Abstract
BackgroundThe liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators - life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM) - since the WTO was established.Methods and FindingsThis was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995–2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995–2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: −0.358 p<0.001; MM: −0.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995–2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services.ConclusionsThe favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995–2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.
Highlights
The process of removing obstacles to cross-border trade in goods and services known as international trade liberalisation was promoted under the assumption that free trade would ensure political stability and promote investment and job creation, contributing to economic growth and improving the health conditions of populations [1]
The favourable association in 2010 between health and liberalisation in services under the World Trade Organisation (WTO) seems to reflect a pre-WTO association observed in the 1995 data
The aim of this study was to contribute further evidence to this debate by determining the association between the liberalisation of trade in services implemented under the WTO and better levels and progress in three basic health indicators, namely life expectancy (LE), Under-5 mortality (U5M) and maternal mortality (MM) in WTO member countries, considering variables associated with social and economic policies that have been related to health, such as per capita income (GDP pc), public expenditure on health (PEH), per capita gross national income (GNI pc) and income inequality
Summary
The process of removing obstacles to cross-border trade in goods and services known as international trade liberalisation was promoted under the assumption that free trade would ensure political stability and promote investment and job creation, contributing to economic growth and improving the health conditions of populations [1]. Sub-sectors of the service sector include hospital services, health and social services, dental care, education, finance and telecommunications, from a total of 12 sub-sectors established by the WTO (Table 1) [5] This variety of activities encompassed within the GATS has generated uncertainty about the potential positive or adverse effects on health. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators - life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM) - since the WTO was established
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