Intended for healthcare professionals


The CPTPP trade deal is a major threat to public health and warrants a health impact assessment

BMJ 2023; 381 doi: (Published 12 April 2023) Cite this as: BMJ 2023;381:e073302
  1. Courtney L McNamara, lecturer in public health12,
  2. Liz Green, consultant in public health and programme director for health impact assessment34,
  3. Pepita Barlow, assistant professor5,
  4. Mark A Bellis, professor of public health and behavioural sciences6
  1. 1Population Health Sciences Institute, Newcastle University, Newcastle, UK
  2. 2Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
  3. 3Policy and International Health, WHO Collaborating Centre on Investment in Health and Wellbeing, Public Health Wales, Wales, UK
  4. 4Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Netherlands
  5. 5Department of Health Policy, London School of Economics and Political Science, London, UK
  6. 6Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, UK
  1. Correspondence to: C McNamara Courtney.McNamara{at}

The UK’s decision to join one of the world’s largest free trade agreements has implications for health that need urgent assessment, argue Courtney McNamara and colleagues

Key messages

  • The UK has joined one of the world’s largest free trade agreements, known as the CPTPP

  • This agreement contains many of the same provisions that made a potential US-UK free trade deal controversial from the perspective of public health

  • Joining the CPTPP could increase industry influence in public health standard setting, make it more difficult for governments to regulate for the benefit of health, increase the costs of medicines, and generate economic insecurity and, potentially, job losses, with knock-on effects for health

  • As the government has not pursued a health impact assessment during the accession process, one should be performed by public health scholars and professionals

The UK government has joined one of the world’s largest free trade agreements, known as the Comprehensive and Progressive Agreement on Trans-Pacific Partnership (CPTPP). The CPTPP is not a new trade agreement waiting to be negotiated, but an already active one among 11 Pacific Rim countries (Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, and Vietnam). Joining the CPTPP commits the UK to several rules concerning trade in goods and services that have important implications for health. Although the US is not a member of the CPTPP, the agreement evolved from the Trans-Pacific Partnership, which initially included—and was shaped by—the US before President Trump withdrew the country from the deal in 2017. As such, many provisions, and even entire chapters, of the CPTPP are near carbon copies of other free trade deals negotiated by the US. But despite how much alarm was raised over the potential health effects of a free trade agreement with the US,1 there has been little discussion of the public …

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