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Paina L, Young R, Oladapo O, Leandro J, Chen Z, Igusa T. Prospective policy analysis-a critical interpretive synthesis review. Health Policy Plan 2024; 39:429-441. [PMID: 38412286 PMCID: PMC11005837 DOI: 10.1093/heapol/czae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
Most policy analysis methods and approaches are applied retrospectively. As a result, there have been calls for more documentation of the political-economy factors central to health care reforms in real-time. We sought to highlight the methods and previous applications of prospective policy analysis (PPA) in the literature to document purposeful use of PPA and reflect on opportunities and drawbacks. We used a critical interpretive synthesis (CIS) approach as our initial scoping revealed that PPA is inconsistently defined in the literature. While we found several examples of PPA, all were researcher-led, most were published recently and few described mechanisms for engagement in the policy process. In addition, methods used were often summarily described and reported on relatively short prospective time horizons. Most of the studies stemmed from high-income countries and, across our sample, did not always clearly outline the rationale for a PPA and how this analysis was conceptualized. That only about one-fifth of the articles explicitly defined PPA underscores the fact that researchers and practitioners conducting PPA should better document their intent and reflect on key elements essential for PPA. Despite a wide recognition that policy processes are dynamic and ideally require multifaceted and longitudinal examination, the PPA approach is not currently frequently documented in the literature. However, the few articles reported in this paper might overestimate gaps in PPA applications. More likely, researchers are embedded in policy processes prospectively but do not necessarily write their articles from that perspective, and analyses led by non-academics might not make their way into the published literature. Future research should feature examples of testing and refining the proposed framework, as well as designing and reporting on PPA. Even when policy-maker engagement might not be feasible, real-time policy monitoring might have value in and of itself.
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Affiliation(s)
- Ligia Paina
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Ruth Young
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Oyinkansola Oladapo
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Jose Leandro
- Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Zhixi Chen
- Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, 3400 N Charles Street, Baltimore, MD 21218, USA
| | - Takeru Igusa
- Department of Civil and Systems Engineering, Johns Hopkins University Whiting School of Engineering, 3400 N Charles Street, Baltimore, MD 21218, USA
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Townsend B, Tenni BF, Goldman S, Gleeson D. Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy. Global Health 2023; 19:60. [PMID: 37612767 PMCID: PMC10463651 DOI: 10.1186/s12992-023-00960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Despite accumulating evidence of the implications of trade policy for public health, trade and health sectors continue to operate largely in silos. Numerous barriers to advancing health have been identified, including the dominance of a neoliberal paradigm, powerful private sector interests, and constraints associated with policymaking processes. Scholars and policy actors have recommended improved governance practices for trade policy, including: greater transparency and accountability; intersectoral collaboration; the use of health impact assessments; South-South networking; and mechanisms for civil society participation. These policy prescriptions have been generated from specific cases, such as the World Trade Organization's Doha Declaration on TRIPS and Public Health or specific instances of trade-related policymaking at the national level. There has not yet been a comprehensive analysis of what enables the elevation of health goals on trade policy agendas. This narrative review seeks to address this gap by collating and analysing known studies across different levels of policymaking and different health issues. RESULTS Sixty-five studies met the inclusion criteria and were included in the review. Health issues that received attention on trade policy agendas included: access to medicines, food nutrition and food security, tobacco control, non-communicable diseases, access to knowledge, and asbestos harm. This has occurred in instances of domestic and regional policymaking, and in bilateral, regional and global trade negotiations, as well as in trade disputes and challenges. We identified four enabling conditions for elevation of health in trade-related policymaking: favourable media attention; leadership by trade and health ministers; public support; and political party support. We identified six strategies successfully used by advocates to influence these conditions: using and translating multiple forms of evidence, acting in coalitions, strategic framing, leveraging exogenous factors, legal strategy, and shifting forums. CONCLUSION The analysis demonstrates that while technical evidence is important, political strategy is necessary for elevating health on trade agendas. The analysis provides lessons that can be explored in the wider commercial determinants of health where economic and health interests often collide.
