SeriesTrade and social determinants of health
Introduction
The effect of trade and trade policy on health has come under increasing attention in recent years, especially aspects related to intellectual property rights and trade in health services. However, the effects of trade and trade liberalisation on social determinants of health—“the conditions in which people live and work that affect their opportunities to lead healthy lives”1—have not received as much attention. Here, we review variables that could be important between trade (liberalisation) and health. Our aim is to ensure that health professionals and policymakers develop a better understanding of how an integrated global economy can affect the health of populations and to show options available to prevent or mitigate negative effects of trade liberalisation.
Section snippets
Conceptual framework
In the past few years, researchers have studied the effects of globalisation on social determinants of health, in the context of the WHO Commission on Social Determinants of Health.1, 2, 3 These published works are useful for our review, since trade liberalisation is an important element of globalisation. In their analysis of the effect of globalisation and health outcomes, Cornia and colleagues identified several pathways to account for how alterations in economic policy can lead to changes in
Income and its distribution
The effect of trade liberalisation on economic growth has been at the centre of lively academic and policy debates in the past 15 years. In widely cited studies published during the 1990s, researchers argued that countries that removed their barriers to international trade—ie, showed great trade openness—saw augmented economic growth and poverty reduction.21, 22, 23, 24 On that basis, openness to trade was suggested to be good for health.25 However, subsequent analysis has led to a
Income inequality
An assumption behind trade liberalisation is that developing countries, which have an abundance of unskilled labourers, would gain from trade in products produced by unskilled labour. Further, the position of unskilled labour in the labour market would be enhanced vis-à-vis other factors of production, leading to a fall in the skills premium and hence reductions in inequality. However, in many cases, the conditions under which these theories are valid do not apply—eg, no full employment,
Economic insecurity
Trade liberalisation is usually accompanied by enhanced openness to foreign capital and liberalisation of financial markets and services. However, the combination of trade and financial liberalisation is often associated with heightened economic insecurity.47, 48, 49, 50, 51, 52, 53 This view is challenged by Bourguignon and colleagues working on East Asia.54 Examples of economic instabilities include financial crises, currency devaluations, and rapid changes in labour markets and employment.55
Diet and nutrition
Trade liberalisation is one variable that can lead to alterations in diet and nutrition. An increase in food prices has been blamed partly on rapid urbanisation and rising wages in some middle-income countries, and these factors are changing demand for particular diets.61 Modifications in food supply have also altered radically the food environment and choices that consumers make.62
Reductions in prices of unhealthy foods—ie, calorie-rich, nutrient-poor, high in saturated fats and salt—compared
Conclusions
Trade policies adopted by national government can affect health outcomes and health systems via a very diverse set of channels and intermediate variables; these causal linkages can be difficult to track and monitor. Moreover, in many political systems, health authorities are not in a position to influence directly trade policy decisions at the national level. Nevertheless, their existing knowledge on the determinants of population health and their jurisdiction over social and health policies
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