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Correspondence to: Patrick Harris, CHETRE, Locked Mail Bag 7103, Liverpool BC, NSW 1871; e-mail; patrick.harris@unsw.edu.au Editorials doi: 10.1111/j.1753-6405.2012.00823.x Strengthening public health engagement in trade policy: PHAA’s policy on Trade Agreements and Health Deborah Gleeson and David Legge School of Public Health and Human Biosciences, La Trobe University, Victoria Trade relations affect the way we live and the determinants of health such as employment patterns, nutrition, economic development and living standards. 1,2 Trade agreements to regulate trade relations can contribute to better health where they lead to increased employment and economic development (assuming benefits are well distributed, decent working conditions are maintained and growth is not achieved at the cost of the environment), but they can also reduce the ability of governments to protect health. 3 Trade agreements can enable transnational corporations to discourage governments from regulating for health (e.g threatening to use indirect expropriation clauses to discourage governments from regulating tobacco packaging) or from regulating for health care (e.g. deploying United States trade power to undermine pharmaceutical pricing and reimbursement schemes). 3 It is important for public health professionals and organisations to engage with trade policy issues. The Public Health Association of Australia (PHAA) policy on Trade Agreements and Health is a significant step towards facilitating such engagement. PHAA Trade Agreements and Health policy The Trade Agreements and Health policy was first developed in the context of negotiations for the Australia US Free Trade Agreement (AUSFTA) in 2004. The US negotiators sought to introduce intellectual property (IP) and pharmaceuticals provisions which would have weakened the Pharmaceutical Benefits Scheme (PBS), and investor-state dispute settlement provisions (ISDS) which would have enabled US corporations to challenge Australian public health policies in international arbitration. 4 PHAA played a strong role in a successful public campaign to preserve the PBS and keep ISDS provisions out of the AUSFTA. 5 The campaign sensitised the public health community to the potential public health consequences of trade agreements. The Trade Agreements and Health policy was developed to strengthen PHAA advocacy in this area. Key points of intersection between public health and trade agreements Many different aspects of trade agreements can affect population health and the provision of healthcare. Intellectual property provisions affect access to medicines; ISDS affects the scope for public health regulation; subsidised agriculture and trade liberalisation affect food security and farmers’ livelihoods; and liberalisation of trade in manufactured goods constrains industrialisation in developing countries and associated possibilities for population health. Intellectual property rights and access to medicines Intellectual property (IP) regulation has been a feature of trade agreements since the TRIPS Agreement (Trade Related Aspects of Intellectual Property Rights) was negotiated in 1994. The South African treatment access campaign from 1997 to 2001 is a famous case illustrating the effect IP regulation can have on access to medicines. In 1997, 39 international pharmaceutical companies brought a case against the South African government saying that its ‘parallel importing’ legislation (designed to improve access to cheaper versions of brand name drugs) ran counter to its TRIPS commitments. At this stage the cost of brand name anti-retrovirals was around US$10,000 per treatment year while generic versions were available for US$350 per year. 6 Over the next four years a powerful civil society campaign arose against the drug companies. In May 2001 the companies accepted defeat, withdrew their action and paid the costs of the South African government. 7 In December 2001 the Ministerial Council of the World Trade Organization (WTO) adopted the Doha Statement on Public Health 8 and agreed to amendments of the TRIPS Agreement for wider access to compulsory licensing. Meanwhile, the stalemate between rich and poor countries over the further development of the WTO treaties led the US and Europe to progress their trade ‘liberalisation’ goals through bilateral and regional trade agreements, many of which have had ‘TRIPS Plus’ provisions included (meaning easier patenting but greater protection of patents). Evidence suggests that TRIPS Plus provisions in the US- Jordan FTA increased medicine prices by twenty percent between