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

T he 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 TradeRelated Intellectual Property Rights* (TRIPS) can place on access to essential medicines. They can also be indirect in two important ways: (1) the degree to which WTO agreements skew economic benefits and the health advantages these bring in favour of already wealthier/ healthier nations and population groups; and (2) WTO expansion into trade related areas that have little to do with reducing borderbarriers to imported goods, and that could restrict national governments’ abilities to regulate in the interests of public health. Part 1 of this glossary introduces the WTO and its origins as an institution, and summarises the WTO rules on trade in goods that are most relevant to public health. Part 2 considers rules specific to trade in services, intellectual property, investment, and government procurement.
THE WORLD TRADE ORGANISATION Creation of the WTO in 1995 capped a set of negotiations known as the Uruguay Round after the country in which meetings began. The Uruguay Round, which began in 1986, extended trade treaties beyond goods to include services, intellectual property rights, and investment measures. All but two of these treaties (on government procurement and on trade in civil aircraft) are multilateral trade agreements to which all nations must accede as a condition of WTO membership. Under the WTO, trade rules—the obligations laid out within trade agreements that are binding on member countries—also became enforceable. The WTO’s predecessor, the General Agreement on Tariffs and Trade (GATT), founded in 1947, relied on commercial diplomacy to settle differences between members. The WTO established a legal dispute settlement process that is ultimately enforceable by allowing aggrieved members to take retaliatory trade actions against the offending member country. This process makes the WTO one of the key institutions of global economic governance. Functioning as a forum for multilateral trade negotiations, the WTO has an influence far beyond what might be suggested by the size of its Secretariat, which is small relative to other multilateral institutions. Its membership has grown to 148 nations, and all but a very few of the remaining nations of the world are engaged in efforts to accede to the WTO. Ongoing negotiations at the WTO aim to extend further the reach of its trade rules, through creation of new agreements and by extending the coverage of existing ones. The preamble of the Marrakech Agreement, the WTO’s founding document, states that trad