prescription drug prices

Example of impact of GATS (General Agreement on Example of impact of GATS (General Agreement on Trade in Services):Trade in Services):

All services including health are covered which requires the All services including health are covered which requires the same level of treatment for all foreign investors. If one same level of treatment for all foreign investors. If one province allows a foreign commercial provider, the rule province allows a foreign commercial provider, the rule could require similar treatment throughout Canadacould require similar treatment throughout Canada


Key ChallengesKey Challenges The WTO remains a largely unaccountable The WTO remains a largely unaccountable

and secretive organizationand secretive organization National government submissions to the National government submissions to the

dispute panels are kept secretdispute panels are kept secret Hearings remain closed to the public, Hearings remain closed to the public,

particularly ngo’sparticularly ngo’s Institutions, our form of governance have Institutions, our form of governance have

not kept up to these rapid and changing not kept up to these rapid and changing challengeschallenges


The need for coordination and coherenceThe need for coordination and coherence International health governance which includes ngos International health governance which includes ngos

has been unable to provide a coordinated response has been unable to provide a coordinated response (Kickbusch)(Kickbusch)

Conflicting and contradictory trade agreements, for Conflicting and contradictory trade agreements, for example, at present several WTO agreements example, at present several WTO agreements prevent national governments from complying with prevent national governments from complying with the terms of environmental and social good the terms of environmental and social good agreements such as Rio Agenda 21 which could agreements such as Rio Agenda 21 which could have serious implications for healthhave serious implications for health


The need for coordination and coherenceThe need for coordination and coherence One impediment to the World Health One impediment to the World Health

Organization enforcement of the Organization enforcement of the international health regulations (IHR) is the international health regulations (IHR) is the impact of reporting outbreaks in regions impact of reporting outbreaks in regions dependent on tourism. This obstacle can dependent on tourism. This obstacle can be exacerbated when the IHRs conflict with be exacerbated when the IHRs conflict with members countries’ WTO trade obligations members countries’ WTO trade obligations


A Framework for Identifying Health Impacts of A Framework for Identifying Health Impacts of Trade and Investment AgreementsTrade and Investment Agreements

A population health framework developed in A population health framework developed in Canada provides a perspective that incorporates Canada provides a perspective that incorporates the determinants of health and allows for the the determinants of health and allows for the inter-relationships of poverty, education, inter-relationships of poverty, education, employment, living and working conditions, employment, living and working conditions, health services, etc. and healthhealth services, etc. and health


ConclusionsConclusions

““Just as health is about more than wealth, trade Just as health is about more than wealth, trade agreements are of more than commercial agreements are of more than commercial significance.”significance.”

““Trade obligations which restrict governments’ Trade obligations which restrict governments’ capacities to achieve health goals through capacities to achieve health goals through legislation or regulation may have very serious legislation or regulation may have very serious health impacts independent of any economic health impacts independent of any economic impact of liberalized trade.”impact of liberalized trade.”


An intersectoral framework and analysis could An intersectoral framework and analysis could support collaboration among policy makers in support collaboration among policy makers in health, trade and other fields to ensure that health, trade and other fields to ensure that interventions acting on the direct determinants of interventions acting on the direct determinants of health are not hampered b conflicting trade health are not hampered b conflicting trade obligations and that appropriate policies are obligations and that appropriate policies are designed to address the indirect determinants of designed to address the indirect determinants of health and the impact of trade policy on health and the impact of trade policy on inequities inequities


Next StepsNext Steps Resolutions to membership of CSIH for Resolutions to membership of CSIH for

consultationsconsultations Reviewed and discussed at Annual General Meeting Reviewed and discussed at Annual General Meeting

of CSIH in November 2000of CSIH in November 2000 Resolutions on Economic globalization, trade Resolutions on Economic globalization, trade

liberalization, governance and health approved by liberalization, governance and health approved by AGMAGM

Dissemination on CSIH web siteDissemination on CSIH web site Letters to key national government departments and Letters to key national government departments and

agencies as well as selected international agencies agencies as well as selected international agencies requesting response to the resolutionsrequesting response to the resolutions

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