Health equity in economic and trade policies

The Global Commission on the Future of Work calls for fundamental changes in health at work
Osseiran N: World Health Organisation, Geneva, Switzerland, 2019

The ILO Global Commission on the Future of Work called for fundamental changes in the way people work in the wave of globalisation, rapid technological development, demographic transition and climate change, according to its report Work for a Brighter Future published in January 2019. The report examines how to achieve a better future of work for all at a time of un­precedented change and exceptional challenges in the world of work. These changes require placing health higher on the agenda of the world of work. Everybody has the right to health, which is defined by WHO as a state of complete physical and mental wellbeing and not only the absence of disease and infirmity. Working people have the right to health and to health care as close as possible to where they live and work. In 2018, WHO and ILO established a global coalition on occupational safety and health as multi-partner initiative of international and national agencies to create common solutions for the challenges for health and safety at work and to stimulate joint actions by health and labour sectors in countries. WHO welcomed the attention given by the Global Commission on the care economy and healthcare is a major part of it. WHO is also working with ILO and OECD to implement a five-year ‘Working for Health’ global action plan to create new and decent job opportunities in health care, to ensure the necessary workforce for universal health coverage and at the same time for stimulating economic growth.

Courts deliver big wins for environment
Sipho Kings: SangoNet Pulse, 2018

South Africa’s environment law has a strange loophole. In theory, every activity that would harm the environment falls under the National Environmental Management Act (Nema) and the Acts linked to it. This allows the government to uphold everyone’s constitutionally guaranteed right to a healthy environment. Nema is what should give the environment department teeth. But mining is exempt because of a 2014 takeover by the mineral resources department of most environmental oversight for mining. Now, far-reaching court decisions are pulling apart the way in which the mining department discharges its job of looking after the environment, and questioning how positive a development this has been. In a stinging rebuke last week, the high court ruled in defence of a wetland in Mpumalanga. This has created a precedent that rights groups say they will use to challenge other cases when mines threaten the environment. This decision follows a judgment earlier this month by the Constitutional Court in a case between residents of villages that fall under the Bakgatla Ba Kgafela tribal administration, near Rustenberg in the North West, and a would-be mining company. Read together, the environmental and land rights judgments are argued by the author to be a serious blow to the carte blanche attitude of the minerals department and its mandate to expand mining. Mining companies will now have to consult all residents. The minerals department will also have to do more than tick boxes based on information given by mines when it comes to looking after the environment.

Trade, investment and public health: compiling the evidence, assembling the arguments
Labonté B: Globalisation and Health 15(1), doi:, 2019

Trade has long been an axiomatic characteristic of globalization, although international rules governing trade are of more recent vintage. In the post-World War II period, an increasing number of countries began negotiating treaties to reduce, first, tariff barriers and, later, non-tariff barriers (government measures of any sort) that could impede the cross-border flow of goods. The rationale, in part, was that countries that became more entwined economically would be less likely to go to war with each other. It wouldn’t be in their own economic interests to do so, or at least that of the firms based within their borders but engaged in transnational trade and dependent upon global supply chains. At first primarily an undertaking in high-income countries, low and middle-income countries slowly enjoined in what, in 1995, became the World Trade Organization. The WTO locked in scheduled declines in tariffs (border taxes), albeit with lesser obligations on low income country members. Importantly, a slew of new agreements that coincided with the establishment of the WTO also sought to liberalize trade in services and not just goods in the General Agreement on Trade in Services, with new rules for agricultural trade, expanded intellectual property rights protections and other agreements ensuring that government food, health, or environmental regulations would not pose an unnecessary barrier to trade. Outside of the WTO system, bilateral or regional investment treaties grant special rights to foreign investors to sue governments for actions perceived to affect the value of their investment similarly exploded in number, dispute frequency, and the size of monetary claims. The breadth and depth of these post-1995 Agreements meant that few areas of general public health concern are potentially untouched. Given mounting evidence that trade and investment liberalization was creating and globally diffusing new health risks, public health researchers began focusing on the specific measures in trade and investment treaties that created such risks, primarily but not exclusively through constraining the ‘policy space’ for new public health regulations. Globalization processes affect health through multiple pathways and not simply through those more directly linked via changes in health systems. This issue explores the methods and issues that this poses for research on globalisation and health.

Transforming the workplace environment to prevent non-communicable chronic diseases: participatory action research in a South African power plant
Schouw D, Mash R, Kolbe-Alexander T: Global Health Action, 11:1, DOI: 10.1080/16549716.2018.1544336, 2018

The workplace is an important setting for the prevention of non-communicable diseases (NCDs). Policies for transformation of the workplace environment for occupational health and safety in South Africa have focused more on what to do and less on how to do it. There are no guidelines and little evidence on workplace-based interventions for NCDs. This study aimed to learn how to transform the workplace environment in order to prevent and control cardio-metabolic risk factors for NCDs amongst the workforce at a commercial power plant in Cape Town, South Africa. The study used participatory action research in the format of a cooperative inquiry group (CIG). The researcher and participants engaged in a cyclical process of planning, action, observation and reflection over a two-year period. The group used outcome mapping to define the vision, mission, boundary partners, outcomes and strategies required. At the end of the inquiry the CIG reached a consensus on their key learning. Substantial change was observed in the boundary partners: catering services (78% of progress markers achieved), sport and physical activities (75%), health and wellness services (66%) and managerial support (65%). Highlights from a 10-point consensus on key learning included the need for: authentic leadership; diverse composition and functioning of the CIG; value of outcome mapping; importance of managerial engagement in personal and organizational change; and making healthy lifestyle an easy choice. Transformation included a multifaceted approach and an engagement with the organization as a living system.

Calling for a New Global Economic Order
PHM, Wemos: Astana, November 2018

In 1978, the Alma-Ata International Conference on Primary Health Care stated, in its final declaration, that “economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all.” In Astana at the Cafe Session this video shares why this call is still relevant today and why it should be recalled and renewed now the world celebrates the 40th Anniversary of the Alma-Ata Declaration at the Global Conference on Primary Health Care in Astana, on 25-26 October. The film reminds that Primary Health Care is more than basic health care and some sort of financial protection but rather a radical comprehensive concept based on economic justice. The video calls for a new economic global order as was called for in 1978.

Seeds of Resistance, Harvests of Hope: Farmers halt a land grab in Mozambique
Wise T: Food Tank, 2018

On July 26, 2018, farmers in Xai-Xai, Mozambique, achieved a milestone. They met to formalize their new farmers’ association, elect leaders, and prepare a petition to the local government for land. The association, christened Tsakane, which means “happy” in the local Changana language, was the culmination of six years of resistance to a Chinese land grab that had sparked protest and outrage. The association now has a request pending for its own land. The difference between a large-scale agricultural development project and a land grab is consultation and consent, and this one had neither. Some 7,000 farmers had moved onto the irrigated lands along the Lower Limpopo River in the 1980s after a state farm ceased operations. Farmers reported that they were encouraged to do so by the local government. Mozambique’s Land Law is one of the most progressive in Africa, recognizing the land rights of peasant farmers whether or not they can show formal title, as long as they have been farming the land for 10 years or more. That applies not only to community or village land, it applies to estate land for which the government holds the formal land title. Instead of giving all the best land and infrastructure—particularly irrigation—to foreign investors who then displace local farmers, they ask why not give the land to those farmers? Help them organize into marketing cooperatives, water use associations, and credit unions. With the formal recognition of the Tsakane Farmers’ Association, the Xai-Xai farmers are planning to do just that. They hope to get collective land title to 750 acres of good land for their 300 members.