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Affiliation(s)
- Belinda Townsend
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia.
| | - Brigitte Frances Tenni
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
- Nossal Institute for Global Health, The School of Population and Global Health, The University of Melbourne, Carlton, VIC, 3010, Australia
| | - Sharni Goldman
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
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McNamara CL, Green L, Barlow P, Bellis MA. The CPTPP trade deal is a major threat to public health and warrants a health impact assessment. BMJ 2023; 381:e073302. [PMID: 37045446 DOI: 10.1136/bmj-2022-073302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Affiliation(s)
- Courtney L McNamara
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
- Centre for Global Health Inequalities Research, Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Liz Green
- Policy and International Health, WHO Collaborating Centre on Investment in Health and Wellbeing, Public Health Wales, Wales, UK
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Netherlands
| | - Pepita Barlow
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Mark A Bellis
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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Babyar J. Trade, intellectual property, and the public health bearing. Health Syst (Basingstoke) 2023; 12:123-132. [PMID: 36926369 PMCID: PMC10013560 DOI: 10.1080/20476965.2022.2062460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The objective of this article is to describe the current fracture between global trade and public health priorities, as well as examine opportunities for harmonisation. A literature review of public health, global trade, and intellectual property articles describes several issues with recommendations. Currently, there is mixed quality of research and a lack of health impact assessments to accompany the global trade agenda. Human rights concepts continue in debate as flexibilities to trade laws remain without organised surveillance or evaluation. There are specific, relevant recommendations to implement a trade agenda inclusive of public health leadership. Recent trade and intellctual property advances in public health collaborations should be supported and continued. Trade groups should produce impact assessments before decisions on policies are made, with quality to the research. Lastly, a global research and development treaty should be an open, accessed path.
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Affiliation(s)
- Julie Babyar
- RN, MPH, 136 Reliant Way American Canyon. CA 94503
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5
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Rapid health impact assessment of a Danish policy document: One Denmark without Parallel Societies: No Ghettos in 2030. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01375-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Garton K, Swinburn B, Thow AM. Who influences nutrition policy space using international trade and investment agreements? A global stakeholder analysis. Global Health 2021; 17:118. [PMID: 34600556 PMCID: PMC8487514 DOI: 10.1186/s12992-021-00764-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/09/2021] [Indexed: 01/22/2023] Open
Abstract
Background Regulation of food environments is needed to address the global challenge of poor nutrition, yet policy inertia has been a problem. A common argument against regulation is potential conflict with binding commitments under international trade and investment agreements (TIAs). This study aimed to identify which actors and institutions, in different contexts, influence how TIAs are used to constrain policy space for improving food environments, and to describe their core beliefs, interests, resources and strategies, with the objective of informing strategic global action to preserve nutrition policy space. Methods We conducted a global stakeholder analysis applying the Advocacy Coalition Framework, based on existing academic literature and key informant interviews with international experts in trade and investment law and public health nutrition policy. Results We identified 12 types of actors who influence policy space in the food environment policy subsystem, relevant to TIAs. These actors hold various beliefs regarding the economic policy paradigm, the nature of obesity and dietary diseases as health problems, the role of government, and the role of industry in solving the health problem. We identified two primary competing coalitions: 1) a ‘public health nutrition’ coalition, which is overall supportive of and actively working to enact comprehensive food environment regulation; and 2) an ‘industry and economic growth’ focussed coalition, which places a higher priority on deregulation and is overall not supportive of comprehensive food environment regulation. The industry and economic growth coalition appears to be dominant, based on its relative power, resources and coordination. However, the public health nutrition coalition maintains influence through individual activism, collective lobbying and government pressure (e.g. by civil society), and expert knowledge generation. Conclusions Our analysis suggests that industry and economic growth-focussed coalitions are highly capable of leveraging networks, institutional structures and ideologies to their advantage, and are a formidable source of opposition acting to constrain nutrition policy space globally, including through TIAs. Opportunities for global public health nutrition coalitions to strengthen their influence in the support of nutrition policy space include strategic evidence generation and coalition-building through broader engagement and capacity-building. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00764-7.
