WHO has too little influence in WTO decisions and is relegated to 'observer' status in a limited range of WTO meetings, thus having little say on trade issues directly affecting health. Both institutions, in an era of globalisation which is expanding world trade, need to work better together. These issues are discussed in the second paper in The Lancet Series on Trade and Health, written by Dr Kelley Lee, London School of Hygiene and Tropical Medicine, UK, and colleagues.
WTO is institutionally complex and highly structured, with its bodies including separate councils for trade in goods, trade in services, and trade-related aspects of international property rights (TRIPS). The authors discuss how WHO has limited access to WTO meetings, restricted to being an observer in the committees on sanitary and phytosanitary measures and technical barriers to trade, and ad-hoc observer in the TRIPS and trade in services councils. They call for permanent observer status to be granted to WHO on the higher level General Council, and say that equal participation of trade and health interests should be granted in appropriate cases of dispute settlement. They express concern that, currently, public-health groups have little weight in setting priorities or settling disputes, while industry lobbyists exert undue influence.
The authors believe that weaknesses in global health governance are partly to blame, saying: "The lack of coherence in global health governance is a major hindrance to more effective representation...Concerted leadership on trade and health issues within the public-health community is needed." They add: "To enable stronger representation by health interests, there is a need by WHO and its member states to commit sufficient resources for this purpose."
There is much that WHO could do to strengthen its influence of the trade-health balance, for example, assisting in training on the health-related implications of trade agreements, and supporting health impact assessments of trade agreements. Such work would require careful alliance building beyond the health sector among appropriate stakeholders, ministries, and the private sector. Civil society organisations have a particularly vital role to play, advocating for public health goals and highlighting when these are harmed by trade interests.
The authors say*: "There are many opportunities for trade and health to mutually benefit from greater policy coherence. Protecting and promoting health should not simply be seen as a trade barrier. The failure to factor health goals into trade policy can harm trade. The predicted impact of an influenza pandemic on the global economy, the heated debates over access to medicines, and the stalemate over the Doha Trade Round all point to the need to address trade and health links."
They conclude: "These challenges must be overcome through a strategic and coordinated approach that would contribute not only to improved protection and promotion of health, but also to the creation of a more sustainable form of economic globalisation."
Dr Kelley Lee, London School of Hygiene and Tropical Medicine (LSHTM), UK T) +44 (0)20 7927 2037 E) Kelley.Lee@lshtm.ac.uk
LSHTM Press Office T) +44 (0) 20 7927 2073 E) lindsay.wright@lshtm.ac.uk / gemma.howe@lshtm.ac.uk
Notes to editors: *Quote direct from authors and cannot be found in text of Series
For full second paper see: http://press.thelancet.com/tradeandhealth2.pdf
Journal
The Lancet