Making trade work for public health

Editor, The recent editorial in the British Medical Journal on the
WTO discussed several issues which are important for health policy (1).

The WTO sets the legal framework for global trade, and decisions taken by
it have consequences for policies made at the national level. It is clear
that
the WTO agreements will have significant implications for health policies
and the organisation of health services across all European countries (2).

According to the background paper by the WTO secretariat, market oriented
reforms in many countries together with the growth of the health care
industry have opened up prospects for increased trade in health services
(3). In European Union Member States negotiating powers with respect to
trade rest with the European Commission and are heavily influenced by
commercial interests. In contrast, social and health
services remain primarily a matter of national governance. In Europe
national health administrations are, for the most part, happily unaware of
the priorities and impact of trade negotiations. Similarly, there is
little public debate by legislators or within the media on the health and
social implications of the agreements which have already been
negotiated. Yet it is clear that these agreements could alter the nature
and way in which health and social policies are defined and implemented in
countries, with important implications for cost and equity. The broad
agenda on services negotiations could for example imply that global
commercial provider chains would have access to competitive bidding on
publicly funded health care markets such as the
NHS.

The Amsterdam Treaty states that implications for health and health
protection should be considered in the planning and implementation of all
Community policies (4). However, we must ensure that these commitments are
respected in relation to trade negotiations. It is important to understand
that trade and investment negotiations do not only deal with trade in
goods between countries, but that they also have
implications for social rights, and the financial and political capacity
of nations to make effective public policies. In the process of trade
negotiations these considerations may well be compromised by an emphasis
on the commercial rights of the corporate sector. It is reassuring that
the WHO will be at the negotiations to represent public health interests
in Seattle, but this is not enough. We need public pressure at national
and European level to ensure that commercial interests do not override
those of health and social policies when trade negotiations are
undertaken.

Meri Koivusalo, MD, PhD

Physicians for Social Responsibility and
Globalism and Social Policy Programme (GASPP)

PO Box 220, 00531 Helsinki, Finland

Mike Rowson

Co-ordinator

Economic Policy and Health Project
Medact,
601 Holloway Road
London N19 4DJ

Gilles de Wildt , MD MSc MRCGP

General Practitioner , Medact

17 Jiggins Lane Surgery, Bartley Green, Birmingham B32 3LE

Reference:

1) Drager N. Making trade work for public health. British Medical
Journal 1999;319:1214.

2) Koivusalo M. World Trade Organisation and Trade-creep in
health and social policies. Occasional Paper 4, GASPP, STAKES. 1999.
Available from world wide web
URL:
www.stakes.fi/gaspp/gaspp.htm#NETWORKING

3) World Trade Organisation. Council for Trade in Services.
Health and Social Services. S/C/W/50.18 September 1998.WTO, Geneva. 1998.

4) Treaty on European Union. Consolidated version of Treaty of
European Union incorporating changes made by Treaty of Amsterdam signed on
2 October 1997. Official Journal C340, 10.11.1997:145-172.