Department of Health Policy, London School of Economics, Houghton Street, London, WC2A 2AE, United Kingdom.
Dondena Centre for Research on Social Dynamics and Department of Social & Political Sciences, Bocconi University, 4 Via Roentgen, 20136, Milano, Italy.
Soc Sci Med. 2021 Apr;275:113807. doi: 10.1016/j.socscimed.2021.113807. Epub 2021 Mar 2.
Do international trade rules and agreements constrain health policy space? A multitude of global actors and institutions with different interests and power can shape national health policy, and trade rules provide one means through which to exert pressure on governments. Yet, the full scope of political pressure on health policy within the global trade regime is insufficiently understood, as previous research largely focussed on challenges to food, alcohol, and tobacco regulations and used small-N case studies. This potentially overlooks other domains of influence and we lack an understanding of quantitative trends and patterns therein. In this article we introduce a novel dataset, WTOhealth, comprising all challenges to national health regulations at the WTO Technical Barriers to Trade (TBT) Committee between 1995 and 2016. The dataset is based on 1496 pages of minutes from 71 TBT meetings. We describe how we developed this dataset and present an exploratory analysis of key patterns within the data. Our analysis shows that WTO members raised 250 trade challenges to health regulations between 1995 and 2016. 83.6% of challenges to low- or lower-middle income country (LMIC) members were raised by high-income countries (HICs). Many challenges centred on food (16.4% challenges), alcohol (10.4%), and tobacco (4.2%) policies, but a substantial proportion concerned other products, including toxic chemicals (9.1%), pharmaceuticals and medical devices (8.1%), machinery (7.8%), and motor vehicles (7.3%). This includes measures targeting medical device safety, increased access to pharmaceuticals, and reduced exposure to toxins harmful to both health and the environment. We further examine these challenges, finding that HIC members made claims with contentious scientific support. In short, diverse health regulations may be changed or delayed following contentious challenges at the TBT Committee. There is a need for further research investigating the nature and influence of WTO challenges to diverse health regulations.
国际贸易规则和协议是否限制了卫生政策空间？众多具有不同利益和权力的全球行为体和机构都可以影响国家卫生政策，而贸易规则则提供了一种对政府施加压力的手段。然而，对于全球贸易体制中对卫生政策的政治压力的全貌还了解不足，因为之前的研究主要集中在对食品、酒精和烟草法规的挑战上，并且使用了小样本案例研究。这可能忽略了其他影响领域，我们也缺乏对其中定量趋势和模式的理解。在本文中，我们引入了一个新的数据集 WTOhealth，其中包含了 1995 年至 2016 年期间在世界贸易组织技术性贸易壁垒（TBT）委员会对国家卫生法规提出的所有挑战。该数据集基于 71 次 TBT 会议的 1496 页会议记录。我们描述了如何开发此数据集，并对数据中的关键模式进行了探索性分析。我们的分析表明，1995 年至 2016 年间，WTO 成员共对卫生法规提出了 250 项贸易挑战。对低收入和中低收入国家（LMIC）成员的挑战中，有 83.6%是由高收入国家（HIC）提出的。许多挑战集中在食品（16.4%的挑战）、酒精（10.4%）和烟草（4.2%）政策上，但相当一部分涉及其他产品，包括有毒化学品（9.1%）、药品和医疗器械（8.1%）、机械（7.8%）和汽车（7.3%）。这包括针对医疗器械安全、增加药品可及性和减少对有害健康和环境的毒素暴露的措施。我们进一步研究了这些挑战，发现 HIC 成员提出了具有争议性科学依据的主张。简而言之，在 TBT 委员会提出有争议的挑战后，各种卫生法规可能会被修改或推迟。需要进一步研究世界贸易组织对各种卫生法规的挑战的性质和影响。
