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Trade and public health: facing the challenges of globalisation
  1. Richard D Smith
  1. Correspondence to:
 Dr R D Smith
 Health Economics Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK; Richard.Smith{at}

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It is vital that public health professionals engage with issues concerning trade organisations and treaties.

The world is getting smaller. Increased globalisation, resulting from advances in travel and telecommunications, has facilitated an ever greater mixing of people, customs and cultures, and more rapid cross border flows of goods and services, people and capital, and ideas and information. For some this heralds increasing standards of living—including health—for all. For others it brings greater exploitation of poor countries, adverse impacts on health, and the destruction of indigenous cultures.1

But why should this concern those working in public health? Because it challenges much of the foundation of modern public health provision, health promotion activities, and public health protection.2 It does this in two main ways. Firstly, trade affects the profile of risk factors for disease. For example, increased trade may lead to increased exposure to infectious disease, through the rapid cross border transmission of communicable diseases (the case of SARS and current concerns over avian flu being topical examples). Similarly, trade may increase the risk of chronic disease, through the marketing of unhealthy products and behaviours (such as tobacco and “fast food”) and increased environmental degradation. Many of these public health issues have historically been dealt with at a national or local level, but they are increasingly beyond the direct control of national public health infrastructure. This presents challenges in maintaining national public health sovereignty and security, and has been the drive behind recent developments in considering alternative means to secure the global finance, provision, and organisation of public health, such as that embodied by “global public goods”.3,4

The second main way in which trade will impact on public health is through the direct finance, provision, and distribution of health related goods, services, and people (patients and professionals). For …

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