Glossary of the World Trade Organisation and public health: part 1.

Accepted for publication 18 August 2005 . . . . . . . . . . . . . . . . . . . . . . . T he relation between health and trade is not new. Disease and pestilence have long followed global trade routes, a pattern that continues into the 21st century. A Chinese trade ship was the source of Latin America’s cholera outbreak in 1991, which resulted in 10 000 deaths. Increased trade in tobacco products and processed foods high in sugar or fat contribute to rising chronic disease rates in poorer countries. 3 Trade can also be good for health, improving peoples’ lives through access to goods or technologies that cure disease or improve wellbeing. Proponents of trade liberalisation argue further that it can increase economic growth and wealth creation, both of which may reduce poverty and allow for greater investments in health care, education, environmental protection, and other population health determinants. Others maintain that the relation is subtler. Development economist, Ha-Joon Chang points out that today’s wealthy countries became so through a variety of policies—infant industry protection, export subsidisation, copying of foreign technologies, and strong state controls over foreign investment—that new trade liberalisation rules increasingly deny poorer countries. Many of these trade rules came into existence with the creation of the World Trade Organisation (WTO) in 1995. The WTO’s influence extends beyond commercial relations to affect health, social welfare, and culture. This two part glossary introduces the WTO trade treaties (the generic term for specific trade agreements) and explains the key principles and concepts of interest to policy makers and practitioners. It aims to explain the WTO through a public health lens that focuses on disease control and prevention, the reduction of a wide range of health risks, and a commitment to reducing health inequities. The public health implications of these agreements can be direct, as in the restrictions the Agreement on TradeRelated Intellectual Property Rights* (TRIPS) can place on access to essential medicines. They can also be indirect in two important ways: