Trade and investment agreements: compatible with health?

Transcription

1 TWHA INTERACTIVE TRAINING MODULE ACCESS TO HEALTH CARE Trade and investment agreements: compatible with health?

2 Objective of the session Participants research the links between trade and investment agreements and health

3 Program What are trade and investment agreements? What is the impact of trade and investments on health and access to health care? What possible mechanisms exist to protect health and health care against possible negative consequences of trade and investment agreements?

4 Trade and investment agreements? New generation of trade and investment agreements (TTIP, TAFTA, CETA, TISA, TPP, etc.) get around World Trade Organisation (WTO): Multilateral trade regime WTO: negotiations have reached a dead end since the Doha Round in Due to the opposition of developing countries clauses have been added to trade agreements (TRIPS, GATS) in which health is a priority WTO was considered too restrictive by strong economic players such as the US and EU Solution? Ignore the WTO and reach bilateral and regional trade and investment agreements which impose a new world trade regime. Economic super powers put weaker countries under pressure to accept new standards if they want to participate in the world economy.

5 Previous generation of trade agreements focus on tariffs = bad because developing countries with informal economies generate income from tariffs on import (customs, VAT)

6 New generation of trade and INVESTMENT agreements Liberalization of ALL sectors = open markets to private investments. Competition private (for-profit) and public (non-profit) sector. Focus on regulations which safeguard health, social and environmental legislation. Through harmonization: competition is an automatic downward spiral. Strict rules do not attract investors. The pharmaceutical and food industry are strictly regulated, so we want to break down the rules in order to maximize profits.

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8 T.T.I.P. 2013: Start negotiations Transatlantic Free Trade Agreement between US and Europe Chiefly economic motives: Geopolitical reasons: position oneself against BRICS emerging economies during crisis in West. Promise of economic growth & jobs: based on study Center for Economic Policy Research in London: 119 billion profit promised when the agreement would be fully implemented. Harmonization of regulations between US and EU or cut the red tape = break down trade barriers.

9 Video T.T.I.P.

10 T.I.S.A. TISA-MANDATE

11 Dispute settlement Trade and investment agreement is a contract. Breach of contract = pay compensation WTO: dispute settlement body (state-to-state) TTIP: Investor-State-Dispute Settlement Mechanism (ISDS: investor-to-state) Consequences Profit more important than health and social protection Governments less inclined to take measures as a function of social protection for fear of damage claims If there are regulating measures, loss of billions of euros in damage claims

12 Transparency of negotiations?

13 Impact: Examples?

14 Impact on health? Working conditions Social protection financial and jobrelated security Stress Bad health Higher suicide ratio Smoking Drinking Unhealthy diet (fat, sugar, hormone-treated meat, 'chlorine chicken') Unhealthy living conditions (pollution) Liberalization Health Care Privatization, diminished access to health care

15 Impact on health? Working conditions Social protection financial and jobrelated security Stress Bad health Higher suicide ratio Smoking Drinking Unhealthy diet (fat, sugar, hormone-treated meat, 'chlorine chicken') Unhealthy living conditions (pollution) Liberalization Health Care Privatization, diminished access to health care

16 Impact on health?

17 Impact on health? (Solar & Irwin, 2010)

18 Via living environment Example: Monsanto products harmful for environment and health Dioxin: 1949 Fire Monsanto factory 200 blue-collar workers chlorine acne and skin diseases discovery carcinogenic herbicide Pollution with carcinogenic PCBs, 2001 Aniston, Alabama Agent Orange, Vietnam war: deformed babies

19 Via living environment Poisoning of farmers with pesticide Lasso: French farmer wins lawsuit, 2012 Bovine growth hormone Posilac: hormone milk causes breast, intestinal and prostate cancer Weed killer 'Roundup' carcinogenic Government must watch over health and environment = regulatory function

20 Trade in health care less access Marketing Commercial market sector is condition for foreign investments in health care increases the pressure to privatize/commercialize Commercialization of health care = competition between private and public service providers Private-sector takes resources away from public health sector: Private-for-profit-sector aims at profit (patients with spending power) public sector also obliged to provide care to people with little spending power and high needs (not profitable)

21 Trade in health care less access public sector: less income and worse quality inequality in access to health care: you pay, you benefit. You don't pay, you don't benefit or you get bad quality Bad quality public sector increases pressure for privatization

22 Trade in health care less access Brain drain Internal (public private) & international (low and middle income countries high income countries) migration of health workers Medical tourism & E-health too expensive for local population reason not to invest here internal brain drain

23 Access to medication TRIPS: Agreement on Trade-Related Aspects of Intellectual Property Rights (WTO): patents protected for 20 years Protest developing countries because they don't have access to medication because of the high prices resulted in TRIPS flexibilities Get around new generation of trade and investment agreements WTO and want TRIPS-PLUS = patent > 20 year protection Access to medication in danger

24 Public and private service providers fundamentally different... we did not develop this product for the Indian market, let s be honest. We developed this product for Western patients who can afford this product. (Marijn Dekkers about cancer medicine Nexavar, 2014)

25 Summary impact on health Liberalization and commercialization health sector Less access to quality health care dismantlement social protection Health, environment and social standards down impact on day-to-day living circumstances through unhealthy diet, environmental pollution, quality of medication, etc. Strict patent protection less access to medication Practically irreversible policy choices due to damage claims!

26 How to safeguard health? Put a stop to all the secrecy: make content of negotiations for trade and investment agreements public Health and social protection are priorities: make precautionary principle + health and social impact studies binding Health care is a fundamental component of universal social protection: no trade in public services

27 References o Smith, R.D., Foreign direct investment and trade in health services: a review of the literature. Social science & medicine (1982), 59(11), pp o Whittaker A (2008). Pleasure and pain: medical travel in Asia. Global Public Health 3(3): o Schrecker, T., Labonté, R., De Vogli, R. Globalisation and Health: the need for a global vision. The Lancet. 2008; 372: o o o Chen, B.Y.Y. & Flood, C.M., Medical Tourism s Impact on Health Care Equity and Access in Low- and Middle-Income Countries: Making the Case for Regulation. journal of law, medicine & ethics, pp Smith R, Martínez Álvarez M, and Chanda R. Medical Tourism: a review of the literature and analysis of a role for bi-lateral trade. Health Policy 2011; 103(2 3): JCrooks VA, Kingsbury P, Snyder J and Johnston R (2010). What is known about the effects of medical tourism in destination and departure countries? A scoping review. International Journal for Equity in Health 9:24 o Chanda, Rupa. Trade in health services. Bulletin of the World Health Organisation. 2002, vol.80, n.2 o Smith, R.D., Chanda, R. & Tangcharoensathien, V., Trade in health-related services. Lancet, 373(9663), pp o Blouin, C., Chopra, M. & van der Hoeven, R., Trade and social determinants of health. The Lancet, 373(9662), pp o Smith, R.D., Lee, K. & Drager, N., Trade and health: an agenda for action. Lancet, 373(9665), pp o TISA Report 2014, Public Services International: o Special Report TISA, 2014, Public Services International: