Health equity in economic and trade policies

Trade challenges at the World Trade Organization to national noncommunicable disease prevention policies: A thematic document analysis of trade and health policy space
Barlow P; Labonte R; McKee M; et al.: PLOS Medicine, doi:, 2018

It has long been contested that trade rules and agreements are used to dispute regulations aimed at preventing noncommunicable diseases (NCDs). Yet most analyses of trade rules and agreements focus on trade disputes, potentially overlooking how a challenge to a regulation’s consistency with trade rules may lead to ‘policy or regulatory chill’ effects, whereby countries delay, alter, or repeal regulations in order to avoid the costs of a dispute. Systematic empirical analysis of this pathway to impact was previously prevented by a dearth of systematically coded data. In this paper, the authors report analysis of a newly created dataset of trade challenges about food, beverage, and tobacco regulations among 122 World Trade Organization (WTO) members from January 1, 1995 to December 31, 2016. The scope and frequency of trade challenges are thematically described, and economic asymmetries between countries are analysed, raising and defending them, and summarised through four cases of their possible influence. Between 1995 and 2016, 93 food, beverage, and tobacco regulations were challenged at the WTO. ‘Unnecessary’ trade costs were the focus of 16.4% of the challenges. Only one (1.1%) challenge remained unresolved and escalated to a trade dispute. Thirty-nine (41.9%) challenges focussed on labelling regulations, and 18 (19.4%) focussed on quality standards and restrictions on certain products like processed meats and cigarette flavourings. High-income countries raised 77.4% of all challenges raised against low- and lower-middle–income countries. The authors further identified four cases in Indonesia, Chile, Colombia, and Saudi Arabia in which challenges were associated with changes to food and beverage regulations. Data limitations precluded a comprehensive evaluation of policy impact and challenge validity. The authors observe that policy makers appear to face significant pressure to design food, beverage, and tobacco regulations that other countries will deem consistent with trade rules. They note that trade-related influence on public health policy is likely to be understated by analyses limited to formal trade disputes.

Chronic respiratory disease among the elderly in South Africa: any association with proximity to mine dumps?
Nkosi V: The Conversation, May 2018

There is increasing evidence that environmental factors such as air pollution from mine dumps increase the risk of chronic respiratory symptoms and diseases. 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 ATS-DLD-78 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. The 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 and that new long term effective dust control measures should be researched and implemented. One possible intervention could be to put buffer zones in place between mining dumps and where people come to settle as a start to what needs to be concerted government efforts to address the problem.

A Bitter Harvest Child Labour and Human Rights Abuses on Tobacco Farms in Zimbabwe
Wurth M; Buchanan J: Human Rights Watch, 2018

Tobacco farming is a pillar of Zimbabwe’s economy. Tobacco is the country’s most valuable export commodity—generating US$933.7 million in 2016—and the crop is particularly significant to Zimbabwean authorities’ efforts to revive the economy. However, Human Rights Watch research in 2016 and 2017 into conditions on tobacco farms in Zimbabwe revealed an industry tainted by child labour and confronted by other serious human rights problems as well. This report—based on extensive field research and interviews with 64 small-scale tobacco farmers, as well as 61 hired workers on tobacco farms in the largest tobacco-growing provinces in Zimbabwe—found several human rights problems in the tobacco sector. Children under 18 were found to work in hazardous conditions on tobacco farms in Zimbabwe, some performing tasks that threaten their health and safety or interfere with their education. Adults involved in tobacco production—both small-scale farmers and hired workers— were reported to face serious health and safety risks, with insufficient information, training, and equipment to protect themselves. Hired workers on some large-scale tobacco farms said they were pushed to work excessive hours without overtime compensation, denied their wages, and forced to go weeks or months without pay. The authors call on companies and government to prohibit children from any work involving contact with tobacco, as a policy that is both protective and straightforward for companies to communicate, implement, and monitor throughout the supply chain.

