Abstract
Background: Despite greater attention to the nexus between trade and investment agreements and their potential impacts on public health, less is known regarding the political and governance conditions that enable or constrain attention to health issues on government trade agendas. Drawing on interviews with key stakeholders in the Australian trade domain, this article provides novel insights from policy actors into the range of factors that can enable or constrain attention to health in trade negotiations. Methods: A qualitative case study was chosen focused on Australia’s participation in the Trans-Pacific Partnership (TPP) negotiations and the domestic agenda-setting processes that shaped the government’s negotiating mandate. Process tracing via document analysis of media reporting, parliamentary records and government inquiries identified key events during Australia’s participation in the TPP negotiations. Semi-structured interviews were undertaken with 25 key government and non-government policy actors including Federal politicians, public servants, representatives from public interest nongovernment organisations and industry associations, and academic experts. Results: Interviews revealed that domestic concerns for protecting regulatory space for access to generic medicines and tobacco control emerged onto the Australian government’s trade agenda. This contrasted with other health issues like alcohol control and nutrition and food systems that did not appear to receive attention. The analysis suggests sixteen key factors that shaped attention to these different health issues, including the strength of exporter interests; extent of political will of Trade and Health Ministers; framing of health issues; support within the major political parties; exogenous influencing events; public support; the strength of available evidence and the presence of existing domestic legislation and international treaties, among others. Conclusion: These findings aid understanding of the factors that can enable or constrain attention to health issues on government trade agendas, and offer insights for potential pathways to elevate greater attention to health in future. They provide a suite of conditions that appear to shape attention to health outside the biomedical health domain for further research in the commercial determinants of health.
Highlights
The need to address the nexus between trade agreements and their potential health impacts has been a topic of global concern for at least the past twenty years.[1]
Interviews indicated that two non-communicable disease (NCD)-related health issues did emerge onto the Australian government’s agenda during the Trans-Pacific Partnership (TPP), that of domestic concerns for access to generic medicines and protecting regulatory space for tobacco control
This contrasted with other NCD-related health issues like alcohol control, nutrition and food systems that did not appear to receive attention
Summary
The need to address the nexus between trade agreements and their potential health impacts has been a topic of global concern for at least the past twenty years.[1] Over the last decade, public health scholars have researched the causal pathways by which trade and investment agreements have shaped the social and commercial determinants of health.[2,3,4] Analyses have highlighted both the potential positive impacts of trade (for example through greater access to health promoting goods and services), as well as the potential negative impacts including constraints on governments’ ability to regulate and the liberalisation of trade in health-harmful commodities.[5,6,7,8,9]Indeed, the global rise in non-communicable diseases (NCDs) as “one of the major challenges for development in the 21st century”[10] is due to a rise in NCD risk factors including tobacco use, harmful use of alcohol, poor physical activity and poor nutrition.[11] Trade agreements have facilitated these NCD risk factors by increasing the volume of health harmful commodity imports, as well as local production, manufacturing and distribution of these products through goods and services liberalisation, provisions that reduce tariffs (ie, border taxes) and the elimination of restrictions on foreign direct investment.[12] Greater influence within regulatory environments afforded to corporations through
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