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Affiliation(s)
- Kelly Garton
- School of Population Health, The University of Auckland, Auckland, New Zealand.
| | - Boyd Swinburn
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Anne Marie Thow
- Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW, Australia
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Townsend B, Friel S, Freeman T, Schram A, Strazdins L, Labonte R, Mackean T, Baum F. Advancing a health equity agenda across multiple policy domains: a qualitative policy analysis of social, trade and welfare policy. BMJ Open 2020; 10:e040180. [PMID: 33158831 PMCID: PMC7651713 DOI: 10.1136/bmjopen-2020-040180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE While there is urgent need for policymaking that prioritises health equity, successful strategies for advancing such an agenda across multiple policy sectors are not well known. This study aims to address this gap by identifying successful strategies to advance a health equity agenda across multiple policy domains. DESIGN We conducted in-depth qualitative case studies in three important social determinants of health equity in Australia: employment and social policy (Paid Parental Leave); macroeconomics and trade policy (the Trans Pacific Partnership agreement); and welfare reform (the Northern Territory Emergency Response). The analysis triangulated multiple data sources included 71 semistructured interviews, document analysis and drew on political science theories related to interests, ideas and institutions. RESULTS Within and across case studies we observed three key strategies used by policy actors to advance a health equity agenda, with differing levels of success. The first was the use of multiple policy frames to appeal to a wide range of actors beyond health. The second was the formation of broad coalitions beyond the health sector, in particular networking with non-traditional policy allies. The third was the use of strategic forum shopping by policy actors to move the debate into more popular policy forums that were not health focused. CONCLUSIONS This analysis provides nuanced strategies for agenda-setting for health equity and points to the need for multiple persuasive issue frames, coalitions with unusual bedfellows, and shopping around for supportive institutions outside the traditional health domain. Use of these nuanced strategies could generate greater ideational, actor and institutional support for prioritising health equity and thus could lead to improved health outcomes.
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Affiliation(s)
- Belinda Townsend
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Toby Freeman
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Ashley Schram
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lyndall Strazdins
- National Centre for Epidemiology and Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Tamara Mackean
- Aboriginal and Torres Strait Islander Health, Flinders University, Adelaide, South Australia, Australia
| | - Fran Baum
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
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Townsend B, Schram A. Trade and investment agreements as structural drivers for NCDs: the new public health frontier. Aust N Z J Public Health 2020; 44:92-94. [DOI: 10.1111/1753-6405.12982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Belinda Townsend
- Menzies Centre for Health Governance, School of Regulation and Global Governance, College of Asia and the PacificAustralian National University Canberra Australian Capital Territory
| | - Ashley Schram
- Menzies Centre for Health Governance, School of Regulation and Global Governance, College of Asia and the PacificAustralian National University Canberra Australian Capital Territory
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An exposé of the realpolitik of trade negotiations: implications for population nutrition. Public Health Nutr 2019; 22:3083-3091. [PMID: 31439059 DOI: 10.1017/s1368980019001642] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore the formal and informal ways in which different actors involved in shaping trade agreements pursue their interests and understand the interactions with nutrition, in order to improve coherence between trade and nutrition policy goals. DESIGN The paper draws on empirical evidence from Australian key informant interviews that explore the underlying political dimensions of trade agreements that act as barriers or facilitators to getting nutrition objectives on trade agendas. SETTING Countries experiencing greater availability and access to diets full of energy-dense and nutrient-poor foods through increased imports, greater foreign direct investment and increasing constraints on national health policy space as a result of trade agreements. PARTICIPANTS Interviews took place with Australian government officials, industry, public-interest non-government organizations and academics. RESULTS The analysis reveals the formal and informal mechanisms and structures that different policy actors use both inside and outside trade negotiations to pursue their interests. The analysis also identifies the discourses used by the different actors, as they attempt to influence trade agreements in ways that support or undermine nutrition-related goals. CONCLUSIONS Moving forward requires policy makers, researchers and health advocates to use various strategies including: reframing the role of trade agreements to include health outcomes; reforming the process to allow greater access and voice to health arguments and stakeholders; establishing cross-government partners through accountable committees; and building circles of consensus and coalitions of sympathetic public-interest actors.
