Ares Gastón, Brunet Gerónimo, Patay Dori, Thow Anne-Marie
Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, Pando, Uruguay.
Espacio Interdisciplinario, Universidad de la República, Montevideo, Uruguay.
Global Health. 2025 May 10;21(1):28. doi: 10.1186/s12992-025-01110-x.
The proliferation of International Investment Agreements (IIAs), as the result of globalization, has been identified as one of the factors contributing to policy inertia or chill on meaningful public health policy action. Health safeguards, i.e., specific clauses to protect the State's right to regulate, have been increasingly included in IIAs to protect health policy. However, an in-depth understanding of the processes involved in the diffusion of health safeguards in IIAs globally and the factors acting as barriers and facilitators for their uptake is still lacking. In this context, the present study intends to fill this research gap by analysing the uptake of health safeguards in the context of Uruguay, a developing Latin American country. The objectives were to: (i) examine the evolution of the inclusion of health safeguards in the Bilateral Investment Treaties (BITs) signed by Uruguay until 2024, (ii) analyse how Uruguay has approached BITs after the Philip Morris ISDS case, (iii) explore Uruguayan stakeholders' perspectives on the inclusion of health safeguards in BITs, (iv) identify barriers and facilitators for the uptake of health safeguards in the BITs.
Documentary analysis of the BITs signed by Uruguay showed an ascending trend in the inclusion of health safeguards, reaching 100% since 2010. Interviews with key stakeholders suggested that health safeguards diffused from abroad through transnational transfer networks. While Uruguay has not faced challenges in including health safeguards in recent BITs, the renegotiation of old generation BIT agreements with developed countries has proven to be difficult. A wide range of factors that act as facilitators and barriers for the inclusion for health safeguards in the BITs were identified, which were related to both the national and intergovernmental levels.
Results contribute to the understanding of the factors that influence the evolution of the interface between investment agreements and public health policy by analysing the adoption of health safeguards in BITs. Strong recommendations from international organizations to renegotiate old generation BITs may contribute to overcoming the existing power dynamics and support developing countries in the protection of their regulatory space.
全球化导致国际投资协定（IIA）激增，这被视为导致政策惰性或阻碍有意义的公共卫生政策行动的因素之一。卫生保障措施，即保护国家监管权的特定条款，越来越多地被纳入国际投资协定以保护卫生政策。然而，目前仍缺乏对全球国际投资协定中卫生保障措施扩散过程以及影响其采用的障碍和促进因素的深入了解。在此背景下，本研究旨在通过分析乌拉圭（一个拉丁美洲发展中国家）采用卫生保障措施的情况来填补这一研究空白。目标如下：（i）研究截至2024年乌拉圭签署的双边投资条约（BIT）中卫生保障措施纳入情况的演变；（ii）分析在菲利普·莫里斯国际仲裁案后乌拉圭如何对待双边投资条约；（iii）探讨乌拉圭利益相关者对在双边投资条约中纳入卫生保障措施的看法；（iv）确定在双边投资条约中采用卫生保障措施的障碍和促进因素。
对乌拉圭签署的双边投资条约的文献分析表明，卫生保障措施的纳入呈上升趋势，自2010年以来达到100%。对关键利益相关者的访谈表明，卫生保障措施通过跨国转移网络从国外扩散而来。虽然乌拉圭在近期双边投资条约中纳入卫生保障措施方面没有遇到挑战，但事实证明，与发达国家重新谈判旧一代双边投资条约协议很困难。确定了一系列影响双边投资条约中卫生保障措施纳入的促进因素和障碍，这些因素与国家和政府间层面都有关。
通过分析双边投资条约中卫生保障措施的采用情况，研究结果有助于理解影响投资协定与公共卫生政策之间关系演变的因素。国际组织关于重新谈判旧一代双边投资条约的强烈建议可能有助于克服现有的权力动态，并支持发展中国家保护其监管空间。
