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


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


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.

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.
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.
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.


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”

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  • 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


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Volume 10, Issue 10
October 2021
Pages 613-624
  • Receive Date: 12 February 2020
  • Revise Date: 13 May 2020
  • Accept Date: 27 May 2020
  • First Publish Date: 01 October 2021