Looking upstream: a framework for analysing the impact of trade on public health

Abstract

BackgroundTrade has been a commercial and political determinant of health since the Middle Ages. It was the transmission route for increased prosperity and, as the result of mobility, pandemics, such as plague. The importance of trade agreements (TA), their potential to increase inequity and restrict scope for regulating for health are not discussed widely in public health. Comprehensive TAs, emerging impacts of Brexit, global disruption associated with SARS-CoV-2, access to vaccines and climate change require urgent attention. With renewed interest in economy of wellbeing we examine the impact of trade and TAs for public health practice.ResultsWe present a six-part framework for analysis of trade-related measures for public health practice: Trade flows and/or mobility of people, goods, services or capital. Trade can enhance access to fruits, nuts and vegetables, but also tobacco, alcohol and junk food. Tariffs, tax and minimum unit pricing need to be balanced.Scope for regulation and policy measures at national level irrespective of trade flows.Obligations such as intellectual property rights and investment protection that protect corporations against local action.Authority and reference standards. TAs have changed reference agencies (e.g. Codex, ISO) and can include e-health, medical devices and data-related provisions.New provisions can signal a role for trade in improving health or undermine other international agreements.Public health and crisis exemptions so that essential local services and production can take place LessonsThis framework enables a focus on trade flows and what is negotiated under trade agreements to inform political decision-making and evaluate what negotiated documents imply for population health.Key messages Trade impacts on public health depend on trade flows and what is negotiated in trade agreements.The framework for analysis helps in assessing diverse types of public health relevant impact and identifying priorities for action.