Global trade policies have powerful impacts on health and need to be incorporated into public health policy considerations and deliberations. Public health professionals could influence trade policy by serving on the committees that advise trade negotiators and regulators, but they are currently forgoing that opportunity. This can and should be remedied.
Perhaps the most obvious area of intersection of trade policy and health policy is chronic disease. The reorientation of global health concerns toward chronic disease has been accelerated by increased urbanization, greater internet connectivity, decreased fertility, enhanced educational opportunities, and rising wealth profiles. Not only are traditional chronic diseases increasing in prevalence, but they are also gaining in fiscal relevance and budgetary impact.
Trade policies encompass nutrition, tobacco regulations, and drug prices as well as intellectual property issues, labor relations, and transformations in agricultural practice. Inevitably, ministries of heath around the world will be focusing attention on commercial as well as social determinants of health.
Deleterious impacts of bilateral and multilateral trade agreements have been a growing concern for public health in this century and attracted increased attention during the deliberations surrounding the Trans-Pacific Partnership Agreement (TPP). The TPP was negotiated during the Obama administration but never adopted. The roles of Big Food, Big Tobacco, and Big Pharma came under the spotlight and were shown to be conducive to negative long-term health outcomes. As the fiscal and societal impacts of premature illness tied to trade policy become manifest and enter the political arenas of emerging economies, trade agreements will become an increasingly relevant and troublesome political issue.
Public Health Can Play A Role In Future Trade Negotiations
The Office of the US Trade Representative (OUSTR) has multiple advisory committees that welcome membership from various non-governmental institutions and organizations and should include the public health community. As currently constituted, there are no public health voices on any of the eight committees and approximately 25 subcommittees. The Biden administration is rewriting the committee charters, and repopulating the committees has already begun.
In the long term, the advanced economies will not want to be accused of exporting diabetes, heart disease, and cancer; dominating agricultural land allocation; or restricting local industrial activity. In the short term, however, the lobby groups that currently populate these committees will resist change and will be reluctant to concede that the private sector possesses the capacity to both do good and do well. One might reasonably conclude that public health advisers will make little progress, at least initially. However, trading partners in the emerging economies are more than likely to recognize public health professionals on the committees as allies to support in the public forum. These collaborations, both feasible and important, can begin progress toward long-term benefit. We should note that the Trade and Environment Policy Advisory Committee (TEPAC), now open for applications, does include numerous academics and representatives from environmental non-government organizations, hence such organizations are not categorically excluded.
Half of the advisory committees are managed solely by the OUSTR and the other half jointly with relevant federal departments, namely the Departments of Agriculture, Commerce, and Labor. These departments initiate staffing, requesting approval from OUSTR. A detailed overview of the program is available on the user-friendly website of the OUSTR, where moving from one department to another is straightforward. The committees meet two or three times a year.
The websites list current committee and subcommittee membership and document the total absence of public health. The committees under the jurisdiction of the Departments of Agriculture, Commerce, and Labor are currently closed but will likely open later this spring. The remaining three committees (Africa, Intergovernmental Policy, and Trade Policy and Negotiation) are not at their full complement of members and are open. The formal announcements are published in the Federal Register.
The TEPAC contact person, known as the designated federal officer, is Amada B. Mayhew ([email protected] [202-395-9629]). For information regarding all other committees, the contact person is Ethan M. Holmes ([email protected]). There will be no outreach to invite public health professionals to join the new committees. To participate, interested and informed members will need to apply; the details for TEPAC are available in the Federal Register. Participation requires approval based on a vetting process that will examine prior relevant experience. However, there is no financial support. Travel and other expenses are the responsibility of the applicant or the applicant’s sponsor.
