Is trade liberalization of services the best strategy to achieve health-related Millennium Development Goals in Latin America? A call for caution.

In September 2000, at the United Nations (UN) Millennium Summit, 147 heads of state adopted the Millennium Declaration, with the aim of reflecting their commitment to global development and poverty alleviation. This commitment was summarized in 8 goals, 14 targets, and 48 measurable indicators , which together comprise the Millennium Development Goals (MDGs), to be attained by 2015. All of the MDGs contribute to public health, and three are directly health-related: MDGs 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV/AIDS, malaria, and other diseases) (1). Progress towards these goals has proved difficult. In an attempt to identify practical steps to achieve the MDGs, the UN Development Programme initiated the UN Millennium Project in 2002. This three-year " independent " advisory effort established 13 task forces to identify strategies and means of implementation to achieve each MDG target , and each task force produced a detailed report (2). A Task Force on Trade was created for MDG 8 to develop a global partnership for development. The mandate of the Task Force on Trade was to explore how the global trading system could be improved to support developing countries, with special attention to the needs of the poorest nations (3). Trade is an important means of generating wealth that can lead to faster economic growth and improved health (although these are not necessarily linked). As such, it is potentially a key determinant of all the MDGs. The types of trade policies promoted thus have a significant influence on progress towards these goals. Latin America and the Caribbean have the greatest disparities in income distribution in the world. A quarter of total income accrues to a mere 5% of the population, and the top 10% receive 40% of the total income. Poverty remains unacceptably high in Latin America (43% of the population in 2001), with the number of people living in poverty increasing from 200 million in 1990 to 214 million in 2001 (4). The Task Force on Trade recommendations are therefore especially relevant if socioeconomic and health conditions of Latin American peoples are to be improved by trade policies. The aim of this paper is to consider the main trade policy recommendations of the report (3) as a strategy to achieve the health-related MDGs in Latin America. The Task Force on Trade report insists that trade liberalization is the basis for progress for developed and developing countries alike. …