17.B. Round table: Including public health considerations in trade and investment agreements

Abstract There is widespread recognition that trade and investment agreements (TIAs) can affect health services, access to medicines, NCD prevention (particularly related to tobacco, alcohol and unhealthy food) and health systems structures. In addition, these binding international economic agreements can constrain the policy space available for innovative, evidence-based health policymaking. Although TIAs can have positive outcomes for employment and economic growth, these benefits are only likely to accrue when governments are pro-active in implementing complementary policies to mitigate impacts on other sectors and to address potential inequalities arising. The aim of this panel session is to examine the ways in which TIAs can be designed to achieve economic goals while also protecting public health, and identify complementary policy measures that may be needed as well as strategies for strategic policy engagement. This panel will be hosted by the UK-PRP PETRA Network (Prevention of the noncommunicable disease using trade agreements). The UK will be negotiating a range of new TIAs over the coming years, representing a window of opportunity for strategic engagement with policymakers regarding how public health can be protected and promoted within these agreements. There is an emerging global body of evidence regarding how consideration of health can be integrated into TIAs, both textually and through strategic engagement with policymakers before and during the negotiation phase. Experience to date indicates common global challenges and opportunities for health and trade, as well as significant potential for cross country learning regarding trade and health. The panel discussion will use the UK experience as a springboard to address these global issues. The expert panel, drawn from the PETRA Network with expertise in political economy, trade law, economics and public health advocacy, will provide brief overview of the current issues in trade and health and how public health can be protected in trade agreements. The 5-minute panel presentations will briefly summarise how inclusions in TIAs can support and protect policy space for health systems and health services, access to medicines, NCD prevention, and nutrition and food systems. The session will then open for a roundtable discussion among participants regarding 1) country-specific examples and questions regarding health protections; 2) experiences related to health-trade policy engagement; 3) lessons for elevating health on the political agenda, particularly regarding trade. (Note that if there are more than 16 participants, then the workshop will split into small groups for discussion with panel/ PETRA Network resource people. The panel session and discussion will provide the basis for a planned public health-oriented briefing note by the PETRA Network on including public health considerations in trade and investment agreements. Key messages Including consideration of health in trade and investment, agreements can protect policy autonomy for public health and promote good public health outcomes; In order to promote consideration of public health in trade and investment agreements, strategic engagement with trade policymakers before and during the negotiation period is critical.

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Including public health considerations in trade and investment agreements

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.834 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Thow ◽

A Garde ◽

M Mabhala ◽

R Smith ◽

P Kingston ◽

...

Keyword(s):

Public Health ◽

Panel Discussion ◽

Access To Medicines ◽

Noncommunicable Disease ◽

Global Issues ◽

Challenges And Opportunities ◽

Strategic Policy ◽

The Uk ◽

Investment Agreements ◽

Trade And Investment

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International Trade and Investment Agreements as Barriers to Food Environment Regulation for Public Health Nutrition: A Realist Review

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.189 ◽

2020 ◽

Author(s):

Kelly Garton ◽

Anne Marie Thow ◽

Boyd Swinburn

Keyword(s):

Public Health ◽

International Trade ◽

Food Environment ◽

Policy Design ◽

Realist Review ◽

Nutrition Policy ◽

Fiscal Policies ◽

Policy Space ◽

Investment Agreements ◽

Trade And Investment

Background: Achieving healthy food systems will require regulation across the supply chain; however, binding international economic agreements may be constraining policy space for regulatory intervention in a way that limits uptake of ‘best-practice’ nutrition policy. A deeper understanding of the mechanisms through which this occurs, and under which conditions, can inform public health engagement with the economic policy sector. Methods: We conducted a realist review of nutrition, policy and legal literature to identify mechanisms through which international trade and investment agreements (TIAs) constrain policy space for priority food environment regulations to prevent non-communicable diseases (NCDs). Recommended regulations explored include fiscal policies, product bans, nutrition labelling, advertising restrictions, nutrient composition regulations, and procurement policies. The process involved 5 steps: initial conceptual framework development; search for relevant empirical literature; study selection and appraisal; data extraction; analysis and synthesis, and framework revision. Results: Twenty-six studies and 30 institutional records of formal trade/investment disputes or specific trade concerns (STCs) raised were included. We identified 13 cases in which TIA constraints on nutrition policy space could be observed. Significant constraints on nutrition policy space were documented with respect to fiscal policies, product bans, and labelling policies in 4 middle-income country jurisdictions, via 3 different TIAs. In 7 cases, trade-related concerns were raised but policies were ultimately preserved. Two of the included cases were ongoing at the time of analysis. TIAs constrained policy space through 1) TIA rules and principles (non- discrimination, necessity, international standards, transparency, intellectual property rights, expropriation, and fair and equitable treatment), and 2) interaction with policy design (objectives framed, products/services affected, nutrient thresholds chosen, formats, and time given to comment or implement). Contextual factors of importance included: actors/institutions, and political/regulatory context. Conclusion: Available evidence suggests that there are potential TIA contributors to policy inertia on nutrition. Strategic policy design can avoid most substantive constraints. However, process constraints in the name of good regulatory practice (investor-state dispute settlement (ISDS), transparency, regulatory coherence, and harmonisation) pose a more serious threat of reducing government policy space to enact healthy food policies.