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10
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Townsend B, Schram A, Labonté R, Baum F, Friel S. How do actors with asymmetrical power assert authority in policy agenda-setting? A study of authority claims by health actors in trade policy. Soc Sci Med 2019; 236:112430. [PMID: 31351362 DOI: 10.1016/j.socscimed.2019.112430] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 11/28/2022]
Abstract
How health advocates and industry actors attempt to assert their authority as a strategy of influence in policymaking remains underexplored in the health governance literature. Greater exploration of the kinds of authority sources used by health actors vis-à-vis market actors and the role ideational factors may play in shaping access to these sources provides insight into advocates' efforts to exert influence in policy forums. Using the trade domain in Australia as a case study of the way in which the commercial determinants of health operate, we examined the different ways in which health, public interest and market actors assert their authority. Drawing on a political science typology of authority, we analysed 87 submissions to the Australian government during the Trans-Pacific Partnership negotiations. We identify four types of authority claims; institutional authority, derived from holding a position of influence within another established institution; legal authority through appeals to legal agreements and precedents; networked authority through cross-referencing between actors, and expert authority through use of evidence. Combining these claims with a framing analysis, we found that these bases of authority were invoked differently by actors who shared the dominant neoliberal ideology in contrast to those actors that shared a public interest discourse. In particular, market actors were much less likely to rely on external sources of authority, while health and public interest actors were more likely to appeal to networked and expert authority. We argue that actors who share strong ideational alignment with the dominant policy discourse appear less reliant on other sources of authority. Implications of this analysis include the need for greater attention to the different strategies and ideas used by industry and public health organisations in trade policy agenda-setting for health, which ultimately enable or constrain the advancement of health on government agendas.
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Affiliation(s)
- Belinda Townsend
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, 0200, Australia.
| | - Ashley Schram
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, 0200, Australia.
| | - Ronald Labonté
- Institute of Population Health, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Department of Public Health, Flinders University, Adelaide, 5042, Australia.
| | - Sharon Friel
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, 0200, Australia.
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Labonté R, Crosbie E, Gleeson D, McNamara C. USMCA (NAFTA 2.0): tightening the constraints on the right to regulate for public health. Global Health 2019; 15:35. [PMID: 31088499 PMCID: PMC6518719 DOI: 10.1186/s12992-019-0476-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
Background In late 2018 the United States, Canada, and Mexico signed a new trade agreement (most commonly referred to by its US-centric acronym, the United States-Mexico-Canada Agreement, or USMCA) to replace the 1994 North American Free Trade Agreement (NAFTA). The new agreement is the first major trade treaty negotiated under the shadow of the Trump Administration’s unilateral imposition of tariffs to pressure other countries to accept provisions more favourable to protectionist US economic interests. Although not yet ratified, the agreement is widely seen as indicative of how the US will engage in future international trade negotiations. Methods Drawing from methods used in earlier health impact assessments of the Trans-Pacific Partnership agreement, we undertook a detailed analysis of USMCA chapters that have direct or indirect implications for health. We began with an initial reading of the entire agreement, followed by multiple line-by-line readings of key chapters. Secondary sources and inter-rater (comparative) analyses by the four authors were used to ensure rigour in our assessments. Results The USMCA expands intellectual property rights and regulatory constraints that will lead to increased drug costs, particularly in Canada and Mexico. It opens up markets in both Canada and Mexico for US food exports without reducing the subsidies the US provides to its own producers, and introduces a number of new regulatory reforms that weaken public health oversight of food safety. It reduces regulatory policy space through new provisions on ‘technical barriers to trade’ and requirements for greater regulatory coherence and harmonization across the three countries. It puts some limitations on contentious investor-state dispute provisions between the US and Mexico, provisions often used to challenge or chill health and environmental measures, and eliminates them completely in disputes between the US and Canada; but it allows for new ‘legacy claims’ for 3 years after the agreement enters into force. Its labour and environmental chapters contain a few improvements but overall do little to ensure either workers’ rights or environmental protection. Conclusion Rather than enhancing public health protection the USMCA places new, extended, and enforceable obligations on public regulators that increase the power (voice) of corporate (investor) interests during the development of new regulations. It is not a health-enhancing template for future trade agreements that governments should emulate.
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Affiliation(s)
- Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Eric Crosbie
- School of Community Health Sciences, Ozmen Institute for Global Studies, University of Nevada Reno, 1664 N. Virginia Street, Reno, NV, 89557-0274, USA
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Courtney McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
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Labonté R. Trade, investment and public health: compiling the evidence, assembling the arguments. Global Health 2019; 15:1. [PMID: 30606214 PMCID: PMC6318870 DOI: 10.1186/s12992-018-0425-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/19/2018] [Indexed: 11/10/2022] Open
Abstract
Trade has long been an axiomatic characteristic of globalization, although international rules governing trade are of more recent vintage. Notably in the post-World War II period, an ever 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 of developed (high-income) countries, developing (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 developing country members (a problematic nomenclature given the vast geographic, economic, and development differences between such countries, but which nonetheless persists within the WTO). Importantly, a slew of new agreements that coincided with the establishment of the WTO also sought to liberalize trade in services (not just goods) (The General Agreement on Trade in Services), create new rules for agricultural trade (Agreement on Agriculture), expand intellectual property rights protections (The Agreement on Trade-Related Aspects of Intellectual Property Rights), limit trade-distorting government subsidies (Agreement on Subsidies and Countervailing Measures), and ensure that government food, health, or environmental regulations would not pose an unnecessary barrier to trade (the Technical Barriers to Trade and the Sanitary and Phytosanitary Measures Agreements). Outside of the WTO system, bilateral or regional investment treaties granting special rights to foreign investors to sue governments for actions perceived to affect the value of their investment (such as direct expropriation or passage of new laws and regulations considered 'tantamount to expropriation') 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.
