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Globalization and Health
Published in: Globalization and Health 1/2017

Open Access 01-12-2017 | Research

The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis

Authors: Pepita Barlow, Martin McKee, Sanjay Basu, David Stuckler

Published in: Globalization and Health | Issue 1/2017

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Abstract

Background

Regional trade agreements are major international policy instruments that shape macro-economic and political systems. There is widespread debate as to whether and how these agreements pose risks to public health. Here we perform a comprehensive systematic review of quantitative studies of the health impact of trade and investment agreements. We identified studies from searches in PubMed, Web of Science, EMBASE, and Global Health Online. Research articles were eligible for inclusion if they were quantitative studies of the health impacts of trade and investment agreements or policy. We systematically reviewed study findings, evaluated quality using the Quality Assessment Tool from the Effective Public Health Practice Project, and performed network citation analysis to study disciplinary siloes.

Results

Seventeen quantitative studies met our inclusion criteria. There was consistent evidence that implementing trade agreements was associated with increased consumption of processed foods and sugar-sweetened beverages. Granting import licenses for patented drugs was associated with increased access to pharmaceuticals. Implementing trade agreements and associated policies was also correlated with higher cardiovascular disease incidence and higher Body Mass Index (BMI), whilst correlations with tobacco consumption, under-five mortality, maternal mortality, and life expectancy were inconclusive. Overall, the quality of studies is weak or moderately weak, and co-citation analysis revealed a relative isolation of public health from economics.

