The Trans-Pacific Partnership Agreement and health: few gains, some losses, many risks.
In early October 2015, 12 nations signed the Trans-Pacific Partnership Agreement (TPPA), promoted as a model '21(st) century' trade and investment agreement that other countries would eventually join. There are growing concerns amongst the public health community about the potential health implications of such WTO+ trade and investment agreements, but little existing knowledge on their potential health impacts.



We conducted a health impact review which allows for a summary estimation of the most significant health impacts of a set of policies, in our case the TPPA. Our analysis shows that there are a number of potentially serious health risks, with the following key pathways linking trade to health: access to medicines, reduced regulatory space, investor-state dispute settlement (ISDS), and environmental protection and labor rights. We also note that economic gains that could translate into health benefits will likely be inequitably distributed.



Our analysis demonstrates the need for the public health community to be knowledgeable about trade issues and more engaged in trade negotiations. In the context of the COP21 climate change Agreement, and the UN Sustainable Development Goals, this may be an opportune time for TPPA countries to reject it as drafted, and rethink what should be the purpose of such agreements in light of (still) escalating global wealth inequalities and fragile environmental resources-the two most foundational elements to global health equity.
Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, K1G 3Z7, ON, Canada.
Ronald
R
Labonté
Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, K1G 3Z7, ON, Canada.
Ashley
A
Schram
Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 850 Peter Morand Crescent, Ottawa, K1G 3Z7, ON, Canada. aruckert@uottawa.ca.
Arne
A
Ruckert
D003132:Commerce / Q000379:methods / Q000592:standards*; D006291:Health Policy / Q000639:trends; D006801:Humans; D038622:Internationality / Q000331:legislation & jurisprudence*; D017008:Negotiating / Q000379:methods*; D011634:Public Health / Q000639:trends; D012926:Social Control, Formal / Q000379:methods
Health policy; Population health; Social determinants of health; Trade and investment policy