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Global Health Watch 5: Health threatened by trade agreements

D 19 October 2018    


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Health threatened by trade agreements

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Trade agreements can have harmful effects on health. They create more precarious jobs, undermine working conditions and open up healthcare more widely to the market. This is the analysis of the Working Group « International Determinants of Health » of Be-cause Health and the Platform for Action on Health and Solidarity.

Since the failure of the "Doha Round" (2004), designed to remove barriers to world trade in a number of sectors and to reduce agricultural subsidies, negotiations on international trade have followed a different logic from that considered by the World Trade Organisation (WTO). Political and geographical entities such as the US or the EU conclude Free Trade Agreements (FTAs) with each other or, separately, with individual countries or groups of countries. These so-called "bilateral" or regional agreements, which complement rather than replace multilateral obligations since the creation of the WTO (1995), cover a number of sectors that go far beyond products alone: services, investment, intellectual property rights, public procurement, etc.

Trade unions and civil society organisations strongly oppose the emergence of such bilateral and regional trade agreements. They promote business interests at the expense of the social and environmental policies of the states and rewrite the rules of the world economy. They also sometimes go beyond the "mere" removal of tariff barriers to imports and exports and have a significant impact on regulations on the production of goods and social protection. The proponents of the FTA generally claim that they contribute to economic growth and job creation, thereby improving the welfare of all. This is largely rebutted by the facts, for various reasons.

The state is weakened or made powerless

The first reason is that free trade agreements systematically result in lower government revenues through the abolition or reduction of customs duties. The result: poor and/or vulnerable countries are no longer able to invest in social or health policies. The coverage of health care by the state (if any) is also weakened, limiting access to health care and affordable medicines. The second reason is that the clauses of free trade agreements very often open up health care to competition, leading to phenomena such as the privatisation of hospitals, the growing power of private insurance, an exodus of health workers to rich countries, "medical tourism", etc. Thirdly, the way of life, a fundamental determinant of health, is seriously disrupted by the opening up of markets. Thus, between 1985 and 2000, when the average customs tariffs in Central America fell from 45% to 6%, the doors of several countries were quickly opened to the import of other foodstuffs that were less nutritious and were at the root of various pathologies: diabetes, cardiovascular diseases, hypertension, obesity, etc. These are now spreading at a rapid pace in countries in the global south. Fourthly, free trade agreements contribute enormously to environmental pollution and thus have a negative impact on everyone’s health.

Although the causal link is less visible, the impact of liberalized trade on employment and working conditions weighs heavily on health. The globalization of trade contributes to the increase in informal jobs, precarious contracts and poor working conditions. The effects on health are obvious.
Take the example of banana plantation workers in Ecuador, the world’s largest exporter of bananas. Most of them work under precarious or temporary contracts, without social security. They work under unhealthy and dangerous conditions: 14-hour working days lead to physical exhaustion, excessive use of pesticides leads to poisoning and various health problems, the lack of the right to protective clothing results in accidents at work, etc. All of this for a working day of 14 hours. All this for a salary that often does not even meet the basic needs of the family. Workers who organize themselves into trade unions are intimidated and criminalised.

In 2016 Ecuador signed a free trade agreement with the EU, Colombia and Peru. Exports to Europe will be even more intensive, which will certainly be at the expense of workers’ health.

Cosmetic adjustments

Indeed, over the last twenty years, several labour-related provisions inspired by the International Labour Organisation (ILO) have been incorporated into free trade agreements. For example, the EU-Ecuador Convention contains a chapter on trade and sustainable development. Such provisions have had some positive effects, such as more efficient inspections. But in most cases they are merely cosmetic or theoretical adjustments, because they have been drafted without the involvement of stakeholders (primarily the social partners) or because there are no control mechanisms for consolidation and generalization. No control of standards? No sanction possible!

If the growth in employment resulting from free trade agreements results in the maintenance of precarious or informal employment situations, this will not benefit the health of workers. The liberalization of health care must never be included in such agreements or in any form of trade agreement. The latter are only desirable if they are accompanied by genuinely binding social and environmental clauses supported by a strong social protection system and controlled by civil society and trade unions. Only decent work for all can safeguard the health of workers and their families.


This article is a summary of a chapter written by the working group "Determinants of International Health" of Be-cause Health and the Belgian Platform for Action on Health and Solidarity (website in Nl & Fr) in the "Global Health Watch 5 (GHW5)".

GHW5 is the alternative report on international health of the People’s Health Movement.

Read the full chapter


Let’s come together at the 4th People’s Health Assembly !

The fourth People’s Health Assembly (PHA) taking place 15-19 November 2018 in Dhaka, Bangladesh organized by the People’s Health Movement, ally of the European Network against the commercialization and privatization of Health and Social Protection.

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PHA is held approximately every five years, which draws in civil society organizations and networks, social movements, academia and other stakeholders from around the globe. The PHA provides a unique space for sharing experiences, mutual learning and joint strategizing for future actions. The first PHA was held in Savar, Bangladesh in December 2000 and was attended by more than 1453 people from 75 countries; the People’s Charter for Health was developed and endorsed at PHA1. The second Assembly was held in Cuenca, Ecuador in July 2005 and attended by 1492 people from 92 countries. The third Assembly was held in Cape Town (South Africa) 6-11 2012 and attended by about 1000 people from over 90 countries.

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