Petition to Exclude Tobacco from TPP Negotiations

The following petition was forwarded to the IH leadership by section member Mary Anne Mercer, liaison to APHA’s Trade and Health Forum.

U.S. Trade Proposal Caves to Big Tobacco

U.S. Medical, Public Health, Public Interest Groups Urge Protection for Health & Wealth

Please sign here to protect tobacco controls from attacks by tobacco multinationals and their corporate allies.

The U.S. Trade Representative intends to introduce a proposal on tobacco at negotiations to create the Trans Pacific Partnership (TPP), a trade agreement among 12 nations, at meetings in Brunei this week. The proposal capitulates to multinational tobacco corporations, jeopardizing the nation’s health and economic welfare.

Tobacco companies have recently accelerated their use of trade rules to attempt to delay and reverse tobacco control measures that limit marketing  in the U.S., Australia, Uruguay, Norway, and Ireland. Trade rules grant corporations rights to contest nations’ public health and other policies. Countries that lose trade challenges face stiff financial penalties, payable to the complaining corporation.

Public health and medical advocates in the U.S. and abroad have urged the USTR to exclude tobacco control protections from trade challenges under the TPP.  The USTR informally floated a policy in 2012 that could create a “safe harbor” for some tobacco control regulations. Many legal and medical experts noted that tobacco companies could easily exploit the remaining substantial loopholes.

But the tobacco industry marshaled opposition claiming that the U.S. proposal might actually reduce tobacco use, tobacco-related deaths, and tobacco sales.  Other corporations backed up Big Tobacco, expressing concern that addressing the uniquely lethal effects of tobacco in trade agreements could set a precedent for reining in their own practices. On Aug. 15, USTR announced it would not advance that proposal.

The new proposal offers less than a fig leaf for trade rules that grant corporations rights over public health protections, and often eliminate them.  It proposes simply to refer to the TPP the general health exception described in two multilateral agreements under the jurisdiction of the World Trade Organization (WTO): Article XX of the General Agreement on Tariffs and Trade (GATT), and Article XIV of the General Agreement on Trade in Services (GATS), and inserts a statement into the exception that repeats the self-evident observation that tobacco measures are health measures.These exceptions offer significant loopholes that favor companies asserting trade charges.[1] The exceptions do not apply to investment claims that tobacco companies could bring under the TPP.  Even in trade disputes, the exceptions apply with great uncertainty in very limited situations.  They require multi-year, multi-million-dollar litigation to mount a defense – a burden that many countries cannot afford.  The tobacco industry exploits the cost and uncertainty of using the exceptions. (As a regional agreement, the TPP claims some latitude in varying from WTO rules.)

It also tacks on an additional layer of consultation among Health Ministers in the case of tobacco-related trade challenges between nations, added to the procedures and rules already provided.  In effect, it conscripts health officials to consult in the context of trade rules they had no role in shaping, over trade challenges they did not initiate and have no power to adjudicate.

Tobacco use costs the U.S. far more in lives and health care expenses than tobacco farming or manufacturing contribute to the economy.

  • Tobacco use kills 1,200 Americans daily. Cigarette smoking is responsible for an estimated $193 billion in annual health-related economic losses in the U.S. (nearly $96 billion in direct medical costs and an additional $97 billion in lost productivity).[2]
  • In contrast, total tobacco exports generate 0.10 percent (one tenth of one percent) of total U.S. annual exports (.07% unmanufactured, and .03% manufactured).[3] Tobacco manufacturing has declined exponentially in the U.S., and tobacco farming is also in decline, due in part to U.S. programs intended to facilitate the transition to more sustainable crops.[4]
  • Exports of cigarettes and other U.S.-manufactured tobacco products dropped from $3.9 billion in 1999 to $488 million in 2011, as large U.S. manufacturers sold off their international businesses or formed subsidiaries located abroad.[5] Ninety-eight percent of exported U.S. cigarettes go to 5 countries, only one of which is a TPP partner (Japan). Lower tariffs would lower the price of tobacco products, resulting in cheaper prices and increased consumption and use, especially among younger people. For this reason, international health policy and U.S. law prohibit the U.S. from using trade agreements to promote the sale or export of tobacco products. Yet the U.S. proposes to eliminate tariffs on tobacco products. Other TPP partners can reasonably object to encouraging the import of U.S. brand cigarettes.

Tobacco is the only legal consumer product that kills when used as intended. Tobacco use is the leading preventable cause of death worldwide, accounting for 6 million preventable deaths annually,[6] and is a major contributor to the global pandemic of non-communicable diseases, including childhood morbidity and mortality. As a unique product, it must be treated differently from other products and services that are traded across borders.

