The Potential Impact of the Trans-Pacific Partnership Agreement on Health Equity, with Illustration From New Zealand

Abstract

The Trans-Pacific Partnership agreement (TPPA) is a multi-lateral trade and investment agreement between 12 Pacific-rim countries (Australia, Brunei Darussalam, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the USA and Vietnam), which was agreed and its text finally made available in late 2015 [1]. It expands the existing provisions for international trade and investment of the World Trade Organization (WTO). We are not able to cover all of the provisions in the TPPA (which has 30 chapters, multiple annexes and side letters); however, this commentary highlights a number of factors in the TPPA likely to exacerbate health inequity by raising cost and implementation barriers that can affect policy adoption [2]. The significant potential conflicts between health, increasing trade in risk commodities and pharmaceutical costs have resulted in repeated calls for health impact assessment of the TPPA [3]. Assessing the impacts of trade agreements on health and equity is feasible and useful [4, 5, 6]. No such assessment has been made available by any TPPA government. Instead, reports by TPPA negotiators themselves (such as the New Zealand National Impact Assessment [NIA]) are limited by a conflict of interest, and are deficient in their assessment of health impacts. The NIA points to a patchwork of clauses that governments can use to defend public health policies, emphasising the optional, partial exclusion of manufactured tobacco from one form of dispute (investor–state dispute settlement [ISDS]) and the preservation of the pharmaceutical purchasing agency PHARMAC. The NIA accepts that there will be restraints in developing new policy [7]. Here we indicate some ways that delays, disputes and costs can affect policies for health equity.