International Journal of Health Policy and Management

International Journal of Health Policy and Management

What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership

Document Type : Original Article

Authors
Belinda Townsend 1
Sharon Friel 1
Ashley Schram 1
Fran Baum 2
Ronald Labonté 3
1 School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
2 Southgate Institute for Health, Society and Equity, Department of Public Health, Flinders University, Adelaide, SA, Australia
3 Institute of Population Health, University of Ottawa, Ottawa, ON, Canada
10.34172/ijhpm.2020.80
Abstract
Background
Despite greater attention to the nexus between trade and investment agreements and their potential impacts on public health, less is known regarding the political and governance conditions that enable or constrain attention to health issues on government trade agendas. Drawing on interviews with key stakeholders in the Australian trade domain, this article provides novel insights from policy actors into the range of factors that can enable or constrain attention to health in trade negotiations.

Methods
A qualitative case study was chosen focused on Australia’s participation in the Trans-Pacific Partnership (TPP) negotiations and the domestic agenda-setting processes that shaped the government’s negotiating mandate. Process tracing via document analysis of media reporting, parliamentary records and government inquiries identified key events during Australia’s participation in the TPP negotiations. Semi-structured interviews were undertaken with 25 key government and non-government policy actors including Federal politicians, public servants, representatives from public interest nongovernment organisations and industry associations, and academic experts.
 
Results
Interviews revealed that domestic concerns for protecting regulatory space for access to generic medicines and tobacco control emerged onto the Australian government’s trade agenda. This contrasted with other health issues like alcohol control and nutrition and food systems that did not appear to receive attention. The analysis suggests sixteen key factors that shaped attention to these different health issues, including the strength of exporter interests; extent of political will of Trade and Health Ministers; framing of health issues; support within the major political parties; exogenous influencing events; public support; the strength of available evidence and the presence of existing domestic legislation and international treaties, among others.
 
Conclusion
These findings aid understanding of the factors that can enable or constrain attention to health issues on government trade agendas, and offer insights for potential pathways to elevate greater attention to health in future. They provide a suite of conditions that appear to shape attention to health outside the biomedical health domain for further research in the commercial determinants of health.

Highlights

Commentaries Published on this Paper

  • Expanding Public Health Policy Analysis for Transformative Change: The Importance of Power and Ideas; Comment on “What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership”

        Abstract | PDF

 

  • COVID-19, Trade, and Health: This Changes Everything?; Comment on “What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership”

        Abstract | PDF

 

  • Reducing the Power of the Alcohol Industry in Trade and Investment Agreement Negotiations Through Improved Global Governance of Alcohol; Comment on “What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership”

