Reprinted from hcrenewal.blogspot.com
This week's spectacle in Washington, DC was a nearly unanimous Democratic minority in the Senate blocking a proposal for expedited consideration of multinational trade agreements favored by the Republican majority, but also by the Democratic President and his trade negotiators (look here). Democrats mainly based their actions on perceptions that the trade agreements favored multinational corporations over people.
While trade agreements may seem to be another, albeit international species of wonkery, these agreements could have major effects on patients' and the public's health. Since these concerns have been essentially ignored by the US medical and health care literature, (although they have appeared in UK journals, Australian, and New Zealand journals in English), they I will discuss them below. Worthy of further discussion is the possibility that these potential threats to health care and public health may arise not just from ideological disagreements, but also from health care corporations' increasing capture of government, facilitated by the conflicts of interest generated by the revolving door.
Corporate Friendly Trade Agreements
The US has been negotiating two major multinational trade agreements, the Trans-Pacific Partnership (TPP) and the Transatlantic Trade and Investment Partnership (TTIP) for years.
In a March, 2014, commentary, renowned economist Joseph E Stiglitz summarized the objections to the these proposed trade agreements. His greatest fears were that such agreements
will benefit the wealthiest sliver of the American and global elite at the expense of everyone else.
This seems surprising, since most people think of trade agreements solely in terms of their effects on tariffs, not a big concern for health care and public health professionals. However, Stiglitz noted
Tariffs around the world are already low. The focus has shifted to 'nontariff barriers,' and the most important of these -- for the corporate interests pushing agreements -- are regulations. Huge multinational corporations complain that inconsistent regulations make business costly. But most of the regulations, even if they are imperfect, are there for a reason: to protect workers, consumers, the economy and the environment.
What's more, those regulations were often put in place by governments responding to the democratic demands of their citizens. Trade agreements' new boosters euphemistically claim that they are simply after regulatory harmonization, a clean-sounding phrase that implies an innocent plan to promote efficiency. One could, of course, get regulatory harmonization by strengthening regulations to the highest standards everywhere. But when corporations call for harmonization, what they really mean is a race to the bottom.
In the US, and other developed countries, there are lots of regulations that have major effects on health care and public health. Changes in these regulations, or their implementation, could have major effects again on health care and the public health. So those interested in health care and public health ought to be concerned about how such trade agreements could affect such regulation.
International Tribunals Could Trump National Law
One of Stiglitz's concerns was that the trade agreement would allow international tribunals that could override national law, particularly law promoting public health:
What we know of ... particulars [of the TTP] only makes it more unpalatable. One of the worst is that it allows corporations to seek restitution in an international tribunal, not only for unjust expropriation, but also for alleged diminution of their potential profits as a result of regulation. This is not a theoretical problem. Philip Morris has already tried this tactic against Uruguay, claiming that its antismoking regulations, which have won accolades from the World Health Organization, unfairly hurt profits, violating a bilateral trade treaty between Switzerland and Uruguay.
In fact, Philip Morris has also used such tribunals to overturn Australian laws meant to discourage smoking for public health purposes. The details of the Philip Morris case summarized in May, 2015 in an article by Lauren Carasik in Foreign Policy, show the major public health implications of such trade tribunals,
In 2011, Australia passed a tobacco-control law to discourage smoking. It required cigarettes to be sold in plain packages with prominent warnings, with brand information relegated to the bottom of the box. Touted as 'one of the most momentous public health measures in Australia's history' by the country's health minister, the law was meant to deter a habit that will ultimately kill 1.8 million current Australian smokers, according to a recent study. After the country's highest court upheld the constitutionality of the anti-smoking law, tobacco giant Philip Morris claimed that it violated the company's corporate rights and launched a suit using a little-known provision called investor-state dispute settlement (ISDS). The case is pending, as is a similar case against Uruguay. A similar tobacco-control measure in New Zealand is on hold pending the outcome of these cases.
So these examples suggest that national laws meant to promote the public health could be challenged in these trade tribunals by multinational corporations based on these laws' postulated effects on corporate profits, regardless of the laws' public health rationale or legality in their own countries.
Furthermore, a letter to the Lancet(1) noted,
Investor state dispute settlement (ISDS) provisions allow investors to sue governments if policy changes or even court rulings substantially affect the value of their investment, yet do not allow governments to sue investors for breaching the right to health. ISDS processes constrain governments' abilities to regulate on the basis of the precautionary principle, or even to implement health policies on the basis of established evidence. These processes can have a chilling effect on efforts to address key health issues, such as alcohol, the obesity epidemic, and climate change. In New Zealand, the fear of costly ISDS litigation is already constraining government regulation on tobacco plain packaging.
Thus, creation of such international tribunals could favor financial concerns of multinational corporations over individual countries' governments' attempts to promote health care or public health. So, while these undemocratic tribunals are touted as a way to reduce non-tariff trade barriers, an editorial in the British Medical Journal(2) asserted,
Yet these barriers are some of our most prized social and environmental standards, including regulations on food safety, pesticide residues, and toxic chemicals....
Not only would these tribunals we able to override national laws, their operation would lack procedural safeguards. Demonstrating that opposition to these trade agreements is also multinational, an article in the UK Independent in October, 2014, noted,