Pathways Frameworks

1. Pathways Frameworks

2. Types of trade andinvestment agreements BILATERAL REGIONAL WTO

6. BackgroundTrade in Tobacco Projected increase in tobacco consumption in Pan American Region (egArgentina, Brazil, Mex)–will offset declines in North America Report on tobacco industry influence in Latin America and the Caribbean, suggest that it is important to recognize that the tobacco industry is the ‘vector’ for tobacco-caused diseases. Direct and Indirect effects of Tobacco Consumption The direct effects--increased risk for chronic and infectious diseases – including cancer, cardiovascular disease, respiratory diseases and tuberculosis. The indirect effects--greater health care expenditures and loss in workforce productivity. Burden of Tobacco Consumption Report by the World Bank suggests that the costs required to mitigate the health consequences of tobacco consumption exceeds revenue generated by tobacco production, distribution and sales by 200 billion dollars In 2005, Argentina experienced a loss of economic productivity of approximately 0.17% of the gross national product hese indirect effects can contribute to further health effects including mental health issues resulting from illness and a subsequent decreased engagement in daily life activities, such as employment and recreation.

7. Liberalization of trade and tobacco The association between trade and the disease consequences of tobacco consumption is connected through: Industry activity in the environment of trade liberalization a The effectiveness of tobacco control efforts.

8. Trade liberalization and tobacco consumption Several studies demonstrated that trade liberalization has lead to an increase in tobacco consumption in low- and middle-income countries increased level of consumption is tied to the combination of trade liberalization coupled with minimal tobacco control measures “Objective: To prevent the passage of unfavorable legislation aimed at restricting or banning advertisement and promotion of our products” (Philip Morris 1994-1996 strategic plan for Latin America)

9. A basic logic supporting the link between the trade of tobacco products and health. When tobacco trade is liberalized there is: increased competition in domestic markets a reduction in the prices of tobacco products and, an increase in advertising and promotion expenditure These three points highlight the risk that liberalization or market opening will lead to increases in tobacco consumption There is a second risk stemming from trade agreements, that ‘the provisions of trade agreements governing non-tariff barriers to trade will limit effective and comprehensive tobacco control.’

10. Government autonomy and trade agreements Ninety percent of global trade is in accordance with the rules of trade set out by the World Trade Organization through the General Agreement on Tariffs and Trade (GATT) The primary purpose of these rules is to reduce barriers to trade (Taylor et al., 2000). One of the key principles underlying this purpose is non-discrimination: the foreign good or committed service covered by a trade treaty must be treated the same as the domestic good or service, and vice versa. For example, a country cannot, under the rules of GATT, impose tobacco control measures such as tax increases on foreign tobacco products if it is not willing to enact the same measures on domestic products.

11. Tobacco products generally fall under the GATT and the Agreement on Technical Barriers to Trade (Taylor et al., 2000); But tobacco production would also be governed by the Agreement on Agriculture and tobacco marketing by both the General Agreement on Trade in Services (GATS) and the Agreement on Trade-Related Intellectual Property Rights (TRIPS). Within the WTO system is a tacit reference to health as an interpretative principle (Bloche 2002). There are exceptions that allow countries to argue derogate from WTO trade rules if such policies would be a detriment to the health of their citizens. Both the GATT and the GATS agreements allow exceptions for measures ‘necessary to protect human, animal or plant life and health’ (GATT article XX(b), GATS XIV(b)). Dispute panels, however, have applied a very stringent necessity test to these exceptions, requiring that countries provide sufficient evidence that particular health measures, such as labeling restrictions on cigarette packages, will protect the health of the population, despite the rights of companies to use their trademarks under such measures as TRIPS. The Framework Convention on Tobacco Control (FCTC), which was negotiated within the World Health Organization system, seeks to strengthen tobacco control policy and legislation on a global scale, thus creating a basis for enhanced control over tobacco production, distribution, marketing and sales.

12. Marketing and Social Norms Liberalization of trade of tobacco products has increased their availability in the PAHO region. A study by Efroymson and colleagues (2001) dispelled the myth that tobacco consumption is proportional to income level. In a study of the Bangladeshi population, it was found that the poorest are twice as likely to smoke as the wealthiest (Efroymson et al., 2001). This study concluded that tobacco consumption was an additional burden to those who were already impoverished and that impoverishment did not dissuade consumption. The challenge to addressing consumption patterns remains the extent to which countries can implement tobacco control measures amidst the pressures that arise from trade agreements. There are a number of challenges to marketing and social norms with the emergence of such agreements. For example, with the increased presence of TTCs in Latin American and 5 Caribbean countries, there is an incentive to increase their profits through domestic markets, which leads to a rise in marketing the social image of smoking . Such strategies include the distribution of cigarettes to youth, public advertising and the lobbying of governments to ensure that such strategies are not countered by legislation (WHO, 2008).

13. Tobacco Consumption and Health Effects: Chronic diseases account for the greatest number of deaths globally Although chronic diseases were once thought to be diseases of high-income countries, there is an increasing shift in prevalence to both low- and middle-income countries part of the epidemiological transition, and is creating a ‘double burden’ studies havee documented linkages between tobacco consumption and chronic diseases, such as cancer, cardiovascular disease (CVD), respiratory diseases and diabetes In addition to chronic diseases there is also evidence to suggest that tobacco consumption increases TB infection rates, incidence rates and death rates, although the body of evidence is not as strong

14. Summary Highlighted the pathways that link the trade of tobacco with health. It describes two main risks stemming from trade liberalization and agreements. The first is that liberalization in tobacco trade will lead to increases in consumption (McGrady, 2008). The second is that trade agreements may restrict the implementation of tobacco control measures The central thrust of this presentation points to relationship between trade agreements, particularly those that support trade liberalization, and the challenges that these agreements face for government support for tobacco control measures, the direct health consequences of tobacco consumption and the indirect consequences such as the economic consequences pertaining to burdened health and social systems. s report