          Abstract | PDF

Keywords
Agenda-Setting
Trade Policy
Governance
Non-communicable Disease
Health Policy
  1. World Health Organization (WHO). International Trade and Health: Report by the Secretariat. Geneva: WHO; 2006. https://apps.who.int/gb/archive/pdf_files/WHA59/A59_15-en.pdf.  Accessed October 15, 2019.
  2. Burns DK, Jones AP, Suhrcke M. The relationship between international trade and non-nutritional health outcomes: a systematic review of quantitative studies. Soc Sci Med. 2016;152:9-17. doi:10.1016/j.socscimed.2016.01.021
  3. Barlow P, McKee M, Basu S, Stuckler D. The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis. Global Health. 2017;13(1):13. doi:10.1186/s12992-017-0240-x
  4. Cowling K, Thow AM, Pollack Porter K. Analyzing the impacts of global trade and investment on non-communicable diseases and risk factors: a critical review of methodological approaches used in quantitative analyses. Global Health. 2018;14(1):53. doi:10.1186/s12992-018-0371-8
  5. Labonte R. Globalization, health, and the free trade regime: assessing the links. Perspectives on Global Development and Technology. 2004;3(1):47-72. doi:10.1163/1569150042036710
  6. Thow AM. Trade liberalisation and the nutrition transition: mapping the pathways for public health nutritionists. Public Health Nutr. 2009;12(11):2150-2158. doi:10.1017/s1368980009005680
  7. Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med. 2012;9(6):e1001235. doi:10.1371/journal.pmed.1001235
  8. Friel S, Hattersley L, Townsend R. Trade policy and public health. Annu Rev Public Health. 2015;36:325-344. doi:10.1146/annurev-publhealth-031914-122739
  9. O’Brien P, Mitchell AD. On the bottle: health information, alcohol labelling and the WTO Technical Barriers to Trade Agreement. QUT Law Review. 2018; 18(1): 1-32.
  10. World Health Organization (WHO). Tackling NCDs: 'Best Buys' and other Recommended Interventions for the Prevention and Control of Noncommunicable Diseases. Geneva: WHO; 2017.
  11. Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet. 2013;381(9867):670-679. doi:10.1016/s0140-6736(12)62089-3
  12. Schram A, Ruckert A, VanDuzer JA, et al. A conceptual framework for investigating the impacts of international trade and investment agreements on noncommunicable disease risk factors. Health Policy Plan. 2018;33(1):123-136. doi:10.1093/heapol/czx133
  13. Schram A, Townsend B, Youde J, Friel S. Public health over private wealth: rebalancing public and private interests in international trade and investment agreements. Public Health Res Pract. 2019;29(3). doi:10.17061/phrp2931919
  14. Gleeson D, Lexchin J, Lopert R, Kilic B. The Trans Pacific Partnership Agreement, intellectual property and medicines: differential outcomes for developed and developing countries. Glob Soc Policy. 2018;18(1):7-27. doi:10.1177/1468018117734153
  15. McNeill D, Birkbeck CD, Fukuda-Parr S, Grover A, Schrecker T, Stuckler D. Political origins of health inequities: trade and investment agreements. Lancet. 2017;389(10070):760-762. doi:10.1016/s0140-6736(16)31013-3
  16. Smith R, Blouin C, Mirza Z, Beyer P, Drager N. Trade and Health: Towards Building a National Strategy. Geneva: World Health Organization; 2015.
  17. Jarman H. Trade policy governance: what health policymakers and advocates need to know. Health Policy. 2017;121(11):1105-1112. doi:10.1016/j.healthpol.2017.09.002
  18. 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? Crit Public Health. 2020;30(1):115-126. doi:10.1080/09581596.2018.1509059
  19. Friel S, Ponnamperuma S, Schram A, et al. Shaping the discourse: What has the food industry been lobbying for in the Trans Pacific Partnership trade agreement and what are the implications for dietary health? Crit Public Health. 2016;26(5):518-529. doi:10.1080/09581596.2016.1139689
  20. Neuwelt PM, Gleeson D, Mannering B. Patently obvious: a public health analysis of pharmaceutical industry statements on the Trans-Pacific Partnership international trade agreement. Crit Public Health. 2016;26(2):159-172. doi:10.1080/09581596.2015.1022510
  21. Baker P, Friel S, Gleeson D, Thow AM, Labonte R. Trade and nutrition policy coherence: a framing analysis and Australian case study. Public Health Nutr. 2019;22(12):2329-2337. doi:10.1017/S1368980019000752
  22. 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. doi:10.1016/j.socscimed.2019.112430
  23. Battams S, Townsend B. Power asymmetries, policy incoherence and noncommunicable disease control - a qualitative study of policy actor views. Crit Public Health. 2019;29(5):596-609. doi:10.1080/09581596.2018.1492093
  24. Friel S, Baker P, Thow AM, Gleeson D, Townsend B, Schram A. An exposé of the realpolitik of trade negotiations: implications for population nutrition. Public Health Nutr. 2019;22(16):3083-3091. doi:10.1017/s1368980019001642
  25. Gleeson D, Friel S. Emerging threats to public health from regional trade agreements. Lancet. 2013;381(9876):1507-1509. doi:10.1016/s0140-6736(13)60312-8
  26. Thow AM, Snowdon W, Labonté R, et al. Will the next generation of preferential trade and investment agreements undermine prevention of noncommunicable diseases? a prospective policy analysis of the Trans Pacific Partnership Agreement. Health Policy. 2015;119(1):88-96. doi:10.1016/j.healthpol.2014.08.002
  27. Hirono K, Haigh F, Gleeson D, Harris P, Thow AM. Negotiating Healthy Trade in Australia: Health Impact Assessment of the Proposed Trans-Pacific Partnership Agreement. Liverpool, NSW: Centre for Health Equity Training Research and Evaluation; 2015.
  28. Shiffman J, Smith S. Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet. 2007;370(9595):1370-1379. doi:10.1016/s0140-6736(07)61579-7
  29. George AL, Bennett A. Case Studies and Theory Development in the Social Sciences. Massachusetts: The MIT Press; 2005
  30. Alphapharm. 2011. Submission on TPP. On file with authors. 
  31. Telstra 2012.  Further Submission to the Department of Foreign Affairs and Trade on IP Chapter of the Trans-Pacific Partnership Agreement, on file with authors.
  32. Productivity Commission. Bilateral and Regional Trade Agreements. Canberra: Commonwealth of Australia; 2010.
  33. Trans Pacific Partnership Agreement. Article 29.5. https://ustr.gov/trade-agreements/free-trade-agreements/trans-pacific-partnership/tpp-full-text.   Accessed October 16, 2019.
  34. Lencucha R, Thow AM. How neoliberalism is shaping the supply of unhealthy commodities and what this means for NCD prevention. Int J Health Policy Manag. 2019;8(9):514-520. doi:10.15171/ijhpm.2019.56
  35. International Labor Organization. Guidelines for a just transition towards environmentally sustainable economies and societies for all. https://www.ilo.org/wcmsp5/groups/public/---ed_emp/---emp_ent/documents/publication/wcms_432859.pdf.   Published 2015.
  36. European Commission. Transparency Policy in DG Trade. https://trade.ec.europa.eu/doclib/docs/2018/november/tradoc_157486.pdf.  Accessed October 16, 2019. Published 2018.
  37. Thaiprayoon S, Smith R. Capacity building for global health diplomacy: Thailand's experience of trade and health. Health Policy Plan. 2015;30(9):1118-1128. doi:10.1093/heapol/czu117
  38. Casswell S, Thamarangsi T. Reducing harm from alcohol: call to action. Lancet. 2009;373(9682):2247-2257. doi:10.1016/s0140-6736(09)60745-5
  39. Magnusson RS. Framework legislation for non-communicable diseases: and for the Sustainable Development Goals? BMJ Glob Health. 2017;2(3):e000385. doi:10.1136/bmjgh-2017-000385
International Journal of Health Policy and Management
Volume 10, Issue 10
October 2021
Pages 613-624

  • Received Date 12 February 2020
  • Revised Date 13 May 2020
  • Accepted Date 27 May 2020
  • First Published Date 01 October 2021
  • Published Date 01 October 2021