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”

Document Type : Commentary


Department of Health Policy, London School of Economics and Political Science, London, UK


Townsend and colleagues highlighted the myriad political forces which fostered attention to health issues during negotiations to establish a new trans-pacific trade deal in Australia (the CP-TPP [Comprehensive and Progressive Agreement for Trans-Pacific Partnership], formerly known as TPP). Among the factors they identify, exporter interests and exogenous events helped to generate attention to trade-related concerns about tobacco and access medicines, and limited attention to nutrition and alcohol. These are important considerations as the United Kingdom negotiates a trade deal with the United States in haste, whilst at the same time attempting to manage the ongoing coronavirus disease 2019 (COVID-19) pandemic. In this commentary, I reflect on changing attention to trade and nutrition during the COVID-19 pandemic in light of Townsend and colleagues’ analysis. I explore scope for greater attention to nutrition in US-UK trade negotiations, and the challenges created by the vested interests of major UK and US processed food exporters. I further discuss the utility of the theoretical tools employed by Townsend and colleagues for wider debates in the political economy of health.


Main Subjects

  1. Peabody JW. Economic reform and health sector policy: lessons from structural adjustment programs. Soc Sci Med. 1996;43(5):823-835. doi:10.1016/0277-9536(96)00127-x
  2. Brenner MH. Political economy and health. Soc Health. 1995;1:211-246.
  3. Labonté R, Schrecker T. Globalization and social determinants of health: Introduction and methodological background (part 1 of 3). Global Health. 2007;3:5. doi:10.1186/1744-8603-3-5
  4. Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health effects of financial crisis: omens of a Greek tragedy. Lancet. 2011;378(9801):1457-1458. doi:10.1016/s0140-6736(11)61556-0
  5. Barlow P. Does trade liberalization reduce child mortality in low- and middle-income countries? a synthetic control analysis of 36 policy experiments, 1963-2005. Soc Sci Med. 2018;205:107-115. doi:10.1016/j.socscimed.2018.04.001
  6. Barlow P, Loopstra R, Tarasuk V, Reeves A. Liberal trade policy and food insecurity across the income distribution: an observational analysis in 132 countries, 2014–17. Lancet Glob Health. 2020;8(8):e1090-e1097. doi:10.1016/S2214-109X(20)30263-1
  7. Mendez Lopez A, Loopstra R, McKee M, Stuckler D. Is trade liberalisation a vector for the spread of sugar-sweetened beverages? a cross-national longitudinal analysis of 44 low- and middle-income countries. Soc Sci Med. 2017;172:21-27. doi:10.1016/j.socscimed.2016.11.001
  8. Schram A, Labonte R, Baker P, Friel S, Reeves A, Stuckler D. The role of trade and investment liberalization in the sugar-sweetened carbonated beverages market: a natural experiment contrasting Vietnam and the Philippines. Global Health. 2015;11:41. doi:10.1186/s12992-015-0127-7
  9. Barlow P, McKee M, Basu S, Stuckler D. Impact of the North American Free Trade Agreement on high-fructose corn syrup supply in Canada: a natural experiment using synthetic control methods. CMAJ. 2017;189(26):E881-E887. doi:10.1503/cmaj.161152
  10. Barlow P, McKee M, Stuckler D. The impact of US free trade agreements on calorie availability and obesity: a natural experiment in Canada. Am J Prev Med. 2018;54(5):637-643. doi:10.1016/j.amepre.2018.02.010
  11. Schooling CM, Lam TH, Thomas GN, Cowling BJ, Janus ED, Leung GM. Does childhood environment contribute to sex differences in cardiovascular risk? Hong Kong as a natural experiment. Early Hum Dev. 2006;82(8):523.
  12. Cowling K, Stuart EA, Neff RA, Vernick J, Magraw D, Pollack Porter K. The relationship between joining a US free trade agreement and processed food sales, 2002-2016: a comparative interrupted time-series analysis. Public Health Nutr. 2020;23(9):1609-1617. doi:10.1017/s1368980019003999