Calling for a New Global Economic Order
Peoples Health Movement; Medicus Mundi International; G2H2: Astana 2018

In 1978, the Alma-Ata International Conference on Primary Health Care stated, in its final declaration, that “economic and social development, based on a New International Economic Order, is of basic importance to the fullest attainment of health for all.” This video raises why this call is still relevant today and why it should be recalled and renewed now we celebrate the 40th Anniversary of the Alma-Ata Declaration at the Global Conference on Primary Health Care in Astana, on 25-26 October 2018.

The causes of the growth of 'populism'
Navarro V: Other News, October 2018

In this article (original in Spanish) the author analyses current movements termed 'populist'. He notes that they have some points in common. One of them is their clear opposition to globalization and economic integration and to the cultural and political homogenization that they entail and that is perceived as a threat to their national identity. A desire to recover identity and national control conditions is a nationalist sentiment based primarily (though not exclusively) on globalization being identified with a decline in the quality of life and well-being of the social classes behind this populism, even while this was due to the enormous increase in the wealth and welfare of wealthy minorities at the expense of the great decline in welfare and standard of living of the majority of the population The author asserts that socialist movements that have an opposition and alternative to a neoliberal conservative establishment differs from most populisms, which have an anti-establishment dimension but lack a proactive dimension . At the same time he argues that the failure of socialist or social democratic parties to develop an effective response to neoliberalism has been one of the main causes of the growth of right wing populist movements. The author argues for responses that recognise that the different sectors of the population have elements and conditions in common, that also provides more radical proposals for how to address these conditions.

Chronic respiratory disease among the elderly in South Africa: any association with proximity to mine dumps?
Nkosi V; Wichmann J; Voyi K: Environmental Health 14(33), doi:, 2015

This study investigated the association between proximity to mine dumps and prevalence of chronic respiratory disease in people aged 55 years and older. Elderly persons in communities 1-2 km (exposed) and 5 km (unexposed), from five pre-selected mine dumps in Gauteng and North West Province, in South Africa were included in a cross-sectional study. Structured interviews were conducted with 2397 elderly people, using a previously validated questionnaire from the British Medical Research Council. Exposed elderly persons had a significantly higher prevalence of chronic respiratory symptoms and diseases than those who were unexposed., Results from the multiple logistic regression analysis indicated that living close to mine dumps was significantly associated with asthma, chronic bronchitis, chronic cough, emphysema, pneumonia and wheeze. Residing in exposed communities, current smoking, ex-smoking, use of paraffin as main residential cooking/heating fuel and low level of education emerged as independent significant risk factors for chronic respiratory symptoms and diseases. This study suggests that there is a high level of chronic respiratory symptoms and diseases among elderly people in communities located near to mine dumps in South Africa.

Why India’s IP policy needs a South African tweak
Syed S: The Hindu BusinessLine, July 2018

South Africa recently adopted a new Intellectual Property Policy, which seeks to align IP with the country’s national development plan. What works for the new SA policy is that it addresses the interface between IP and public health. In facilitating local production and export of pharmaceuticals in line with its industrial policy, the new policy recommends the following changes: introduction of substantive patent search and examination, introduction of patent opposition, strengthening of patentability criteria, incorporation of disclosure requirements, parallel importation, exceptions, provisions to regulate voluntary licensing, compulsory licences, use of IP and competition law. All these provisions use flexibilities provided in the TRIPS (Trade related aspects of IP Rights) Agreement to safeguard development objectives. The South African policy mentions that it must engender the ethos of the South African Constitution and also reflect the country’s broader social economic development objectives. In contrast, India’s IP policy fails to take notice of obligations under Fundamental Rights and Directive Principles of the right to health in its Constitution while promoting IP rights. Instead it focuses on enhancing the protection and enforcement of IP rights, which goes beyond its international obligations (referred as ‘TRIPS-plus’) without taking into consideration their negative implications. Despite being at the forefront of international fora in defending the TRIPS flexibilities, the author observes that India ignores their use for itself at the domestic level, and recommends following the South African approach.