We urge TPP Partner countries to advance proposals that promote public health and stem preventable deaths from diseases related to tobacco, by guaranteeing nations’ sovereign domestic rights and abilities to adopt or maintain measures to reduce tobacco use and to prevent tobacco-related deaths and diseases:

  1. Exclude tobacco control measures from existing and future trade agreements.
  2. Do not request or agree to lower tariffs on tobacco leaf or products.
  3. Remove investor-state dispute settlement (ISDS) provisions; these grant tobacco corporations rights to contest nations’ public health and other policies directly for financial damages through the global trade arena.
  4. Set trade policy through a transparent public process.

President Obama’s 2013 State of the Union message promised to lead an economy for the 21st Century, to reduce preventable deaths among youth, and to conduct policy transparently. Trade negotiations that expand corporate rights and powers, while undermining the public’s health, cannot advance sustainable economic growth or wellbeing.

PleaseSign the petition to protect tobacco controls from attacks by tobacco multinationals and their corporate allies – and send this note to your lists. 

If the link does not work for you, please go to this web address:

Post on Facebook:  Sign the Open Petition to Smoke Out Tobacco from the TPP!

Twitter: Sign on to protect tobacco controls from attacks by tobacco multinationals and their corporate allies.  Please sign here: #StopTPP #TobaccoOutTPP #SmokeOutTPP@CPATH @USTradeRep @CouncilofCDNs

Initial Sponsoring Organizations:

Action on Smoking and Health (ASH), Chris Bostic, MSFS, JD, Deputy Director for Policy

American College of Obstetricians and Gynecologists, Barbara S. Levy, Vice President, Women’s Health Policy

American College of Physicians

Center for Policy Analysis on Trade and Health (CPATH), Ellen R. Shaffer, PhD, and Joe Brenner, MA, Co-Directors

Corporate Accountability International, John Stewart, Campaign Director, Challenge Big Tobacco

Human Rights and Tobacco Control Network (HRTCN), Carolyn Dresler, MD, Chair

International Association for the Study of Lung Cancer, Mike Cummings, MD, Chair, Tobacco Control Committee

Initial Sponsoring Individuals:

Tom Houston, MD, McConnell Heart Health Center, Columbus, Ohio

Don Zeigler, PhD, Adjunct Associate Clinical Professor, UIC School of Public Health

[1] R. Stumberg, Safeguards for Tobacco Control: Options for the TPPA. America Journal of Law and Medicine, 39 (213); 382-441.
[2] Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report 2008;57(45):1226–8 [accessed Aug. 17, 2013].
[3] FDA, Report to Congress. United States Tobacco Product Exports That Do Not Conform to Tobacco Product Standards. 3/8/13.
[5] U.S. Government Accountability Office report, “Illicit Tobacco: Various Schemes are Used to Avoid Taxes and Fees,” accessed August 18, 2013, from
[6] Thomas H. Frieden.

Conference Calls and Radio Shows of Interest

Our very own Mini Murthy and Elvira Beracochea are co-hosting a radio show on the MDGs! The inaugural episode aired last week, but you can listen to it in the archives and tune in for future episodes. They will be on every Thursday at 12 p.m. EST. More information can be found below.

Millennium Development Goals: Progress and Challenges

PROGRAM: Millennium Development Goals
TOPIC OF DISCUSSION: Millennium Development Goals: Progress and Challenges


In 2000, 189 nations made a promise to free people from extreme poverty and multiple deprivations. This pledge became the eight Millennium Development Goals to be achieved by 2015. The MDGs provide a framework for the entire UN system to work coherently together toward a common end. UNDP, global development network on the ground in 177 countries and territories, is in a unique position to advocate for change, connect countries to knowledge and resources, and coordinate broader efforts at the country level. In September 2010, the world recommitted itself to accelerate progress towards these goals.

The declaration established eight Millennium Development Goals (MDGs) and time-bound targets by which progress can be measured. With the 2015 deadline looming, how much progress has been made? And is the pace of progress sufficient to achieve the goals? The MDGs break down into 21 quantifiable targets that are measured by 60 indicators.

In our inaugural episode we hope to give a brief over view of the progress and challenges made from the year 2000- 2005 and focus on Sub Saharan Africa to review the progress made with reference to MDGs 1 and 4.

Join us as we explore this very important topic on MDGs.

Padmini (Mini) Murthy is a physician and an activist who did her residency in Obstetrics and Gynecology. She has practiced medicine in various countries. She has a Master’s in Public Health and a Masters in Management from New York University (NYU). Murthy has been on the Dean’s list at NYU stein hart School of Education and named Public service scholar at the Robert F Wagner Graduate School at New York University. She is also a Certified Health Education Specialist.

