Rethinking governance for trade and health

Strengthening governance for more “healthy” trade is a recognised public health priority,1 and increasingly so given recent shifts in the international trade regime.2 After the second world war increasing trade liberalisation became a focus of international attention, and the General Agreement on Tariffs and Trade (GATT) was set up to coordinate international trade agreements. This was highly successful, and average world tariff rates fell from about 40% in 1948 to 4% in the early 1990s.3

At this time, GATT was replaced by the World Trade Organization (WTO), which had an increased scope. However, over the past two decades bilateral and regional trade agreements have proliferated. These have generally been negotiated in extreme secrecy, with increasingly “deep” commitments that go beyond those required by the WTO.2 4 These commitments, the specifics of which have been well documented,2 5 6 7 have important implications for public health. One focus of concern is the investor-state dispute settlement (ISDS) mechanism, which allows foreign companies to sue host governments for compensation when policy changes …