The Economic Partnership Agreements (EPAs) between the European Union (EU) and regions of African, Caribbean and Pacific states (ACP) are designed to encourage regional integration and improve trade capacity building and other aid interventions into the developing partner regions. The agreements cover not only trade in goods but also in services and other trade-related areas including intellectual property rights, which affect the production and availability of cheaper generic medicines for developing countries. The objective of this paper is to analyse why the trade and cooperation discussions with the EU have not made further progress towards the objective of African regional integration. This paper first presents an overview of the EPAs negotiations and outlines the main debates about EPAs. It then looks into regional integration in sub-Saharan Africa. It goes on to describe the precise integration objective associated with EPAs and how results have generally been disappointing in meeting the objective of furthering regional integration. The conclusion proposes recommendations on how to boost the negotiation process.
Health equity in economic and trade policies
Bowing to huge international pressure, major pharmaceutical companies have made significant efforts to make their patented antiretroviral drugs available in Africa while ensuring that they – not generic manufacturers – maintain market control in the continent. Globally, the ARV market accounts for less than 3% of pharmaceutical sales worldwide and Africa’s portion of this has been negligible. However, with the World Health Organisation’s campaign to get three million people on ARV treatment by the end of this year (the 3-by-5 campaign), there has been a scramble to ensure improved supplies.
Many developing countries have entered into bilateral investment treaties (BITs) to protect foreign direct investment (FDI), which entail substantial restrictions on the sovereignty of recipient countries. At the end of 2011, 2,833 BITs had been signed worldwide. The granting of legal protection to foreign investors under BITs and other agreements (such as chapters in free trade agreements negotiated with developed countries) has often been seen as necessary to attract FDI. However, the author of this article argues that it is doubtful whether they have actually been effective in generating investment flows and promoting development gains. Moreover, many low or middle income countries that have signed BITs have been sentenced by international arbitral tribunals to pay millions of dollars as a result of alleged violations to these treaties. The authors caution that awards by tribunals have been based on overbroad definitions in the agreements and ambiguous legal standards such as “fair and equitable treatment” that have led to negative court outcomes for policies adopted in the public interest. The author presents a case study of Uruguay, where the government is being sued by a major tobacco manufacturer for issuing stricter packaging and labelling requirements for cigarettes to reduce tobacco consumption.
Health has gained importance on the global agenda. It has become recognized in forums where it was once not addressed. In this article three issues are considered: global health policy actors, global health priorities and the means of addressing the identified health priorities. The arenas for global health policy-making have shifted from the public spheres towards arenas that include the transnational for-profit sector. Global health policy has become increasingly fragmented and verticalized. Infectious diseases have gained ground as global health priorities, while non-communicable diseases and the broader issues of health systems development have been neglected. Approaches to tackling the health problems are increasingly influenced by trade and industrial interests with the emphasis on technological solutions.
In this open letter to Margaret Chan, Director-General of the World Health Organization (WHO), Health Action International (HAI) urges WHO to dissociate itself from the work of IMPACT, a global intellectual property (IP) enforcement body that seeks to impose an IP agenda to deal with broader problems of medical products with compromised quality, safety and efficacy. It further demands that WHO no longer involve itself in IP enforcement with regard to pharmaceuticals and other medical products. It argues that, not only is the IP enforcement agenda ineffective in terms of addressing the wider public health threats from spurious and sub-standard medical products, but it has also been shown to impede access to medicines by undermining competition from generic medicines. WHO should continue to prioritise public health issues over issues of trade, which HAI points out has always been WHO's proper mandate.
Since the 1980s, neoliberal policies have prescribed reducing the role of governments, relying on market forces to organize and provide health care and other vital human services. In this context, international trade agreements increasingly serve as mechanisms to enforce the privatization, deregulation, and decentralization of health care and other services, with important implications for democracy as well as for health. Critics contend that social austerity and "free" trade agreements contribute to the rise in global poverty and economic inequality and instability, and therefore to increased preventable illness and death.
The G20, a group of wealthy, industrialised nations, met for their fifth summit on 11–12 November 2010, in Seoul, Korea. On par with previous summits, the leaders’ primary focus was on economic and financial issues. While the leaders did not discuss health in a major way, it was specifically referenced in their final summit documents. Most notably, non-communicable diseases and the importance of health issues were highlighted in both the Seoul Development Consensus and the Multi-Year Action Plan for Shared Growth. The related issue of development was a prominent theme, culminating in the Seoul Development Consensus for Shared Growth. Other health-related issues, including climate change, food security, and poverty reduction, were also discussed. At the Seoul Summit, while still very limited, the G20 referenced health – directly and indirectly – more than it had at any previous meeting. According to this article, health is likely to continually increase in importance on the G20 agenda. If so, the G20 could have a major impact on global health.
At the United Nations’ meeting on non-communicable diseases (NCDs) in September 2011, heads of state were told that cancers, heart disease and mental health issues were critical to the future of the global economy: NCDs are forecast to cost $47 trillion, or 4% of global gross domestic product (GDP), over the next 20 years. This, the author of this article points out, was the only figure put forward to contextualise NCDs, as the meeting failed to produce any concrete targets, funds and action plan. Although the UN General Assembly called on the World Health Organisation (WHO) to develop a global monitoring framework over the next twelve months, the framework will contain only voluntary targets and there is little in the declaration that is specific on international co-operation or coordination. Most action is for sovereign interpretation and subject to domestic interests. Health system development, the regulation of industry and key interventions across sectors such as education, environment, agriculture, and transport remain areas for intervention at the national level only. While trade issues concerning access to medicines, food regulation and tobacco control are affected by global policy, governments remained divided in their interpretation of such policies. On the one hand, health ministries now recognise the human and economic cost of overt protection of industries but on the other hand, commerce officials continue to promote consumption of goods domestically and internationally with simplistic assumptions about individual and social impacts.
With regard to The Lancet’s series of articles on the inter-relations between the two policy spheres of trade and health, the author of this paper expresses his disappointment with the hazy direction and lack of leadership of the global governance in addressing inadequate access to essential medicines for the poorest population as a result of market exclusivity and patent protection, rendering statements and declarations made by heads of states and leaders of international organisations as rhetoric. The paper draws this conclusion from lessons learned from the experience of compulsory licensing in Thailand and the management of disptutes between Thailand and patent-holding companies and their parent-country governments.
According to the World Health Organisation, the right mix of climate change mitigation policies for the housing sector could lead to very large health co-benefits, including reductions in noncommunicable and infectious diseases. Non-communicable diseases can be reduced through mitigation measures that: reduce exposure to extreme heat and cold; reduce mould and dampness; improve natural ventilation and provide for safer, more energy-efficient home heating and appliances. There is also evidence that housing improvements increase well-being and mental health. Infectious diseasescan be prevented through low-energy and climate-friendly designs to: improve natural ventilation; limit vector and pest infestations (e.g. sealing of cracks, window screening); and improve access to safe drinking water and sanitation as part of planning and siting. Good ventilation is critical to ensure health gains from energy-efficient and weather-tight housing, as insufficient natural ventilation is associated with higher risk of airborne disease transmission, dampness and accumulation of indoor pollutants that are risk factors for allergies and asthma. Energy-efficient biomass and gas cookstoves can help avert a large proportion of chronic obstructive pulmonary disease in poor countries by reducing exposure to indoor cookstove smoke.