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Townsend B, Schram A, Baum F, Labonté R, Friel S. How does policy framing enable or constrain inclusion of social determinants of health and health equity on trade policy agendas? CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1509059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Belinda Townsend
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Ashley Schram
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Fran Baum
- Department of Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Ronald Labonté
- Institute of Population Health, University of Ottawa, Ottawa, Canada
| | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
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Buse CG, Lai V, Cornish K, Parkes MW. Towards environmental health equity in health impact assessment: innovations and opportunities. Int J Public Health 2018; 64:15-26. [PMID: 29911285 DOI: 10.1007/s00038-018-1135-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES As global environmental change drives inequitable health outcomes, novel health equity assessment methodologies are increasingly required. We review literatures on equity-focused HIA to clarify how equity is informing HIA practice, and to surface innovations for assessing health equity in relation to a range of exposures across geographic and temporal scales. METHODS A narrative review of the health equity and HIA literatures analysed English articles published between 2003 and 2017 across PubMed, PubMed Central, Biomed Central and Ovid Medline. Title and abstract reviews of 849 search results yielded 89 articles receiving full text review. RESULTS Considerations of equity in HIA increased over the last 5 years, but equity continues to be conflated with health disparities rather than their root causes (i.e. inequities). Lessons from six literatures to inform future HIA practice are described: HIA for healthy cities, climate change vulnerability assessment, cumulative health risk assessment, intersectionality-based policy analysis, corporate health impact assessment and global health impact assessment. CONCLUSIONS Academic reporting on incorporating equity in HIA practice has been limited. Nonetheless, significant methodological advancements are being made to examine the health equity implications of multiple environmental exposures.
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Affiliation(s)
- Chris G Buse
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada.
| | - Valerie Lai
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Katie Cornish
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Margot W Parkes
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
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Delany L, Signal L, Thomson G. International trade and investment law: a new framework for public health and the common good. BMC Public Health 2018; 18:602. [PMID: 29739460 PMCID: PMC5941687 DOI: 10.1186/s12889-018-5486-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International trade and investment agreements can have positive outcomes, but also have negative consequences that affect global health and influence fundamental health determinants: poverty, inequality and the environment. This article proposes principles and strategies for designing future international law to attain health and common good objectives. ARGUMENT Basic principles are needed for international trade and investment agreements that are consistent with the common good, public health, and human rights. These principles should reflect the importance of reducing inequalities, along with social and environmental sustainability. Economic growth should be recognised as a means to common good objectives, rather than an end in itself. Our favoured approach is both radical and comprehensive: we describe what this approach would include and outline the strategies for its implementation, the processes and capacity building necessary for its achievement, and related governance and corporate issues. The comprehensive approach includes significant changes to current models for trade and investment agreements, in particular (i) health, social and environmental objectives would be recognised as legitimate in their own right and implemented accordingly; (ii) changes to dispute-resolution processes, both state-to-state and investor-state; (iii) greater deference to international legal frameworks for health, environmental protection, and human rights; (iv) greater coherence across the international law framework; (v) limitations on investor privileges, and (vi) enforceable corporate responsibilities for contributing to health, environmental, human rights and other common good objectives. We also identify some limited changes that could be considered as an alternative to the proposed comprehensive approach. Future research is needed to develop a range of model treaties, and on the means by which such treaties and reforms might be achieved. Such research would focus also on complementary institutional reforms relevant to the United Nations and other international agencies. Advocacy by a range of communities is needed for effective change. Reform will require informed debate, determined engagement with decision-makers and stakeholders, and some agreement across health, social and environmental sectors on alternatives. CONCLUSIONS Current frameworks of international law that govern trade and economic development need radical change, in relation to treaty processes, content, and contexts, to better attain public health objectives.