The burden of tobacco smoking on public health
Specioza A: Centre for Health, Human Rights and Development, 2018

The tobacco industry has for a long time affected innocent lives world over through several ways including; advertising and encouraging direct smoking of cigarettes, secondhand smoke exposure, smoking of other combustible tobacco products , smokeless tobacco and electronic nicotine delivery systems (ENDS) among others. The WHO report on Global Tobacco Epidemic 2008, confirms that the global tobacco epidemic is one of the greatest public health threats of modern times as smoking causes so many deleterious health effects. Some of these health effects include; diminished health status, susceptibility to acute illnesses and respiratory symptoms, death, coronary heart disease, cancers of any organ of the body, chronic obstructive pulmonary disease or COPD, pre-mature births, among others. Uganda has taken a great leap in tobacco control interventions through ratification of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and consequently the enactment of the Tobacco Control Act of 2016.

Africa is not poor, we are stealing its wealth
Dearden N: Al Jazeera, May 2017

"Africa is rich, but we steal its wealth". That's the essence of a report from several campaign groups released in May 2017. Based on a set of new figures, it finds that sub-Saharan Africa is a net creditor to the rest of the world to the tune of more than $41bn. It reports that there is money going in to sub-Saharan Africa the tune of around $161bn a year in the form of loans, remittances from those working outside Africa and sending money back home, and from development aid. There's also $203bn leaving the continent. Some of this is direct, such as $68bn from taxes foregone, such as when multinational corporations legally organise flows to indicate that they are generating their wealth in tax havens. These flows are asserted by the author to amount to around 6% percent of the continent's entire gross domestic product and three times what Africa receives in aid. The report estimates that $29bn a year is being lost from Africa through illegal logging, fishing and trade in wildlife. Given these and other sources of loss the author asserts that if African countries are to benefit from foreign investment, they must be allowed to - even helped to - legally regulate that investment and the corporations that often bring it.

Flexibilities provided by the Agreement on Trade-Related Aspects of Intellectual Property Rights
Correa C: Bulletin of the World Health Organisation 96(3) 148, 2018

To minimize the problems caused by the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), academics, governments of low-income countries, many nongovernmental organizations, the World Health Organization (WHO) and other United Nations organizations pay special attention to the Agreement’s so-called flexibilities. The extent to which such flexibilities have already been incorporated into national laws and practice shows substantial variation. Several compulsory licenses – allowing a company to produce a patented product or process without the consent of the patent owner – have been issued for medicines, mainly to treat infections with human immunodeficiency virus. Most of these licenses have led to substantial reductions in the costs of treatment. The use of such licenses is not limited to low- and middle-income countries. Another important flexibility is provided by the definition of the standards of patentability, and the rigour with which they are applied in determining whether a claimed invention is patentable. Weaknesses or gaps in such standards can allow ever-greening by the pharmaceutical industry. Research has shown that the TRIPS flexibilities are poorly exploited and that much more could be done to align intellectual property protection with public health policies. To support the more extensive exploitation of the flexibilities provided by the Agreement on TRIPS, the author argues that a continuous effort from academics, governments, international and nongovernmental organizations is needed, observing that the health of a large part of the world’s population depends on timely and effective action.

IMF conditionality: still undermining healthcare?
Brunswijck G; Griffiths J: Global Health Check, April 2018

An IMF blog in March 2017 claimed that: “A number of studies have found that IMF support for countries’ reforms, on average, either preserve or increase public health spending.” However, the evidence provided was weak. Of the six studies referenced, one, by Oxford and Cambridge university researchers flatly contradicts this claim. Two were not related to health expenditure: one looked at revenue, not expenditure, and the second had a broader remit and contained no new evidence on the IMF and health. One was over a decade old and did not directly support the claim; while another was a link to an IMF page on the Ebola crisis. In fact the only referenced study that supported the claim was written by the staff who authored the blog. The IMF’s concern not to be seen to be impacting negatively on health expenditure in the poorest countries can be viewed as an improvement. However, the authors suggest that it is clear that IMF conditionality can constrain expenditure on health and other related services, at odds with the SDG commitment to achieve universal health coverage. The next scheduled review of IMF funding to low-income countries is planned for 2018. The authors argue that it is time for a much broader reform of IMF conditionality. Citing Eurodad’s detailed study, in 2014, that found that IMF conditions are often highly controversial and intrusive on key economic policy issues, they suggest that these policies should be the crux of democratic debate in country, not mandated from Washington.

