PHIRN: Population Health Improvement Research Network

Trade, Growth and Population Health: An Introductory Review

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Caroline Andrew. Louise Bouchard, Ronald Labonté, Vivien Runnels (Editors)
Ronald Labonté,Canada Research Chair, Globalization and Health Equity, Institute of Population Health, Professor, Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa
Chantal Blouin, Associate Director, Centre for Trade Policy and Law, Carleton University, Ottawa
Lisa Forman, Assistant Professor, Dalla Lana School of Public Health, Director, Comparative Program on Health and Society, Munk Centre for International Studies, University of Toronto
Vol. 2(1) 2010 Transdisciplinary Studies in Population Health Series
PDFAvailable online as PDF [94p.] at:

“……..Human societies have long histories of trade with each other. One might describe barter and exchange as inherently human social qualities. When such barter extends beyond the village marketplace, however, issues of power and elite interests inevitably surface. Trade between societies has been marked by conflict as much as by equanimity: witness the forced opening of the closed economies of China by the British in the 19th century, Japan by the USA in the early 20th century, and the allegations of more contemporary coercion exercised by powerful countries over weaker ones in today’s free trade negotiations, a point addressed later in this paper.

This paper focuses on one central question: What are the actual or potential implications of today’s global trade regime on health?

We do not address this question through detailed examination of the multiplicity and complexity of trade rules, the proper treatment of which would be book length. Rather, we approach the question indirectly through an examination of a broad range of health-trade relationships. This reflects the paper’s intent, which is to familiarize researchers and students across a range of disciplines engaged in population health with some of the key health issues and controversies associated with contemporary trade.
We begin by examining how trade liberalization is thought to improve social welfare, generally, and health, specifically. This includes an assessment of trade liberalization as part of the larger neoliberal economic orthodoxy that has dominated international policy-making for the past three decades. This deconstruction of the dominant historical and current arguments supporting liberalized trade is important since its basic premise – increasing economic growth, development and ‘trickle-down’ poverty reduction – has failed to live up to its theoretical promise and is flawed by its absence of any reference to ecological scale.

The paper then turns to the actual and potential constraints trade treaties impose on the policy space and capacity of governments to regulate for health goals. This assessment is followed by more detailed accounts of trade agreements that directly affect health through liberalization of trade in health and other health-determining services, and through the global expansion of intellectual property rights. Most population health discussions of trade begin and end with these two issues. But, as this paper next argues, treaties and ongoing negotiations related to tariffs reduction, agriculture, investment, government procurement and standards-setting are likely to have more long-term, if indirect, health impacts.

One of the acknowledged innovations of today’s global trading system is its formalization of dispute settlements when one country perceives another as breaking agreed upon trade rules. Because dispute settlements can penalize countries that break the rules economically, trade treaties are amongst the ‘harder’ of international laws governing inter-state relations.

This raises questions about how well trade law accommodates public and global health equity concerns. Although this theme runs throughout the entire paper, we conclude with a discussion of trade and global governance issues, and offer a brief account of reforms to the global trading system that have been mooted by a number of researchers and development economists to  ‘put trade in its place:’ that is, to ensure that trade liberalization retains its place as a means to other development goals (including health) and not as an end in itself to which other goals should be subordinated……………..”

Table of Contents

  • Introduction
  • Shrinking policy space meets diminishing policy capacity to create greater economic insecurity
  • From the general to specific: trade treaties’ direct effects on policy space and capacity on health
    Agreements with direct health effects
  • Agreements with indirect health effects
  • Health in dispute
  • Reforming global economic governance: redistribution, regulation and rights
  • References 
Last Updated ( Thursday, 19 August 2010 16:27 )  

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