Conclusion

We identified limitations in existing studies which preclude definitive conclusions of the health impacts of regional trade and investment agreements. Few address unobserved confounding, and many possible consequences and mechanisms linking trade and investment agreements to health remain poorly understood. Results from our co-citation analysis suggest scope for greater interdisciplinary collaboration. Notwithstanding these limitations, our results find evidence that trade agreements pose some significant health risks. Health protections in trade and investment treaties may mitigate these impacts.
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Literature
1.
2.
Baldwin R. 21st century regionalism: filling the gap between 21st century trade and 20th century trade rules. CEPR Policy Insight. 2011;56:23.
3.
González, A. Mega-regional Trade Agreements Game-Changers or Costly Distractions for the World Trading System ? World Econ. Forum Glob. Agenda Counc. Trade Foreign Direct Invest. 2014;(July):1–48.
4.
Dür A, Baccini L, Elsig M. The design of international trade agreements: introducing a new dataset. Rev Int Organ. 2014;9(3):353–75.CrossRef
5.
6.
Sapsin J, Kimball AM. International trade agreements: vehicle for better public health? J Law Med Ethics. 2005;33(4 Suppl):111–4.PubMed
7.
McNeill D, Barlow P, Birkbeck CD, Fukuda-Parr S, Grover A, Schrecker T, Stuckler D. Trade and investment agreements: Implications for health protection. Journal of World Trade. 2017;51(1):159–82.
8.
9.
Voon T. Evidentiary challenges for public health regulation in international trade and investment Law. J Int Econ Law. 2015;18:795–826.
10.
Thow AM. Trade liberalisation and the nutrition transition: mapping the pathways for public health nutritionists. Public Health Nutr. 2009;12(11):2150–8.CrossRefPubMed
11.
Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet. 2013;381(9867):670–9.CrossRefPubMed
12.
Hawkes C, Blouin C, Henson S, et al. Trade, food, diet and health: perspectives and policy options. 2010.
13.
Blouin C, Chopra M, van der Hoeven R. Trade and social determinants of health. Lancet. 2009;373(9662):502–7.CrossRefPubMed
14.
Friel S, Hattersley L, Townsend R. Trade policy and public health. Annu Rev Public Health. 2014;36(November 2014):141210140240005.
15.
United Nations. Resolution adopted by the General Assembly on 25 September 2015. UN Gen. Assem., (A/RES/70/1), Agenda items 15 and 116. 2015.
16.
17.
18.
Martens P, Akin S-M, Maud H, Mohsin R. Is globalization healthy: a statistical indicator analysis of the impacts of globalization on health. Global Health. 2010;6(1):16.CrossRefPubMedPubMedCentral
19.
Krieger N. Epidemiology and the web of causation: Has anyone seen the spider? Soc Sci Med. 1994;39(7):887–903.CrossRefPubMed
20.
Beckfield J, Krieger N. Epi + demos + cracy: linking political systems and priorities to the magnitude of health inequities—evidence, gaps, and a research agenda. Epidemiol Rev. 2009;31(1):152–77.CrossRefPubMed
21.
Link BG, Phelan J. Social conditions as fundamental causes of disease social conditions as fundamental causes of disease. J Health Soc Behav. 1995;35(1995):80–94.CrossRef
22.
23.
Friel S, Hattersley L, Townsend R. Trade policy and public health. Annu Rev Public Health. 2015;36(November 2014):141210140240005.
24.
Burns DK, Jones AP, Suhrcke M. The relationship between international trade and non-nutritional health outcomes: a systematic review of quantitative studies. Soc Sci Med. 2016;152:9–17.CrossRefPubMed
25.
Smith RD. Foreign direct investment and trade in health services: a review of the literature. Soc Sci Med. 2004;59(11):2313–23.CrossRefPubMed
26.
Friel S, Hattersley L, Snowdon W, et al. Monitoring the impacts of trade agreements on food environments. Obes Rev. 2013;14(S1):120–34.CrossRefPubMed
27.
Gleeson D, Friel S. Emerging threats to public health from regional trade agreements. Lancet. 2013;381(9876):1507–9.CrossRefPubMed
28.
Legge D, Sanders D, McCoy D. Trade and health: the need for a political economic analysis. Lancet. 2009;373(9663):527–9.CrossRefPubMed
29.
Schram A, Labonte R, Baker P, et al. The role of trade and investment liberalization in the sugar-sweetened carbonated beverages market: a natural experiment contrasting Vietnam and the Philippines. Global Health. 2015;11(1):41.CrossRefPubMedPubMedCentral
30.
31.
Thomas BH, Ciliska D, Dobbins M, Micucci S. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evid Based Nurs. 2004;1(3):176–84.CrossRefPubMed
32.
Craig P, Cooper C, Gunnell D, et al. Using natural experiments to evaluate population health interventions: new medical research council guidance. J Epidemiol Community Health. 2012;66(12):1182–6.CrossRefPubMedPubMedCentral
33.
Trinquart L, Johns DM, Galea S. Why do we think we know what we know? A metaknowledge analysis of the salt controversy. Int J Epidemiol. 2016;45(1):dyv184.
34.
Stuckler D, Reeves A, Karanikolos M, McKee M. The health effects of the global financial crisis: Can We reconcile the differing views? a network analysis of literature across disciplines. Heal Econ Policy Law. 2015;10(1):83–99.CrossRef
35.
Barlow P, Reeves A, McKee M, et al. Unhealthy diets, obesity and time discounting: a systematic literature review and network analysis. Obes Rev. 2016;7:1–10.
36.
van Eck NJ, Waltman L. Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics. 2010;84(2):523–38.CrossRefPubMed
37.
Chatterjee S, Rae A, Ray R. Globalisation, India’s evolving food economy and trade prospects for Australia and New Zealand. In: Globalisation, agriculture and development: perspectives from the Asia-pacific. Cheltenham, UK: Edward Elgar Publishing; 2011.
38.
Thow AM, Heywood P, Schultz J, et al. Trade and the nutrition transition: strengthening policy for health in the pacific. Ecol Food Nutr. 2015;50(February):18–42.
39.
Thow AM, Snowdon W. The effect of trade and trade policy on diet and health in the Pacific Islands. Trade, food, diet and health: Perspectives and policy options. 2010;147.
40.
Sharif S, Javed MS, Abbas A, Hassan S. Impact of WTO’s trade liberalisation on selected food crops in Pakistan. Pak Dev Rev. 2008;47(4):547–60.
41.
Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med. 2012;9(6):10.
42.
Drope J, Chavez JJ. Complexities at the intersection of tobacco control and trade liberalisation: evidence from southeast Asia. Tob Control. 2014;24:128–36.CrossRef
43.
Chaloupka, F.J., and Laixuthai, A. U.S. Trade Policy and Cigarette Smoking in Asia. NBER Work. Pap. No. 5543, (April), 1–3. 1996.
44.
Yamabhai I, Mohara A, Tantivess S, et al. Government use licenses in Thailand: an assessment of the health and economic impacts. Global Health. 2011;7(1):28.
45.
Umaña-Peña R, Franco-Giraldo Á, Díaz CÁD, et al. Assessment of the association of health with the liberalisation of trade in services under the World Trade Organisation. PLoS One. 2014;9(7).
46.
Tausch, A. Is globalization really good for public health? Int J Health Plann. Manage. 2015;31(4).
47.
Bozorgmehr K, San Sebastian M. Trade liberalization and tuberculosis incidence: a longitudinal multi-level analysis in 22 high burden countries between 1990 and 2010. Health Policy Plan. 2014;29(3):328–51.CrossRefPubMed
48.
Goryakin Y, Lobstein T, James WPT, Suhrcke M. The impact of economic, political and social globalization on overweight and obesity in the 56 low and middle income countries. Soc Sci Med. 2015;133:67–76.CrossRefPubMedPubMedCentral
49.
Vogli RD, Kouvonen A, Elovainio M, Marmot M. Economic globalization, inequality and body mass index: a cross-national analysis of 127 countries. Critical Public Health. 2014;24(1):7–21.CrossRef
50.
Dreher A. Does globalization affect growth? Evidence from a new index of globalization. Appl Econ. 2006;38(2000):1091–110.CrossRef
51.
Clemens MA, Williamson JG. Why did the tariff-growth correlation change after 1950? J Econ Growth. 2004;9(1):5–46.CrossRef
52.
Zimmet P. Globalization, coca-colonization and the chronic disease epidemic: Can the doomsday scenario be averted? J Intern Med. 2000;247(3):301–10.CrossRefPubMed
53.
54.
Evans M, Sinclair RC, Fusimalohi C, Liava’a V. Globalization, diet, and health: an example from Tonga. Bull World Health Organ. 2001;79(9):856–62.PubMedPubMedCentral
55.
Beaglehole R, Yach D. Globalization and the prevention and control of non communicable diseases: the neglected chronic diseases of adults. Lancet. 2003;362:903–8.CrossRefPubMed
56.
Weiss M, Middleton J, Schrecker T. Warning: TTIP could be hazardous to your health. J Public Health (Bangkok). 2015;37(3):367–9.CrossRef
57.
Metadata
Title
The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis
Authors
Pepita Barlow
Martin McKee
Sanjay Basu
David Stuckler
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2017
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/s12992-017-0240-x

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