African leaders sign continental free-trade agreement
Al Jazeera News: 21 March 2018

African leaders have signed an agreement to set up a massive free-trade area to improve regional integration and boost economic growth across the continent. The deal to create the African Continental Free Trade Area (AfCFTA) was signed at an extraordinary summit in Kigali, Rwanda by representatives of 44 of the 55 African Union (AU) member states. The agreement commits countries to removing tariffs on 90 percent of goods, with 10 percent of "sensitive items" to be phased in later. It will also liberalise trade in services and might in the future include free movement of people and a single currency. AfCFTA will now have to be ratified by individual countries. Nigeria pulled out of the signing ceremony. The Nigeria Labour Congress (NLC) had warned government against signing the agreement, calling it a "renewed, extremely dangerous and radioactive neo-liberal policy initiative". A further protocol, the Protocol on Free Movement of People has to date been signed by 27 countries.

Listeriosis: One of many food horrors of South Africa’s profit-driven, corporate-controlled food system
COPAC, SAFC: South Africa, March 2018

The South African Food Sovereignty Campaign (SAFSC) and Co-operative and Policy Alternative Centre issued as press statement calling the outbreak of listeriosis in South Africa as a food horror of a profit-driven corporate food system, with limited state regulation. They blame the current corporate controlled food system for compromised health standards in South Africa, which has led to food horrors of not only listeriosis, but also obesity, hunger, malnutrition, child stunting and diabetes. The private sector with profit as its main motive, claims that it has solutions to end food crises, but these organisations say that it is perpetuating the very crises that the poor and vulnerable face on a daily basis, and that the listeriosis outbreak, as well as ongoing hunger, hiking obesity and diabetes rates and contamination of soils with pesticides, tell a story of the failure of the corporate food system to ensure adequate nutrition for all citizens, and the destruction of natural environments. The South African Food Sovereignty Campaign (SAFSC) calls for greater state regulation based on the People’s Food Sovereignty Act. This Act calls for the democratic planning of the food system, increased state regulation on destructive practices of the corporate controlled food system, prioritising local food supply over trade, a ban on advertising of all junk food, and greater reliance on small-scale food producers to feed citizens culturally appropriate and nutritious food.

The institutional context of tobacco production in Zambia
Labonté R; Lencucha R; Drope J: Globalisation and Health 14(5) doi:, 2018

Tobacco production is said to be an important contributor to Zambia’s economy in terms of labour and revenue generation. In light of Zambia’s obligations under the WHO Framework Convention of Tobacco Control (FCTC) the authors examined the institutional actors in Zambia’s tobacco sector to better understand their roles and determine the institutional context that supports tobacco production in Zambia. Findings from 26 qualitative, semi-structured individual or small-group interviews with key informants from governmental, intergovernmental and non-governmental organisations were analysed, along with data and information from published literature. Although Zambia is obligated under the FCTC to take steps to reduce tobacco production, the country’s weak economy and strong tobacco interests make it difficult to achieve this goal. Respondents uniformly acknowledged that growing the country’s economy and ensuring employment for its citizens are the government’s top priorities. Lacklustre coordination and collaboration between the institutional actors, both within and outside government, contributes to an environment that helps sustain tobacco production in the country. A Tobacco Products Control Bill has been under review for a number of years, but with no supply measures included, and with no indication of when or whether it will be passed. As with other low-income countries involved in tobacco production, there is inconsistency between Zambia’s economic policy to strengthen the country’s economy and its FCTC commitment to regulate and control tobacco production. The absence of a whole-of-government approach towards tobacco control has created an institutional context of duelling objectives, with some government ministries working at cross-purposes and tobacco interests left unchecked. With no ultimate coordinating authority, this industry risks being run according to the desire and demands of multinational tobacco companies, with few, if any, checks against them.