The Lancet Vol 385 February 14, 2015
Call for transparency in new generation trade deals
Joshua Freeman, Gay Keatingemail, Erik Monasterio, Pat Neuwelt, Deborah Gleeson, on behalf of 27 signatories
As mentioned in Deborah Gleeson and Sharon Friel’s Viewpoint,1 new proposed agreements for trade and investment threaten the ability of governments worldwide to provide aff ordable health care and to put in place health and environmental laws that protect public health and mitigate health inequity. One such agreement, the TransPacific Partnership agreement (TPPA), is in the final stages of negotiation between 12 Pacific-Rim countries, affecting more than 700 million people. Although USA-based industry advisers have been granted privileged access to negotiating documents,2 health agencies have been forced to rely on leaks for information.
As for the proposed Trans-Atlantic Trade and Investment Partnership between the European Union and the USA, serious concerns about the health effects of the TPPA have been highlighted in medical journals and by civil society.1–6 The concerns include unprecedented expansion of intellectual property rights that would prolong monopolies on pharmaceuticals and reduce access to affordable and lifesaving generic medicines.2–4 Effective price regulation of medicines could also be undermined.2,5 Rising medicine costs would disproportionately affect already vulnerable populations, obstructing efforts to improve health equity within and between countries.1,5
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.6
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 eff ect 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.6
As health practitioners in seven of the involved Pacific-Rim countries, we call on our governments to publicly release the full draft TPPA text, and to secure independent and comprehensive assessments of the health and human rights consequences of the proposed agreement for each nation. The assessments should evaluate the direct and indirect—and short-term and long-term—effects of the TPPA on public health policy and regulation, publicly funded health systems, the cost of medicines, and health equity; they should also be openly released to allow full public and legislative discussion before any political trade-offs are made and the agreement is signed.
DG is a member of the Public Health Association of Australia and receives funding from the Australian Research Council for research on the Trans Pacific Partnership, nutrition and health. GK had been employed by the Public Health Association of New Zealand. None of the other authors declare any competing interests.
Joshua Freeman, *Gay Keating, Erik Monasterio, Pat Neuwelt, Deborah Gleeson, on behalf of 27 signatories [email protected]
Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (JF, PN); Eru Pōmare Māori Health Research Centre, University of Otago Wellington School of Medicine and Health Sciences, Wellington, New Zealand (GK); Christchurch School of Medicine, University of Otago, Christchurch, New Zealand (EM); and School of Psychology and Public Health, La Trobe University, Melbourne, Australia (DG)
1 Gleeson D, Friel S. Emerging threats to public health from regional trade agreements. Lancet 2013; 381: 1507–09.
2 Lopert R, Gleeson D. The high price of “free” trade: US trade agreements and access to medicines. J Law Med Ethics 2013; 41: 199–223.
3 Médecins Sans Frontières. Trading away health: the Trans-Pacific Partnership Agreement. Briefing note; July 2014. http:// www.msf.ca/sites/canada/files/tpp_ issuebriefing_july2014.pdf (accessed Dec 17, 2014).
4 UNITAID. The Trans-Pacific Partnership Agreement: implications for access to medicines and public health. Report; April 2014. http://www.unitaid.eu/images/marketdynamics/publications/TPPA-Report_Final.pdf (accessed Dec 17, 2014).
5 Monasterio E, Gleeson D. The Trans Pacific Partnership Agreement: exacerbation of inequality for patients with serious mental illness. Aust NZ J Psychiatry 2014; 48: 1077–80.
6 Kelsey J. The Trans-Pacific Partnership Agreement: a gold-plated gift to the global tobacco industry? Am J Law Med 2013; 39: 237–64.