How will a trade agreement – the TPP — impact global health?

Guest post by Mary Anne Mercer, Senior MCH Advisor for Health Alliance International and the IH Section’s liaison with the Trade and Health Forum. Mary Anne spoke at a recent activist rally in Seattle on January 31st about public health concerns related to the TPP.

Only six months ago, when the TPP, or the Trans-Pacific Partnership, was brought up in discussions, even well-informed activists generally gave blank stares.  TP what?  But in recent weeks it’s been the subject of increasing news coverage, along with exposure to the so-called fast track authority bill that would grant President Obama authority to sign the agreement without prior Congressional review.  Although extensive negotiations on the TPP have been going on in secret over the past several years, as information about the TPP becomes better known, activist groups around the world have organized to oppose it. Just what is the TPP, and why do we care about it?

The Trans-Pacific Partnership is a “trade” deal (but encompassing many other areas of corporate rights) among 12 countries of the Pacific Rim, including the United States. Official discussions are held behind closed doors without public information or input, and without input from our elected representatives in Congress, so little is known about the specific terms of the agreement.  However, WikiLeaks has published two chapters over the past few months detailing regulations concerning intellectual property and the environment. We have good reason to expect that the TPP will ratchet up terms that are prominent in existing trade agreements that have been signed between individual countries. So although only the negotiating committees, which include about 600 diplomats and corporate representatives, know the exact terms of the deal, we have substantial cause for concern.

National and international groups concerned about global health have voiced opposition to many terms of the agreement, believing that they would affect the health and quality of life of people around the world if enacted.  Some of the main health-related concerns about the TPP include:

  • Restrictions on individual countries’ abilities to pass and enforce laws protecting public health. Through a mechanism known as Investor-State Dispute resolution, corporations would be entitled to sue sovereign governments for passing laws that ‘restrict trade’ – even public health measures such as restricting tobacco advertising on cigarette packaging, which the Australian and other governments are now facing.
  • Intellectual property laws that would set up barriers to accessing generic medicines and other health commodities (including AIDS drugs), thus dramatically increasing their costs. By extending the already lengthy duration of patents and other corporate protections, Big Pharma will have an even stronger hold on the economic gains to be made from health problems around the world.
  • Detrimental effects on equity, including the distribution of income and other resources.  There is good evidence 20 years after NAFTA that poverty and inequality have increased in Mexico and wages in the US have stagnated.  The promises of NAFTA have not been kept.

But the TPP is far from a done deal.  Many progressive groups, including a number of labor, environmental and community organizations, as well as APHA’s Trade and Health Forum, are working to oppose the TPP and the Fast Track bill.

Sen. Harry Reid, Majority Leader in the U.S. Senate, recently indicated that he is not interested in having the Senate vote on legislation granting Fast Track Authority this year. There is no question that Reid’s decision is a result of mobilization of voters across the country. We need to continue to educate and inform as many people as possible about the content of the TPP and the negative impact it would have on jobs, the environment, and on public health in the US and globally.

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.

Global Health News Last Week

September 5 was Labor Day.


  • The State Department has announced the official US Delegation to the UN High Level Meeting on NCDs, which will take place September 19-20.
  • Access to affordable lifesaving medicines will be threatened where they are needed most—in parts of the developing world—if the U.S.insists on implementing restrictive intellectual property policies in the Trans-Pacific Partnership (TPP) trade agreement, says Médecins sans Frontières (Doctors without Borders).
  • Sarah Boseley shares the great news that Kenya has officially made female genital mutilation illegal.
  • A federal appeals court in Virginia has dismissed two lawsuits challenging the constitutionality of President Barack Obama’s health care overhaul.
  • United Nations chief Ban Ki-moon singled out sustainable development as the top issue facing the planet with the world’s seven billionth person expected to be born next month. Key to this was climate change, and he said time was running out with the population set to explode this century.
  • Thousands of proposed cuts in the US Congress could lead to significant cuts to USAID.
  • The Philippines reproductive health bill is still making its way through the senate.  Meanwhile, 7 villages in Bataan, the Philippines have banned “artificial contraception” amid national debate over the bill.
  • A report co-authored by an Australian academic highlights the need for healthy ecosystems as the basis for sustainable water resources and stable food security for people around the world.


  • Sometime this fall, the world’s population will reach 7 billion people. Experts now forecast that by 2050, the population could be 10 billion. Some say those numbers should force policy makers to focus more intently on making family planning much more widely available in the developing world.
  • The Institution of Mechanical Engineers has put together a one day conference bringing together innovators and health workers to share ideas about ways to more easily deliver interventions.
  • It has been commonly held that insecticide treated bed nets reduce the rate of malaria for people who use them. Now there is hard evidence to back up that assumption.


  • A new study shows that less than three doses of the vaccine against cervical cancer can effectively protect women in the developing world where 80% of global deaths due to cervical cancer take place.
  • Only three African countries are on track to achieve MGD 5, according to an African Institute for Development Policy study.
  • Most efforts in the Western world seeking to find solutions for developing world problems tend to think of inventing new technologies or, at least, using the tools we typically use to fix things — modern drugs for diseases, improved seeds for crops, a better mousetrap. Sometimes, all you need is a newly geared donkey
  • Scientists may have developed a new TB vaccine after tests showed the elimination of TB from infected tissue in mice.
  • A socially active lifestyle can dramatically speed up weight loss through the burning of fat in mice, a study shows. Researchers at Ohio State University in the US identified a link between the amount of social interaction in a mouse’s environment and its weight.
  • An easy-to-use diagnostic chip for HIV could “give results in minutes” and be a game changer in the field of cheap diagnostics for remote regions, claim the researchers who developed it.


  • Having to contend with drones and the crossfire between the Taliban and the Pakistani army, the residents of Pakistan’s tribal areas find access to treatment for HIV/AIDS harder than in most other parts of the world.
  • Three-quarters of a million people are facing death by starvation in Somalia according the United Nations, who declared Monday that famine had spread to a sixth southern region of the beleaguered Horn of Africa state.  Meanwhile, an investigation has revealed that masses of food meant for famine victims in Somalia are being stolen. There have also been reports of rioting and killings during food distribution at camps for famine victims.
  • A magnitude 6.6 earthquake struck 100km southwest of the city of Medan, Sumatra and 110km beneath the earth’s crust.
  • A New York Times editorial castigates the international community’s response to the cholera outbreak in Haiti.
  • The CEO of insulin manufacturer Novo Nordisk says the WHO should buy low cost diabetes drugs in bulk for the developing world.
  • Messages of good health and positive self-esteem for girls aren’t hard to come by in kid lit, so what’s the deal with all the attention for a not-yet-published rhyming picture book about an obese, unhappy 14-year-old named Maggie?