Elvira Beracochea, MD, MPH, has more than 25 years of experience that encompass her work as physician, public health and international development expert, human rights advocate, epidemiologist, health policy advisor, researcher, health systems and hospital manager, consultant, professor and coach. She has worked in over 30 countries in Latin America, Africa, Asia, Eastern Europe and the South Pacific. Dr Elvira is committed to helping realize the right to health and the right to development and to improving the effectiveness of development assistance. For this reason, in 2005, she founded MIDEGO, an organization with an urgent rights-based mission: accelerate the achievement of the Millennium Development Goals (MDGs) approved by the United Nations in the year 2000.

The Millennium Development Goal is a weekly discussion on AV Radio based on the Millennium Declaration, adopted by all 189 United Nations Member States in 2000, promised a better world with less poverty, hunger and disease; a world in which mothers and children have a greater chance of surviving and of receiving an education, and where women and girls have the same opportunities as men and boys. It promised a healthier environment and greater cooperation-a world in which developed and developing countries work in partnership for the betterment of all.


Next month, APHA’s Trade and Health Forum will be holding an open Educational Session on Tobacco and International Trade Agreements. It will take place on April 12 at 2:30 PM Pacific/5:30PM Eastern.

The first 30 minutes of the call will be an educational session about recent activity pertaining to alcohol and tobacco in trade agreements and the question of “carve outs”. Donald Zeigler, PhD, Director of Prevention and Healthy Lifestyles at the American Medical Association (AMA) will lead the session. Dr. Zeigler has been active in the Trade and Health Forum, representing the Alcohol, Tobacco and Other Drug Section of the American Public Health Association and has been interested in trade and health issues for almost a decade. He was instrumental in getting the AMA to adopt policy on trade and has worked with other medical specialty societies to adopt policy, as well. The AMA recently called on the US Trade Representative to carve out tobacco and alcohol from the proposed Trans-Pacific Partnership agreement.
The second 30 minutes of the call will be dedicated to Trade and Health Forum business. You are welcome to join for the full call, and we welcome your input.

To dial in, please call (605) 475-4850 and use the following access code: 810329#. If you have questions, please direct them to Natalie Sampson (nsampson@umich).

Very best,

American Public Health Association’s
Trade & Health Forum Leaders

Peace, Love, and Fair Trade

There is an ongoing debate within my circle of friends about whether Austin is a truly “hippie” town, or if it is merely “hipster,” and the [aggravation caused by an influx of people and traffic for the] South by Southwest music festival intensified the argument last week. The live music capital of the world prides itself on offering vegetarian and vegan options at every restaurant (e.g. tofu tacos at Mexican restaurants), boasts avid cycling and recycling communities, and even has green and eco-friendly furniture shops and dry cleaning establishments. As a coffee lover, though, what stands out most to me is that every independent coffee shop carries as much fair trade coffee, tea, and chocolate as it can cram into its menu (though it should be noted that this is a trend among coffee shops in general, no matter where they are). Whether genuine or for show, Austin is as eco-hip as they come.

While I appreciate the emphasis on sustainability, I wonder if it overshadows fair trade’s emphasis on improving the lives and livelihoods of the farmers and artisans it serves. While many are aware of its emphasis on sustainable agriculture and organic farming methods, perhaps less known is the fact that it can help improve infrastructure, provide education, empower farmers, and improve health care for fair trade producers and their communities.

TransFairUSA's "Fair Trade Certified" label
TransFairUSA's "Fair Trade Certified" label

Fair trade producers typically work (and may even live) in organized co-operatives that may or may not be linked to a particular company or organization. Products with a “fair trade” label have been certified by that organization to have been produced ethically (i.e. guaranteeing basic human rights, without child and slave labor, in a manner that protects the environment, allowing workers to unionize, etc.) and to have been purchased at a price that covers the cost of production. (TransFair USA’s criteria can be found here.) In addition to ensuring wage and practice requirements, fair trade organizations collect a small amount of the profits generated from product sales into a “social premium,” or a fund for community development. Producers meet regularly to decide how to invest these funds. Many fair trade communities choose to build a clinic to provide basic health services to residents, or schools to better educate their children (or sometimes both). One wine co-op from Chile, with 1,400 families, established a fund to assist with medical needs, including hospitalization, medicine, house calls for those who cannot travel, and maternal, psychiatric, and dental care for residents. A cocoa-growing community in Côte d’Ivoire used their earnings to build a small health clinic with four providers and an ambulance. Before the clinic was built, the nearest health facility was ten kilometers away, and 30 farmers died each year of treatable diseases; now, the clinic performs approximately 36 life-saving operations in the community each year.

Impact studies have found that fair trade participants have been able to increase gross household income, which allows them to better feed and educate their children, and can even provide an economic boost the surrounding community as a result. Their economic vulnerability to commodity prices is also reduced, and some studies have noted drops in child mortality. One of the most important fruits of these fair trade co-ops, however, is empowerment: farmers gain the ability to diversify their production and improve the quality of their products, they have a say in the development of their communities, and they can even gain political influence in their communities.

A cappuccino in a brown mug with the design of a leaf made by the milk.
Flickr, niallkennedy

While the economic implications of fair trade are still the subject of intense debate, participation in fair-trade co-ops gives farmers the control over their businesses and livelihoods of which they are too often robbed under typical trade structures. It encourages more environmentally sustainable farming practices, and it gives us a warm fuzzy feeling when we buy coffee, tea, or chocolate (or even clothes and accessories). Who wouldn’t want to feel like they were helping the poor and the planet while sipping their cappuccino?

Drug Wars: What does a free trade agreement between India and the EU mean for generics?

When I was a junior in college, I had to give a presentation for my honors Molecular Genetics class. The hot topics that year were avian influenza and HIV. I had just been accepted into the School of Rural Public Health’s MPH program, so I decided to get in the HIV-line, but with a twist: rather than present a paper on the mechanism of infection or a mutant viral protein, I would pull the lens back and look at the disease from a public health standpoint. It was an eye-opener for a lot of my classmates, most of whom were biochemistry majors whose only exposure to HIV had been through pictures of Western blots in peer-reviewed journal articles. Some of the strongest reactions were to cost of care, especially drug prices: when I cited several drugs that entered the market at $25 (darunavir), $29 (tipranavir), or even $61 (efuvirtide) for one day’s dose in the U.S., eyes widened and jaws dropped across the room.

A round white pill.
Flickr, doug88888

The war on drug prices is a long-standing, bitter battle between the pharmaceutical industry and humanitarian groups and lobbyists, with governments and regulators perpetually caught in the middle. International health and humanitarian organizations argue that access to inexpensive medicines is vital to the survival of the poor who need them, and that Big Pharma is driven by greed and cares only for its profit margins. Pharmaceutical companies counter that intellectual property protection and patents encourage innovation and the development of newer and better drugs. The solution to this dilemma in developing countries, including India and many African nations, has been generics. India’s patent laws make it easy for regulators to deny drug patent applications, allowing Indian pharmaceutical companies to use the data from clinical trials already performed to get approval to produce cheap generic versions of patented medications. India is the world’s leading producer of inexpensive generic drugs – its pharmaceutical industry makes most of its money by producing generic versions of drugs patented by Western companies – which has earned its reputation as “the pharmacy of the developing world.” India supplies 80% of the medicines distributed by medical humanitarian organizations in poor countries; in particular, 93% of ARVs going to HIV patients in these countries are Indian-made.

The EU is currently negotiating a free-trade deal that may change all of this: in addition to agricultural tariffs and work visa agreements, Europe is trying to negotiate a period of exclusive access to pharmaceutical companies’ research and clinical trial data. No specific amount of time has been finalized, but without information from the clinical trials already conducted, generics manufacturers would have to conduct their own testing to register their products. Opponents of this provision fear that this will drive up the cost of generic medicines and make them unaffordable for the poor. Médicins sans Frontières (Doctors without Borders) has launched their “Europe! HANDS OFF our Medicine” campaign specifically against this component of the agreement. The WHO and the UN’s special rapporteur on the Right to Health Anand Grover are also concerned, and the Indian generic pharmaceutical industry is predicting a global health crisis if the trade agreements lead to production restrictions. The European Commission insists that the negotiations will not negatively impact India’s generics industry, but worries will persist until a draft of the agreement is released.

The ever-continuing debate underscores the need to find a balance between encouraging economic growth and innovation, and ensuring affordable access to medicines for those who need them. Though the start-to-finish cost of producing drugs can admittedly cost billions of dollars, the question of whether it justifies such high new value benchmarks has not yet been settled. The fact that so many millions wait in line for these drugs begs this ever-persistent question: what is the point of charging so much for drugs that so many need if so few can afford them?

Best of the Best

There was much to appreciate about the APHA 2008 meeting in San Diego, but two sessions that started off the meeting will stand out in my mind for a long time.

On Saturday we were supposed to have a Trade and Health tour of Tijuana, but because of increased violence there the trip was called off.  Instead, Tijuana came to us.  Over the course of three hours we heard from some inspiring environmental health efforts (a successful community effort to clean up a disgusting toxic waste dump) and occupational health work (a maquila worker-turned-activist).  The last hour was a fantastic film that I highly recommend to anyone interested in either or these topics:


Continue reading “Best of the Best”