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Who influences nutrition policy space using international trade and investment agreements? A global stakeholder analysis

Globalization and Health ◽

10.1186/s12992-021-00764-7 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Kelly Garton ◽

Boyd Swinburn ◽

Anne Marie Thow

Keyword(s):

Public Health ◽

Economic Growth ◽

Food Environment ◽

Stakeholder Analysis ◽

Nutrition Policy ◽

Public Health Nutrition ◽

Policy Space ◽

Investment Agreements ◽

Trade And Investment

Abstract Background Regulation of food environments is needed to address the global challenge of poor nutrition, yet policy inertia has been a problem. A common argument against regulation is potential conflict with binding commitments under international trade and investment agreements (TIAs). This study aimed to identify which actors and institutions, in different contexts, influence how TIAs are used to constrain policy space for improving food environments, and to describe their core beliefs, interests, resources and strategies, with the objective of informing strategic global action to preserve nutrition policy space. Methods We conducted a global stakeholder analysis applying the Advocacy Coalition Framework, based on existing academic literature and key informant interviews with international experts in trade and investment law and public health nutrition policy. Results We identified 12 types of actors who influence policy space in the food environment policy subsystem, relevant to TIAs. These actors hold various beliefs regarding the economic policy paradigm, the nature of obesity and dietary diseases as health problems, the role of government, and the role of industry in solving the health problem. We identified two primary competing coalitions: 1) a ‘public health nutrition’ coalition, which is overall supportive of and actively working to enact comprehensive food environment regulation; and 2) an ‘industry and economic growth’ focussed coalition, which places a higher priority on deregulation and is overall not supportive of comprehensive food environment regulation. The industry and economic growth coalition appears to be dominant, based on its relative power, resources and coordination. However, the public health nutrition coalition maintains influence through individual activism, collective lobbying and government pressure (e.g. by civil society), and expert knowledge generation. Conclusions Our analysis suggests that industry and economic growth-focussed coalitions are highly capable of leveraging networks, institutional structures and ideologies to their advantage, and are a formidable source of opposition acting to constrain nutrition policy space globally, including through TIAs. Opportunities for global public health nutrition coalitions to strengthen their influence in the support of nutrition policy space include strategic evidence generation and coalition-building through broader engagement and capacity-building.

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Analyzing the impact of trade and investment agreements on pharmaceutical policy: provisions, pathways and potential impacts

Globalization and Health ◽

10.1186/s12992-019-0518-2 ◽

2019 ◽

Vol 15 (S1) ◽

Cited By ~ 10

Author(s):

Deborah Gleeson ◽

Joel Lexchin ◽

Ronald Labonté ◽

Belinda Townsend ◽

Marc-André Gagnon ◽

...

Keyword(s):

Human Rights ◽

Intellectual Property ◽

Intellectual Property Rights ◽

Trade Agreements ◽

Analytical Framework ◽

Pharmaceutical Policy ◽

Health And Human Rights ◽

Policy Objectives ◽

Investment Agreements ◽

Trade And Investment

Abstract Background Trade and investment agreements negotiated after the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) have included increasingly elevated protection of intellectual property rights along with an expanding array of rules impacting many aspects of pharmaceutical policy. Despite the large body of literature on intellectual property and access to affordable medicines, the ways in which other provisions in trade agreements can affect pharmaceutical policy and, in turn, access to medicines have been little studied. There is a need for an analytical framework covering the full range of provisions, pathways, and potential impacts, on which to base future health and human rights impact assessment and research. A framework exploring the ways in which trade and investment agreements may affect pharmaceutical policy was developed, based on an analysis of four recently negotiated regional trade agreements. First a set of core pharmaceutical policy objectives based on international consensus was identified. A systematic comparative analysis of the publicly available legal texts of the four agreements was undertaken, and the potential impacts of the provisions in these agreements on the core pharmaceutical policy objectives were traced through an analysis of possible pathways. Results An analytical framework is presented, linking ten types of provisions in the four trade agreements to potential impacts on four core pharmaceutical policy objectives (access and affordability; safety, efficacy, and quality; rational use of medicines; and local production capacity and health security) via various pathways. Conclusions The analytical framework highlights provisions in trade and investment agreements that need to be examined, pathways that should be explored, and potential impacts that should be taken into consideration with respect to pharmaceutical policy. This may serve as a useful checklist or template for health and human rights impact assessments and research on the implications of trade agreements for pharmaceuticals.

