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Glossary of the World Trade Organisation and public health: part 1

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The relation between health and trade is not new. Disease and pestilence have long followed global trade routes, a pattern that continues into the 21st century. A Chinese trade ship was the source of Latin America’s cholera outbreak in 1991, which resulted in 10 000 deaths.1 Increased trade in tobacco products and processed foods high in sugar or fat contribute to rising chronic disease rates in poorer countries.2,3

Trade can also be good for health, improving peoples’ lives through access to goods or technologies that cure disease or improve wellbeing. Proponents of trade liberalisation argue further that it can increase economic growth and wealth creation, both of which may reduce poverty4 and allow for greater investments in health care, education, environmental protection, and other population health determinants.5 Others maintain that the relation is subtler. Development economist, Ha-Joon Chang6 points out that today’s wealthy countries became so through a variety of policies—infant industry protection, export subsidisation, copying of foreign technologies, and strong state controls over foreign investment—that new trade liberalisation rules increasingly deny poorer countries.

Many of these trade rules came into existence with the creation of the World Trade Organisation (WTO) in 1995. The WTO’s influence extends beyond commercial relations to affect health, social welfare, and culture. This two part glossary introduces the WTO trade treaties (the generic term for specific trade agreements) and explains the key principles and concepts of interest to policy makers and practitioners. It aims to explain the WTO through a public health lens that focuses on disease control and prevention, the reduction of a wide range of health risks, and a commitment to reducing health inequities. The public health implications of these agreements can be direct, as in the restrictions the Agreement on Trade-Related Intellectual Property Rights* (TRIPS) …

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  • * Italicised terms refer to glossary entries or other key terms defined within a particular glossary entry.

  • A general glossary on trade terms, without specific reference to health, can be found on the web site of the World Trade Organisation;

  • The GATT refers to both a trade treaty (revised in 1994) and the institution that served as a forum for multilateral trade negotiations before the creation of the WTO.

  • § Its proper title is: “Understanding on Rules and Procedures Governing the Settlement of Disputes;” but it is most commonly referred to as the Dispute Settlement Understanding or DSU.

  • The GATS, or General Agreement on Trade in Services, is a complex treaty covering liberalisation of trade in services. Detail on GATS is provided in part 2 of this glossary.

  • ** The panel found that the French ban did discriminate against Canadian asbestos, as it was “like” the glass fibres used for French insulation. The Appellate Body, however, considered the huge body of evidence of health risks associated with asbestos sufficient to justify the ban.

  • †† The full legal text of this, and all other WTO agreements, can be found on the WTO web site:

  • ‡‡ “Dumping” refers to exports that enter markets at less than “normal” prices. Another WTO agreement covers this practice, allowing members to impose countervailing measures, such as tariffs, if they believe dumping is occurring. This provision has often been used by wealthier countries to reduce imports of goods from developing countries where labour costs are substantially cheaper. Dispute panels eventually and generally rule in favour of developing countries, but not before substantial damage is done to their export industries.

  • §§ As many commentators pointed out, the 2002 US subsidy programme also ran counter to its commitment made in Doha in November 2001 to “reductions, with a view to phasing out, all forms of [agricultural] export subsidies; and substantial reductions in trade-distorting domestic support” [our emphasis].12

  • ¶¶ The use of international standards can have mixed public health implications. On the one hand, it can limit national sovereignty in setting standards higher than those that might be scientifically defensible at any given time. On the other, it can impose a higher level of safety than that presently found in many developing countries that lack the resources to attain such standards. This restricts their export earning capacity, with its potential poverty reducing effects.

  • *** While the Codex uses technical committees to develop standards, only governments have formal voting power.

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