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McNamara C. Assessing the Health Impact of Trade: A Call for an Expanded Research Agenda Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?". Int J Health Policy Manag 2017; 6:293-294. [PMID: 28812818 PMCID: PMC5417152 DOI: 10.15171/ijhpm.2016.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 09/10/2016] [Indexed: 11/16/2022] Open
Abstract
Labonté et al provide an insightful analysis of the Trans-Pacific Partnership (TPP) and its impact on a selection of important health determinants. Their work confirms concerns raised by previous analyses of leaked drafts and offers governments serious and timely reasons to carefully consider provisions of the agreement prior to moving forward with ratification. It also contributes more generally to a growing literature focused on identifying the health impacts of trade. This commentary uses the authors' analysis as a starting point to reflect on two interrelated issues relevant both for taking seriously one of the article's main recommendations and future work in the area of trade and health.
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Affiliation(s)
- Courtney McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Trondheim, Norway
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Thow AM, Gleeson D. Advancing Public Health on the Changing Global Trade and Investment Agenda Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?". Int J Health Policy Manag 2017; 6:295-298. [PMID: 28812819 PMCID: PMC5417153 DOI: 10.15171/ijhpm.2016.129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/21/2016] [Indexed: 11/20/2022] Open
Abstract
Concerns regarding the Trans-Pacific Partnership (TPP) have raised awareness about the negative public health impacts of trade and investment agreements. In the past decade, we have learned much about the implications of trade agreements for public health: reduced equity in access to health services; increased flows of unhealthy commodities; limits on access to medicines; and constrained policy space for health. Getting health on the trade agenda continues to prove challenging, despite some progress in moving towards policy coherence. Recent changes in trade and investment agendas highlight an opportunity for public health researchers and practitioners to engage in highly politicized debates about how future economic policy can protect and support equitable public health outcomes. To fulfil this opportunity, public health attention now needs to turn to strengthening policy coherence between trade and health, and identifying how solutions can be implemented. Key strategies include research agendas that address politics and power, and capacity building for both trade and health officials.
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Affiliation(s)
- Anne Marie Thow
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
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Labonté R, Schram A, Ruckert A. The Trans-Pacific Partnership: Is It Everything We Feared for Health? Int J Health Policy Manag 2016; 5:487-496. [PMID: 27694662 DOI: 10.15171/ijhpm.2016.41] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/12/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Negotiations surrounding the Trans-Pacific Partnership (TPP) trade and investment agreement have recently concluded. Although trade and investment agreements, part of a broader shift to global economic integration, have been argued to be vital to improved economic growth, health, and general welfare, these agreements have increasingly come under scrutiny for their direct and indirect health impacts. METHODS We conducted a prospective health impact analysis to identify and assess a selected array of potential health risks of the TPP. We adapted the standard protocol for Health impact assessments (HIAs) (screening, scoping, and appraisal) to our aim of assessing potential health risks of trade and investment policy, and selected a health impact review methodology. This methodology is used to create a summary estimation of the most significant impacts on health of a broad policy or cluster of policies, such as a comprehensive trade and investment agreement. RESULTS Our analysis shows that there are a number of potentially serious health risks associated with the TPP, and details a range of policy implications for the health sector. Of particular focus are the potential implications of changes to intellectual property rights (IPRs), sanitary and phytosanitary measures (SPS), technical barriers to trade (TBT), investor-state dispute settlement (ISDS), and regulatory coherence provisions on a range of issues, including access to medicines and health services, tobacco and alcohol control, diet-related health, and domestic health policy-making. CONCLUSION We provide a list of policy recommendations to mitigate potential health risks associated with the TPP, and suggest that broad public consultations, including on the health risks of trade and investment agreements, should be part of all trade negotiations.
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Affiliation(s)
- Ronald Labonté
- Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ashley Schram
- Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Arne Ruckert
- Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Keating G, Jones R, Monasterio E, Freeman J. The Potential Impact of the Trans-Pacific Partnership Agreement on Health Equity, with Illustration From New Zealand. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:397-400. [PMID: 27349758 DOI: 10.1007/s40258-016-0252-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Gay Keating
- Department of Public Health, Eru Pōmare Māori Health Research Centre, University of Otago Wellington School of Medicine and Health Sciences, Wellington, New Zealand
| | - Rhys Jones
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Erik Monasterio
- Department of Psychological Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.
| | - Josh Freeman
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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