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Accountable Care Organizations and Clinical Commissioning Groups face an uncertain challenge for improving public health

Journal of Public Health Research ◽

10.4081/jphr.2012.e16 ◽

2012 ◽

Vol 1 (2) ◽

pp. 16

Author(s):

Douglas J. Noble

Keyword(s):

Public Health ◽

Health Services ◽

Population Health ◽

The United States ◽

Accountable Care Organizations ◽

Health Needs ◽

Local Health ◽

Accountable Care ◽

The Usa ◽

The Uk

<p>Accountable Care Organizations (ACO) in the United States of America (USA) and Clinical Commissioning Groups (CCG) in the United Kingdom (UK) are new proposed organizations in health services both tasked with a role which includes improving public health. Although there are very significant differences between the UK and USA health systems there appears to be a similar confusion as to how ACO and CCG will regard and address public or population health. The role of ACO in improving population health and evaluating the health needs of their registered and insured patients remains ill-defined and poorly explored. Likewise, in the current UK National Health Service (NHS) reorganisation, control and commissioning of appropriate local health services are passing from Primary Care Trusts (PCT) to new cross-organizational structures (CCG). CCG groups aim to be, like ACO, physician led. They will also assume a role for public or population health, but this role, like that of the newly-forming ACO, is currently unclear. Lessons learned from the USA and UK experience of new organizations tasked with a role in improving public health may inform mechanisms for physician led organizations in the UK and the USA to assess health needs, monitor population health information and improve population health outcomes.</p>

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The Impact of Brexit on EU27 on Trade, Investments and Financial Services

Global Economy Journal ◽

10.1515/gej-2017-0097 ◽

2018 ◽

Vol 18 (1) ◽

pp. 20170097 ◽

Cited By ~ 1

Author(s):

Scheherazade S. Rehman ◽

Pompeo Della Posta

Keyword(s):

European Union ◽

Financial Services ◽

Trade Agreements ◽

The European Union ◽

Short Term ◽

Legal Principles ◽

Article 50 ◽

The Uk ◽

The Impact ◽

Trade And Investment

On June 23, 2016, the UK decided to leave the European Union (EU), commonly known as “Brexit”. The UK has two years to conclude their new arrangement with the EU27 after evoking Article 50 Treaty of Lisbon officially, which it did on March 27, 2017. While there is a range of possible trade agreements most are unlikely as they would either imply repudiating firm EU legal principles or strong promises that the current UK government is committed to maintain. The article discusses these options. Moreover, the article focuses on the trade and investment flows between the UK and EU27 and discusses the possible short-term implications of Brexit with a specific attention to the most impacted sector, that of financial services.

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Localising Vaccination Services: Qualitative Insights on an Orthodox Jewish Collaboration with Public health during the UK coronavirus Vaccine Programme

10.1101/2021.09.10.21263372 ◽

2021 ◽

Author(s):

Ben Kasstan ◽

Sandra Mounier-Jack ◽

Louise Letley ◽

Katherine M Gaskell ◽

Chrissy H Roberts ◽

...

Keyword(s):

Public Health ◽

Health Services ◽

Implementation Strategies ◽

Childhood Vaccination ◽

Orthodox Jewish ◽

Public Health Services ◽

Structured Interviews ◽

Religious Minorities ◽

Context Specific ◽

The Uk

AbstractEthnic and religious minorities have been disproportionately affected by the SARS-CoV-2 pandemic and are less likely to accept coronavirus vaccinations. Orthodox (Haredi) Jewish neighbourhoods in England experienced high incidences of SARS-CoV-2 in 2020-21 and measles outbreaks (2018-19) due to suboptimal childhood vaccination coverage. The objective of our study was to explore how the coronavirus vaccination programme (CVP) was co-delivered between public health services and an Orthodox Jewish health organisation.Methods included 28 semi-structured interviews conducted virtually with public health professionals, community welfare and religious representatives, and household members. We examined CVP delivery from the perspectives of those involved in organising services and vaccine beneficiaries. Interview data was contextualised within debates of the CVP in Orthodox (Haredi) Jewish print and social media. Thematic analysis generated five considerations: i) Prior immunisation-related collaboration with public health services carved a role for Jewish health organisations to host and promote coronavirus vaccination sessions, distribute appointments, and administer vaccines ii) Public health services maintained responsibility for training, logistics, and maintaining vaccination records; iii) The localised approach to service delivery promoted vaccination in a minority with historically suboptimal levels of coverage; iv) Co-delivery promoted trust in the CVP, though a minority of participants maintained concerns around safety; v) Provision of CVP information and stakeholders’ response to situated (context-specific) challenges and concerns.Drawing on this example of CVP co-delivery, we propose that a localised approach to delivering immunisation programmes could address service provision gaps in ways that involve trusted community organisations. Localisation of vaccination services can include communication or implementation strategies, but both approaches involve consideration of investment, engagement and coordination, which are not cost-neutral. Localising vaccination services in collaboration with welfare groups raises opportunities for the on-going CVP and other immunisation programmes, and constitutes an opportunity for ethnic and religious minorities to collaborate in safeguarding community health.

