Abstract
BackgroundRegional trade agreements are major international policy instruments that shape macro-economic and political systems. There is widespread debate as to whether and how these agreements pose risks to public health. Here we perform a comprehensive systematic review of quantitative studies of the health impact of trade and investment agreements. We identified studies from searches in PubMed, Web of Science, EMBASE, and Global Health Online. Research articles were eligible for inclusion if they were quantitative studies of the health impacts of trade and investment agreements or policy. We systematically reviewed study findings, evaluated quality using the Quality Assessment Tool from the Effective Public Health Practice Project, and performed network citation analysis to study disciplinary siloes.ResultsSeventeen quantitative studies met our inclusion criteria. There was consistent evidence that implementing trade agreements was associated with increased consumption of processed foods and sugar-sweetened beverages. Granting import licenses for patented drugs was associated with increased access to pharmaceuticals. Implementing trade agreements and associated policies was also correlated with higher cardiovascular disease incidence and higher Body Mass Index (BMI), whilst correlations with tobacco consumption, under-five mortality, maternal mortality, and life expectancy were inconclusive. Overall, the quality of studies is weak or moderately weak, and co-citation analysis revealed a relative isolation of public health from economics.ConclusionWe identified limitations in existing studies which preclude definitive conclusions of the health impacts of regional trade and investment agreements. Few address unobserved confounding, and many possible consequences and mechanisms linking trade and investment agreements to health remain poorly understood. Results from our co-citation analysis suggest scope for greater interdisciplinary collaboration. Notwithstanding these limitations, our results find evidence that trade agreements pose some significant health risks. Health protections in trade and investment treaties may mitigate these impacts.
Highlights
Regional trade agreements are major international policy instruments that shape macro-economic and political systems
Two large Regional trade and investment agreements (RTAs) have been at the centre of recent negotiations: the TransPacific Partnership, between the US and 11 Pacific Rim countries, signed in February 2016; and the Transatlantic Trade and Investment Partnership, between the US and the European Union (EU), signed in October 2016 [3]
Eleven studies analysed the impact of RTAs on changes in the availability and consumption of food, tobacco and beverages
Summary
Regional trade agreements are major international policy instruments that shape macro-economic and political systems. Regional trade and investment agreements (RTAs) are increasingly being used to promote international integration and economic growth This has taken particular prominence as world trade has slowed in the wake of the 2008 global financial crisis: in 1990 there were 22 bilateral and regional RTAs, which rose to over 270 by. Two large RTAs have been at the centre of recent negotiations: the TransPacific Partnership, between the US and 11 Pacific Rim countries, signed in February 2016; and the Transatlantic Trade and Investment Partnership, between the US and the European Union (EU), signed in October 2016 [3] These RTAs are as much about facilitating trade as reducing barriers to investment, such as by creating investor protections and by enabling private companies to participate in public sector procurement [4]. The WTO notes that protecting health is a dominant trade concern among members who seek to “strike a balance between trade and health” as they face potential economic costs and legal challenges when introducing new health measures [8, 9]
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