Effects of world trade on public health

Abstract

Sir—Rudolf Adlung (May 19, p 1626) condemns as inaccurate our account of the threats to universal health-care systems posed by the World Trade Organisation (WTO) trade negotiations. However, his unsupported assertions do not address the evidence. The WTO’s General Agreement on Trade in Services (GATS) covers public health care because it targets for removal any government measure that affects entry into any service market of commercial providers and investors. Adlung claims that public services provided in the exercise of government authority are excluded from GATS. Article 1.3 of the treaty does say this, but does not define or equate services with the public sector. The WTO Secretariat and the European Community have raised concerns about this lack of clarity and note that the interpretative methods of the Vienna Convention on the Law of Treaties can give the article a narrow or broad meaning. We show that a WTO committee has argued for a narrow interpretation that could bring all public services under GATS. The WTO admits that the scope might have to be settled by a WTO disputes panel. Thus, Adlung should not assert that public services are exempt from GATS and that the assertion has never been questioned in the WTO. Second, Adlung describes as false our evidence that universal public services would be undermined by application of necessity tests to break up traderestrictive public-provider monopolies and substitute commercial competition. Under WTO rules, the telecoms industry is bound by such a test and influential WTO members and the WTO Secretariat advocate implementing a similar test across all service sectors, including health care. Third, Adlung takes issue with evidence from a trade dispute that the WTO is already using a necessity test to assume powers over public-health policy. Canada invoked WTO rules to overturn a ban on asbestos imports, introduced by France for public health reasons; a WTO panel named the ban a trade issue and said that France was obliged to prove the necessity of the policy to the satisfaction of the WTO. All members are under a similar obligation. Therefore, the WTO invoked a necessity test to assume a power over public-health policy and claimed power of authorisation. Finally, Adlung implies that our criticisms are beside the point because WTO rules reflect a popular will, and that economic power does not play a part in multilateral trade negotiations. Yet he ignores the USA’s use of its economic hegemony to initiate GATS talks and its threats of trade sanctions to secure the agreement, its exclusion of national parliaments from negotiations, the lack of representation at trade talks, and wide power disparities in the negotiating processes. The lack of democracy in the WTO is a constant complaint of less-developed countries and non-governmental critics. Adlung, as an employee of the WTO, shows a worrying disregard for the use of GATS to extend private markets, however denial depends on suppressing the public record.