Intended for healthcare professionals


The threat of a UK-US trade deal to managing non-communicable diseases

BMJ 2021; 374 doi: (Published 16 July 2021) Cite this as: BMJ 2021;374:n1630
  1. Courtney L McNamara, senior research fellow
  1. Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Dragvoll, Trondheim, Norway
  1. Correspondence to: Courtney.McNamara{at}

Courtney McNamara argues that a trade deal between the UK and US could limit the UK’s ability to manage non-communicable diseases unless the agreement includes public health safeguards

For over four decades, the European Union has handled most of the United Kingdom’s trade policy. Now, as the country regains autonomy over its trade policy decision making, the government must carefully consider its approach in pursuing free trade agreements. One of the main trade policy priorities of the UK government is to conclude an agreement with the United States.1 US trade officials have been circumspect in their statements about such an agreement, but ongoing negotiations remain on the US trade policy agenda for 2021,2 and several members of Congress have signalled their support for the timely conclusion of an agreement.3

Public health discussions around a UK-US free trade agreement have been largely focused on whether the agreement would open up the NHS to American corporations and allow for the importation of poor quality foods, like chlorinated chicken. But another pressing concern has received scant attention in the debate so far—a UK-US free trade agreement could endanger the UK’s ability to manage non-communicable diseases.

Responsible for nearly 9 out of 10 deaths in the UK, non-communicable diseases include chronic conditions like cardiovascular diseases, cancer, respiratory diseases, and diabetes.4 Many of these conditions also place people at greater risk of becoming severely ill or dying from covid-19.5 Smoking, harmful use of alcohol, and poor nutrition are the major individual risk factors. Economically speaking, non-communicable diseases usher in tremendous financial burdens. Smoking for example, is estimated to cost the UK £12.5bn (€14.5bn; $17.2bn) every year.6 Alcohol related harms are estimated to have cost the UK an overwhelming £47bn in 2016 alone.6

The US is likely to pursue …

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