The final paper in The Lancet Series on Trade and Health sets out an agenda for action in three key areas: establishing evidence to link trade and health; building capacity to analyse these links, and ensuring the health community has a strong voice in negotiations and decisions concerning these issues. All three require action from a range of bodies, including WHO, WTO, donors, governments and non-governmental organisations. The paper is written by Professor Richard Smith, London School of Hygiene and Tropical Medicine, UK, and colleagues.
To strengthen evidence, more studies must be initiated to analyse electronic health services, international movement of patients, foreign direct investment, and flows of health professionals. The positive and negative effects of these flows on health must be established, with reference to trade liberalization and government funding of public health services. Policy responses are required to mitigate the negative health effects of these flows, as well as optimise health benefits and distribute costs and benefits appropriately across populations. Work must be done to harmonise specific indicators for trade and health for joint analyses — as part of this, the authors suggest a trade component be established in the WHO Global Health Observatory.
Building engagement and capacity between the two spheres of trade and health will require a real cross-sectoral effort, including: interministerial conferences on trade and health; common understanding of trade and policy issues; early, transparent and effective engagement of stakeholders, and development of trade negotiation skills for public health. For capacity building and technical support, the various organisations must promote understanding of technical aspects of trade agreements and support meaningful participation in trade negotiations. They must also inform ministries of finance, trade, foreign affairs, and other relevant parties of health-related implications of trade agreements.
Asserting health goals will require redressing of the current dominance of trade goals over those of public health. The representation of the public health community in trade bodies will need to be enhanced. This could be achieved in a number of ways, including: substantive involvement of WHO in trade organisations (e.g. the General, TRIPS, and GATS Councils of WTO); increasing the role of health authorities in trade-policy-making bodies where health-related issues are at stake; and fostering cooperation across countries on trade and health issues.
The authors outline the key messages of the Series:
- increased trade and trade liberalisation are defining features of globalisation
- direct and indirect health consequences arise from the world trading system
- imbalanced governance structures give insufficient weight to addressing health needs
- failure to protect and promote health within a globalising world will, in turn, undermine world trading system
- global financial crisis offers opportunity to achieve greater policy coherence that will benefit both trade and health
- "means" of trade to achieve the "ends" of good health
The authors conclude: "For the public health community, there is urgent need for substantial and sustained effort to engage with issues of trade, to strengthen institutional capacity in this area, and to push for health to be much higher on the agenda for trade negotiations... The stewardship of a domestic health system in the 21st century requires a more sophisticated understanding of how trade affects, and will affect, a country's health system and policy. This requirement places an onus on those within the health sector to better understand the importance of trade and to engage where appropriate in trade and trade policy."
Professor Richard Smith, London School of Hygiene and Tropical Medicine, UK T) +44 (0) 20 7927 2403 E) richard.smith@lshtm.ac.uk
LSHTM Press Office T) +44 (0) 20 7927 2073 E) lindsay.wright@lshtm.ac.uk / gemma.howe@lshtm.ac.uk
For full sixth paper see: http://press.thelancet.com/tradeandhealth6.pdf
Journal
The Lancet