Trade Policy and Health: From Conflicting Interests to Policy coherence/Politique Commercials et Sante : Passer Des Conflits D'interets a Une Action coherente/Politicas Comerciales Y Salud: De Los Intereses Enfrentados a la Coherencia Normativa
Blouin, Chantal, Bulletin of the World Health Organization
The links between trade agreements and health have been the subject of intense international debate in policy and academic circles in recent years, following the signing of the World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). TRIPS has created a new global regime of patent protection that, when applied to pharmaceutical drugs, can increase drug prices. Therefore, many observers and political actors worry that this trade agreement, together with new bilateral and regional trade agreements that further strengthen patent protection, will reduce access to pharmaceutical drugs in developing countries, especially among the poorest households. The debate about trade and health also reflects worries about the impact of international trade on health systems. For instance, increased liberalization and trade flows in agricultural products may increase risks associated with food safety and the international transmission of disease. The policy implications of making trade commitments in health services are also much debated. (1) Should national governments open up hospital services and health insurance to foreign investors and providers? Should health tourism, that is patients travelling abroad to receive medical care, be promoted as an export industry?
Policy incoherence marks different facets of the interface between trade policy and health. For instance, several bilateral and regional trade agreements encourage the adoption of legislation that does not allow sufficient flexibility in the protection of pharmaceutical patents. (2,3) These trade commitments can greatly restrict the capacity of government to ensure drug affordability. The liberalization of trade in health services also poses risks in terms of access. For example, the active promotion of health tourism can exacerbate the shortage of doctors in rural areas because of internal brain drain. We offer insights and recommendations on how policy-makers can work towards achieving more coherent policies at the intersection between trade and health.
Policy coherence and its political context
Policy coherence can be defined as "a process through which governments make efforts to design policies that take account of the interests of other policy communities, minimize conflicts, maximize synergies and avoid unintended incoherence. A degree of incoherence may sometimes be inevitable, but trade-offs should be transparent and appropriate measures taken to mitigate negative impacts." (4) Why do some national governments fail to adopt trade policies that are coherent with their health objectives? Trade and health policies are influenced by the nature of the political process and therefore, "technical analysis of the economic and health aspects is necessary, but not sufficient". (5) One important theoretical contribution to understanding why some policy options are adopted, and others blocked, comes from political economy, which stresses the distributional consequences of public policies and the dilemmas of collective action. (6-8) This well-established approach highlights how dispersion and concentration of the costs and benefits associated with policies will influence the incentives for collective action. When the benefits of a policy change are large and concentrated among a small group of actors, the group has a strong incentive for acting collectively to support the proposed policy change, and is much more likely to have an influence on the policy-making process. On the other hand, diffuse interests (where minor advantages are expected for a large number of individuals) generally have less influence over the policy process, given difficulties encountered in organizing large groups of individuals.
Social scientists have found this theoretical approach very useful to explain the formulation of trade policy, (9) and have recently expanded this approach to explain other aspects of economic foreign policy, such as policies regarding international finance and exchange rates, and foreign investments. …