  13. Baker P, Friel S. Transnational Food and Beverage Corporations, Food Systems Transformations and the Nutrition Transition in Asia. RegNet Research Paper No. 2015/61.  Published 2015.
  14. Thow AM, Hawkes C. The implications of trade liberalization for diet and health: a case study from Central America. Global Health. 2009;5:5. doi:10.1186/1744-8603-5-5
  15. Friel S, Hattersley L, Snowdon W, et al. Monitoring the impacts of trade agreements on food environments. Obes Rev. 2013;14 Suppl 1:120-134. doi:10.1111/obr.12081
  16. Gleeson D, Lexchin J, Labonté R, et al. Analyzing the impact of trade and investment agreements on pharmaceutical policy: provisions, pathways and potential impacts. Global Health. 2019;15(Suppl 1):78. doi:10.1186/s12992-019-0518-2
  17. Thow AM, Jones A, Hawkes C, Ali I, Labonté R. Nutrition labelling is a trade policy issue: lessons from an analysis of specific trade concerns at the World Trade Organization. Health Promot Int. 2018;33(4):561-571. doi:10.1093/heapro/daw109
  18. Schram A, Aisbett E, Townsend B, Labonté R, Baum F, Friel S. Toxic trade: the impact of preferential trade agreements on alcohol imports from Australia in partner countries. Addiction. 2020;115(7):1277-1284. doi:10.1111/add.14925
  19. Townsend B, Friel S, Schram A, Baum F, Labonté R. 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. Int J Health Policy Manag. 2020; In Press. doi:10.34172/ijhpm.2020.80
  20. 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
  21. van Schalkwyk MCI, Jarman H, Hervey T, Wouters OJ, Barlow P, McKee M. Risks to health and the NHS in the post-Brexit era. BMJ. 2020;369:m2307. doi:10.1136/bmj.m2307
  22. UK Government. New Obesity Strategy Unveiled as Country Urged to Lose Weight to Beat Coronavirus (COVID-19) and Protect the NHS.  Accessed August 14, 2020. Published 2020.
  23. Barlow P, Labonte R, McKee M, Stuckler D. Trade challenges at the World Trade Organization to national noncommunicable disease prevention policies: a thematic document analysis of trade and health policy space. PLoS Med. 2018;15(6):e1002590. doi:10.1371/journal.pmed.1002590
  24. Ahmed A, Richtel M, Jacobs A. In Nafta Talks, U.S. Tries to Limit Junk Food Warning Labels. The New York Times. 2018. Published March 20, 2018.
  25. 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
  26. Klein N. The Shock Doctrine: The Rise of Disaster Capitalism. Penguin; 2007.
  27. WTO. Committee on Technical Barriers to Trade - Minutes of the meeting of 13-14 May 2020 (G/TBT/WM/81).  Accessed August 14, 2020. Published 2020.
  28. Forster T, Kentikelenis AE, Stubbs TH, King LP. Globalization and health equity: the impact of structural adjustment programs on developing countries. Soc Sci Med. 2019:112496. doi:10.1016/j.socscimed.2019.112496
  29. Reeves A, Clair A, McKee M, Stuckler D. Reductions in the United Kingdom's government housing benefit and symptoms of depression in low-income households. Am J Epidemiol. 2016;184(6):421-429. doi:10.1093/aje/kww055
  30. Watkins J, Wulaningsih W, Da Zhou C, et al. Effects of health and social care spending constraints on mortality in England: a time trend analysis. BMJ Open. 2017;7(11):e017722. doi:10.1136/bmjopen-2017-017722
  31. Basu S, Carney MA, Kenworthy NJ. Ten years after the financial crisis: the long reach of austerity and its global impacts on health. Soc Sci Med. 2017;187:203-207. doi:10.1016/j.socscimed.2017.06.026
  32. McCartney G, Hearty W, Arnot J, Popham F, Cumbers A, McMaster R. Impact of political economy on population health: a systematic review of reviews. Am J Public Health. 2019;109(6):e1-e12. doi:10.2105/ajph.2019.305001
Volume 11, Issue 4
April 2022
Pages 525-528
  • Receive Date: 14 August 2020
  • Revise Date: 23 October 2020
  • Accept Date: 24 October 2020
  • First Publish Date: 16 November 2020