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The role of community consultation forums in supporting age-friendly communities: lessons from a disadvantaged British city

10.31234/osf.io/qhwrp ◽

2019 ◽

Author(s):

Katie Wright-Bevans ◽

Alison Stephanie Walker ◽

Emma Vosper

Keyword(s):

Public Health ◽

Health Services ◽

Service Providers ◽

Added Value ◽

Community Consultation ◽

Public Health Services ◽

World Cafe ◽

Health Support ◽

The Uk

In order to be age-friendly, communities need adequate public health support. Community consultation is increasingly favoured as a means of ensuring public health services adequately meet the needs of the populations they serve yet research has highlighted the frequency of inadequate and tokenistic consultation. Our aim was to address the gap in understanding of the subjective benefits of community consultation by being the first study to examine these events in a disadvantaged British city. A naturalistic world café study was co-designed with a community engagement service in the UK. Adults aged 68 to 91 years (n=103) participated in one of two world cafés which aimed to investigate the subjective benefits of consultation forums. Qualitative findings demonstrated how consultation through forums can support age-friendly communities in a variety of expected and unexpected ways. Understanding of the added value of consultation forums may incentivise service providers to facilitate more meaningful consultation.

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The Treatment of Public Health Measures Affecting Intellectual Property Under Multilateral and Plurilateral Trade and Investment Agreements

The Journal of World Investment & Trade ◽

10.1163/22119000-12340155 ◽

2019 ◽

Vol 20 (5) ◽

pp. 759-783

Author(s):

Mark Davison ◽

Patrick Emerton

Keyword(s):

Public Health ◽

Intellectual Property ◽

Intellectual Property Rights ◽

World Trade ◽

Health Measures ◽

The World ◽

Regulatory Measures ◽

Investment Agreements ◽

Indirect Reference ◽

Trade And Investment

Abstract This article considers the interpretation of provisions in international economic agreements that protect intellectual property as they relate to public health measures, and in particular to restrictions on the use of tobacco trademarks. A series of decisions, most recently the World Trade Organization (WTO) panel decision holding that Australia’s plain packaging measures for tobacco products comply with WTO obligations, allow for some generalisations. These include: (1) the nature of intellectual property rights is to confer a privilege of exclusive use on the rights-holder; (2) the interpretation of generally-worded treaty provisions is apt to be informed by recognition of the power of States to regulate for the purposes of public health; and (3) where provisions contain their own specifically-worded balancing tests, any direct or indirect reference to regulation for public health contained in the treaty is likely to be treated as weighing very heavily in favour of the legality of regulatory measures.

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Trade, standards and politics: global pressures on front-of-pack nutrition labelling interventions

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.004 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A M Thow

Keyword(s):

Public Health ◽

National Policy ◽

Policy Decision ◽

Trade Agreements ◽

International Standards ◽

Policy Space ◽

Nutrition Labelling ◽

Health Goals ◽

Policy Level ◽

High Level

Abstract Although interpretive front-of-pack (FOP) nutrition labelling is rightly considered a national health policy decision, it is also influenced by global trade agreements and international standards. Over the past decade, Specific Trade Concerns have been repeatedly raised at the World Trade Organization (WTO) regarding potential impacts of FOP nutrition labelling initiatives on trade. One of the common concerns raised was regarding the consistency of the measures with international standards. The Codex Alimentarius Commission (Codex), which makes global food standards, is currently developing global guidance for FoP nutrition labelling, which will almost certainly influence national policy making. This presentation draws on qualitative policy analysis research on trade concerns and international standards work regarding FOP nutrition labelling. Two challenges are evident at the global policy level. The first is the potential for constraints on policy space for innovative FOP nutrition labelling due to binding trade agreements. The second is the potential for significant industry input into standard development at Codex, which then constitute the reference point for WTO discussions on labelling. Historically, Codex standards have focussed primarily on acute risks, for example, from foodborne disease. This shift in Codex's activities towards standards to address NCDs presents new risks for achievement of public health goals, as a result of the high level of industry involvement in this forum and thus potential commercial conflict of interest. It is imperative that public health actors engage with Codex processes to ensure policy space for national governments to implement strong and effective regulation and allow scope for innovation. At the national policy level, strategic framing of nutrition labelling policy objectives and proactive policy engagement between trade and health can also minimise trade issues.

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