Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, WC1H 9SH, UK.
College of Medicine and Health, University of Exeter, Exeter, UK.
Global Health. 2021 Nov 24;17(1):134. doi: 10.1186/s12992-021-00784-3.
Public health concerns relating to international investment liberalization have centred on the potential for investor-state dispute settlement (ISDS)-related regulatory chill. However, the broader political and economic dimensions that shape the relationship between the international investment regime and non-communicable disease (NCD) policy development have been less well explored. This review aimed to synthesise the available evidence using a political economy approach, to understand why, how and under what conditions transnational corporations may use the international investment regime to promote NCD prevention policy non-decisions.
Methods: Mechanisms explaining why/how the international investment regime may be used by transnational health-harmful commodity corporations (THCCs) to encourage NCD prevention policy non-decisions, including regulatory chill, were iteratively developed. Six databases and relevant grey literature was searched, and evidence was extracted, synthesized and mapped against the various proposed explanatory mechanisms.
Eighty-nine sources were included. THCCs may be incentivised to use the ISDS mechanism since the costs may be outweighed by the benefits of even just delaying regulatory adoption, particularly since the chilling effect tends to ripple out across jurisdictions. Drivers of regulatory chill may include ambiguity in treaty terms, inconsistency in arbitral rulings, potential arbitrator bias and the high cost of arbitration. Evidence indicates ISDS can delay policy adoption both within the country directly involved but also in other jurisdictions. Additionally, governments are adopting standard assessments of public health regulatory proposals for trade and ISDS risk. Various economic, political and industry-related factors likely interact to increase (or decrease) the ultimate risk of regulatory chill. Some evidence indicates that THCCs take advantage of governments' prioritization of foreign investment over NCD prevention objectives to influence the NCD prevention regulatory environment.
While ISDS-related regulatory chill is a real risk under certain conditions, international investment-related NCD prevention policy non-decisions driven by broader political economy dynamics may well be more widespread and impactful on NCD regulatory environments. There is therefore a clear need to expand the research agenda on investment liberalization and NCD policy beyond regulatory chill and engage with theories and approaches from international relations and political science, including political economy and power analyses.
国际投资自由化引发的公共卫生问题主要集中在投资者与国家争端解决（ISDS）相关监管趋冷的潜在风险上。然而，塑造国际投资体制与非传染性疾病（NCD）政策发展之间关系的更广泛政治经济层面问题还没有得到充分研究。本综述旨在采用政治经济学方法综合现有证据，以理解跨国公司为何、如何以及在何种条件下可能利用国际投资体制来推动 NCD 预防政策的不作为。
方法：我们逐步提出解释国际投资体制为何/如何可能被跨国健康危害商品公司（THCC）用于鼓励 NCD 预防政策不作为的机制，包括监管趋冷现象。我们对六个数据库和相关灰色文献进行了检索，并对各种提出的解释机制的证据进行了提取、综合和映射。
共纳入 89 项研究。THCC 可能会受到激励而利用 ISDS 机制，因为即使仅仅是延迟监管措施的采用，其收益也可能超过成本，特别是因为这种冷却效应往往会在管辖范围内蔓延。监管趋冷的驱动因素可能包括条约条款的模糊性、仲裁裁决的不一致性、潜在的仲裁员偏见以及仲裁的高成本。证据表明，ISDS 既可以延迟直接涉及的国家的政策采用，也可以延迟其他管辖范围的政策采用。此外，各国政府正在采用针对贸易和 ISDS 风险的公共卫生监管提案的标准评估。各种经济、政治和行业相关因素可能相互作用，增加（或降低）监管趋冷的最终风险。有证据表明，THCC 利用政府对外国投资的重视超过 NCD 预防目标，来影响 NCD 预防监管环境。
虽然在某些条件下，ISDS 相关的监管趋冷确实存在风险，但由更广泛的政治经济动态驱动的与国际投资相关的 NCD 预防政策不作为，可能更为普遍，并对 NCD 监管环境产生更大影响。因此，显然需要在监管趋冷之外，将投资自由化与非传染性疾病政策的研究议程扩大，并利用国际关系和政治学的理论和方法，包括政治经济学和权力分析。
