Trade agreements have potentially very damaging impacts on health. They multiply precarious jobs, weaken working conditions and open up the health sector more widely to the market. Here is the analysis of the working group of Be-cause Health and the Health and Solidarity Platform for Action on “Determinants of International Health”.

Since the failure of the “Doha Round” (2004), which was to remove barriers to world trade in a variety of sectors and reduce agricultural subsidies, international trade negotiations have been taking place according to an understanding that is no longer the one desired by the World Trade Organization (WTO). Political and geographical entities such as the United States or the European Union enter free trade agreements (FTAs) between themselves or, individually, with a single country or groups of countries. These so-called “bilateral” or regional agreements, which complement rather than replace the multilateral commitments made since the WTO’s creation (1995) concern a diversity of sectors that go far beyond products alone; they also include services, investments, intellectual property rights, public procurement, etc.

Trade unions and civil society groups are strongly denouncing the proliferation of such bilateral and regional trade agreements. These promote corporate interests, to the detriment of state social and environmental policies, and rewrite the rules governing the global economy. They also venture beyond the “simple” lifting of tariff barriers on imports and exports, significantly influencing the rules of production of goods and social protection standards. Supporters of FTAs claim that they contribute to economic growth and job creation, and thereby to the well-being of all. But these claims are largely belied by the facts.

The weakened or powerless state
The first reason for saying this is that FTAs systematically drive down government revenue through the abolition or reduction of tariffs. As a result, poor and / or fragile countries are no longer able to invest in social policies, and particularly health policies. Similarly, health care coverage by the state (where it exists) is weakened, reducing the population’s access to affordable health care and medicines.

The second reason is that FTA clauses very often open up health care to competition, which leads to phenomena such as the privatization of hospital infrastructure, the rise of private insurance, the exodus of health care workers to wealthy countries, “medical tourism”, etc.

A third reason would be that a determinant of health as fundamental as lifestyle is deeply disturbed by the opening of markets. Thus, between 1985 and 2000, when the average tariffs of Central America dropped from 45% to 6%, the doors of several countries concerned quickly opened to the importing of a processed food that was much poorer nutritionally and caused various pathologies such as diabetes, cardiovascular diseases, hypertension, obesity … These are now spreading at a rapid pace in southern countries.

Fourthly, FTAs contribute significantly to environmental pollution, affecting the health of all.

Last but not least, and despite a less obvious cause-and-effect relationship, it is through its impact on employment and working conditions that liberalized trade weighs heavily on health. The globalization of trade contributes to the multiplication of informal jobs, precarious contracts and arduous working conditions. The effects on health are obvious.

Let’s take the example of banana plantation workers in Ecuador, the world’s largest banana exporting country. The majority of them have a precarious or temporary contract, without social security. They work in harmful and dangerous conditions: 14-hour days leading to physical exhaustion, excessive use of pesticides causing intoxication and various health problems, lack of appropriate protective clothing leading to occupational accidents, etc. All this for a salary that often does not even cover the basic needs of the family. Those who organize themselves into unions are intimidated and criminalized.
In 2016, Ecuador ratified the EU’s free trade agreement with Colombia and Peru. Exports to Europe will intensify further, certainly at the expense of workers’ health.

Cosmetic Improvements
Certainly, over the past twenty years, various labour provisions inspired by the International Labour Organization (ILO) have been incorporated into free trade agreements. The EU agreement with Ecuador, for example, includes a chapter on trade and sustainable development. This type of arrangement has had some positive effects here and there, such as more efficient inspections. But in most cases, these improvements are simply cosmetic or theoretical, either because they are done without the involvement of stakeholders (primarily the social partners), or because they lack control ensuring their sustainability and their generalization. No control over standards? No sanction possible!

In the end, if the growth of employment induced by free trade agreements essentially results in strengthening situations of precarious or informal employment, the health of workers will not win out. Liberalization of health care should never be included in such agreements or in any form of trade agreement. These are only desirable if they are accompanied by truly binding social and environmental clauses, supported by a strong system of social protection and monitored by civil society and trade union forces. Only decent work for all is likely to ensure the health of workers and their families.

This article summarizes a chapter written by the “Determinants of International Health” working group of Be-cause Health and the Global Health Watch Health and Solidarity Platform for Action.