GHF2010 – PS30 – Foreign Policy, Trade and Health: Finding The Right Balance

Session Outline

Parallel session PS30, Monday, April 19 2010, 16:00-17:30, Room 13
Chair(s): Nick Drager, Senior Fellow, Global Health Programme, Graduate Institute for International and Development Studies, Switzerland
Discussant: John Hancock, Counsellor, Economic Research Division, World Trade Organization, Switzerland
Summary: There is a growing realization that public health may be affected by trade and the rules set out in international trade agreements. Trade can affect health both positively and negatively. In particular, the increasing liberalization of trade in health services creates new opportunities while posing new challenges for the efficient, equitable and sustainable provision of health services. Many countries have undertaken extensive analysis of these issues, and have gained experience in implementing policies to steer developments in the desired direction. Meanwhile, other countries still struggle to find an entry point for dealing with these often complex and unfamiliar issues that require both knowledge and analytical capacities to understand them. In 2006, the World Health Assembly adopted a resolution on international trade and health, which calls on Member States to ensure that health and trade are balanced. It also highlights the need for capacity building to increase understanding of the health implications of trade and trade agreements. To support national governments in their effort to develop coherent policies on trade and health, WHO, in collaboration with WTO, and country partners are developing a toolkit to assess implications of trade and trade agreements for health. This tool is expected to be available by the end of 2010. Drawing on the experiences of two countries, this session brings together experts actively involved in the development of the toolkit. It presents the new instrument and how it will eventually inform policies and strategies in trade and health, helping countries to identify their capacity building needs in this area.
Shifting Territory: Trade Agreements and the Making of Health Policy in Barbados
Jamila Headley, Department of Public Health, University of Oxford, United Kingdom
Cart before the Horse: A Sri Lankan Experience of Negotiating Trade in Health Services
Manuj Weerasinghe, Senior Lecturer, Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
Introduction to the WHO Trade and Health Assessment Tool Kit
Chantal Blouin, Associate Director, Centre for Trade Policy and Law, Carleton University/University of Ottawa, Canada

Session Document

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Session Report

Photo by John Brownlee, ICVolunteers.org

Dr Nick Drager, chair of the Foreign Policy, Trade and Health session led an impromptu seminar on Global Health Diplomacy and Development, as none of the other speakers or presenters could attend the session. The focus of his presentation was on health diplomacy and the health care system. He discussed the changing policy environment, the development of new instruments, national foreign policy and health, and national global health strategies.

Dr. Drager's discussion on the changing policy environment covered the huge economic impact of infectious disease outbreaks; he cited the high economic cost of SARS versus the relatively small medical cost. In the past, the World Health Organization (WHO) had to rely on countries reporting any outbreak of a communicable disease before it could act; now, WHO has the Strategic Health Operations Centre (SHOC). Every morning, the SHOC meets to trawl through rumours, seeking the truth behind statements received from a number of sources from around the world. SHOC's task includes the verification of disease outbreaks.

A London-based school has been tasked with identifying key emerging issues in health care systems, as well as the top five non-health sector priorities that will affect health. Its work identified the key emerging issues as 1) the sharing of viruses and biological specimens for the development of vaccines; 2) diagnostics and medications; 3) anti-biotic resistance; 4) intellectual property, innovation, access to medicines; and 5) trade in health services. Dr. Drager stated that "developing countries are tired of giving up their specimens and having medicines created that they cannot afford". The school also identified the non-health sector issues as water, food, energy, climate change and population growth, factors that the speaker emphasised as key policy challenges for governments.

Dr. Drager then jumped into a discussion on the collaboration between the WHO and World Trade Organization (WTO). When delegations make official visits abroad, they are accompanied by delegates from the WHO and WTO. Initially this promotes greater access to key officials, but in fact complies with the rising crossover between health and trade. To illustrate his point, Dr. Drager presented a case study on Vietnam and its accession to the WTO. He pointed out that Vietnam had had to resolve specific health issues, such as infectious disease control, by complying with WTO trade accords.

The discussion continued about the risks and opportunities associated with trade in health services. The speaker sees trade as a key determinant of health, and the WTO Trade Related Aspects of Intellectual Property Rights Agreement (TRIPS) could exceed the importance of, for example, universal access to drugs. He noted that significant risks are associated with trade in health services, but they could be outweighed if the key questions were satisfied: lower costs, increased quality of care and increased access to care.

Regime design within the global health domain is another important factor for an equitable system. As evidence, Dr. Drager cited Indonesia’s reluctance to hand over specimens of the H5N1 virus. Indonesia, with the support of others, had rightly questioned the pressure to hand over their biological specimens. They knew that no benefit for their country would be derived from doing so, and argued that by putting the risk to global public health first they would be endangering their own population. Since the H5N1 epidemic, three years of negotiation were necessary to establish a more equitable and binding system of instruments. Although the negotiations are ongoing, talks have been stalled on three issues: intellectual property; whether benefits should be mandatory or voluntary; and trade policy.

In his description of the current range of WHO instruments, Dr. Drager questioned how future instruments and governance procedures should look. Drawing an analogy with the World Trade Organization (WTO) complaint procedure, he noted that governance procedures might have to include an enforcement system. He also pointed out the need to understand the interaction between instruments, to research the effectiveness of binding and non-binding instruments, and to develop a set of measurable criteria to evaluate their effectiveness. Negotiations, he added, were the key to developing instruments to stimulate national action and international cooperation.

The last topic addressed was the increasingly collaborative nature of foreign policy and the need to develop a global health policy. Today, global health touches on all the core functions of foreign policy, and some countries are preparing their diplomats to work in the field of global health strategy. A comprehensive United Nations General Assembly resolution has put ‘Global Health Foreign Policy’ on the international agenda.

Several countries are developing their global health strategies, and Dr. Drager presented the benefits at the national level. To identify priority areas for action, he said, would be the first step in the development of a strategy. The process will inevitably be a long one.

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