Opening up the health services markets may worsen health equity for the poor

At the World Trade Organization's ministerial conference held last week in Doha, Qatar, world trade leaders from the organisation's 142 member governments focused attention on a critical health issue. Trade ministers debated the flexibility in the organisation's agreement on trade related aspects of intellectual property rights (TRIPS) for countries to protect public health in emergencies. Such clarification is critical for developing countries to improve access and affordability of essential medicines for millions of poor people suffering from HIV/AIDS and other life threatening diseases. But access to essential drugs is not the only health issue affected by global trade rules. Agreements made by the organisation also shape national policies and regulations on issues ranging from food safety and imports of hazardous goods to duties on tobacco.

And there is more to come. The World Trade Organization's negotiations launched in 2000 to further liberalise trade in services under the General Agreement on Trade in Services (GATS) could increase the organisation's influence on financing and delivery of health care. In contrast with other agreements, GATS gives countries considerable flexibility to decide which service sectors to open to …