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Brief to the World Trade Organization:
World Trade and Population Health

prepared by Professor Ronald Labonte
Director, Saskatchewan Population Health and Evaluation Research Unit, Inc.
Universities of Saskatchewan and Regina, Canada


The International Union for Health Promotion and Education
The Canadian Public Health Association
The Canadian Society for International Health

Last updated: 4 December 1999

An Introduction to Our Concerns

Our organizations, and their members, have become increasingly concerned with the potential negative effects of economic globalization, notably liberalized trade and investment, on the health of individuals, communities and nations. We join a growing number of civil society organizations and UN agencies which believe, on the basis of good evidence and argument, that the current thrust of economic globalization is jeopardizing many national and multilateral social and environmental accords benefitting the public, in general, and poorer groups in particular.

We support trade that is ecologically sound and leads to greater equity in the distribution of income and other resources within and between nations.

We are not opposed to "freer" global trade and investment per se, nor to changes in tariff structures and other national regulations that impede such trade and investment provided it is ecologically sound and leads to a fairer distribution of goods (including income) within and between nations. We emphasize this latter point because, though improved social equity and environmental protection are often argued as a benefit of liberalized trade and investment, most evidence at present suggests the contrary. As economist, Herman Daly, argues, markets, especially at the abstracted and impersonal "global" scale, are blind to normative issues of distributive equity and ecological scale 1) .

We support inclusion of civil society groups and concerns within WTO discussions and negotiations.

We welcome the invitation to civil society organizations to "join the table" at the Millenium Round of World Trade Organization (WTO) ministerial discussions later this year in Seattle, Washington. The WTO has been frequently criticized for its undemocratic (non-transparent) decision-making process, particularly the exclusion of public interests within its disputes settlement tribunals. Thus, we support a Canadian Communication recommending specific measures to make more public WTO Panel and Appellate Body submissions 2). But we remain concerned at the exclusion of civil society interests in these panels, particularly given that most WTO rulings to date favouring liberalized trade over social and environmental goals. Every challenge to a resource conservation measure (GATT Article XX: General Exceptions) brought before NAFTA and the WTO, for example, has succeeded 3). We are also concerned at the preponderance of industry representatives and business organizations officially participating in WTO meetings or specific agreement negotiations, often outnumbering those representing national governments 4).

We are also disturbed at the way civil society organizations and interests are often portrayed by senior officials overseeing free trade negotiations, e.g. the patronizing dismissal of civil society organizations for "ambushing" the OECD/MAI discussions made by OECD Secretary-General, Donald Johnson 5), and the comment by Clyde Prestowitz of the Economic Strategy Institute that "in retrospect it was a big mistake to have [the millenium WTO round] in the U.S." because it "is the capital of NGOs and it's easy in the U.S. for people to protest and express themselves." 6) Such comments are neither respectful nor conducive to reasoned dialogue and debate. They also reveal what many members of civil society organizations fear about economic globalism and the WTO: That it is an undertaking of elites more concerned with economic growth than with the social or ecological effects of such growth, and who would, it seems, place such growth ahead of a democratic civil society.

We believe the WTO has become, and should remain, a major platform around which global governance issues pertaining to the relationships between market and civil society are brought forward.

We do not claim that civil society organizations are de facto more democratic or intellectually sound than are multilateral bodies such as the WTO or OECD. But to avoid a "clash" between transnational corporation interests and those of civil society at such multilateral trade fora as the WTO, as UNCTAD Secretary-General Rubens Ricupero expresses a desire for 7), misses what we believe to be of fundamental importance at this moment in history. The WTO, with its enforcement measures, has become a major focal point through which emergent global governance issues are being fought over. These issues pertain to how competition between economic and common good (social, environmental) goals should be resolved or otherwise mediated. Similar conflicts between mercantile and civil society interests (primarily, though not exclusively, labour), characterized the development of national capitalist economies through the mid 19th to late 20th century in most European and North American countries. These conflicts were partly moderated through expanding government structures and increased democratic civil rights, and gave rise to the "modern" welfare state with its redistributive and regulatory policies.

A similar process is now being enacted globally. Policy conflicts and clashes, though disruptive and messy, are not unhealthy. Nor are the majority of civil society groups bringing forward environmental and social issues at WTO meetings doing so from parochial or narrow self-interests. They are expressing authentic concerns that the present separation of trade and investment liberalization goals from social and environmental goals is serving to sacrifice the latter to the former.

We believe that, in their current forms, agreements on trade and investment liberalization are doing more harm than good with respect to environmental sustainability and social justice (equity) concerns.

Our Specific Recommendations for the WTO Millenium Talks

We agree with the position of many civil society groups and several of the G-77 nations 8): The Millenium Round of the WTO should not introduce new issues, particularly regarding further liberalization of trade in investments, expansion of trade in environmental goods such as water, or agreements on government procurement.

If talks proceed on investment, however, we specifically reject:

and recommend:

  • Investment talks focus on ways in which speculative finance might be globally regulated (e.g. "speed bumps," financial transaction taxes) to stabilize international currencies, and the subsequent abilities of national governments to manage better internal economic development, social development and environmental protective measures, debt management and repayment, foreign currency reserves and economically healthier trade balances.

We also oppose discussions of increasing trade liberalization in services at this time. It is apparent from United States communications to the WTO that it wishes to include private healthcare, education, environmental services and energy within GATS discussions 9). The U.S. Coalition of Service Industries, in its brief to U.S. Special Trade Representative, Charlene Barshevsky, argued that, while the public provision of health services in many countries made it difficult for the U.S. to export its private healthcare services, the WTO was seen as vehicle through which this barrier could be removed 10). Yet private provision of health services has consistently been shown to be the least cost efficient and most inequitable in delivery. An official with the WHO has expressed concerns that increased trade in health services "could...deepen current inequities in access and promote the migration of skilled health professionals from already underserviced areas." 11)

Should such discussions occur during the Seattle round, we specifically recommend:

We believe several existing WTO agreements need particular attention:

These are only a few of the specific measures we would urge be adopted, or initiated, at the Seattle talks. More generally, we believe the Seattle Round should be used to discuss the extent to which current WTO agreements:

  • Enable, rather than disable, the capacity of developing nations to improve their economic position with respect to developed nations (global equity).

  • Remove ecologically unsound forms of subsidies, rather than allow challenges to subsidies that are environmentally protective (environmental sustainability).

  • Strengthen, rather than weaken, the capacities of national governments to regulate markets for common good welfare goals (social justice).

We recognize that these are complex issues, both ideologically and methodologically. The ideological issues can and must be discussed at the WTO forum. The basic question here is:

What is the goal of increased global trade and liberalized investment?

From our review of WTO documents, this question, apart from a token gesture in the WTO Agreement's first paragraph, is either invisible beneath complex legalistic trade agreement language or answered only in terms of traditional measures of increased economic growth, with little or no reference to the sustainability (environmental or social) of such growth. Many of the G-77 countries have complained in various WTO meetings or other fora that the social development goals of liberalized trade have been routinely ignored by the WTO 17). A recent Appellate Body ruling against the use of import protections by developing nations for purposes of improving poor living standards made a distinction between "development policy" and "macro-economic policy," giving the latter superordinancy in WTO disputes 18).

We believe that economic practices should be seen (and regulated) as means to achieve social and environmental goals, rather than as ends in themselves, particularly when those ends actually come at the expense of de-regulating past public government and civil society efforts to accomplish social and environmental goals. This position has been declared by numerous civil society NGOs, and by several UN agencies, including the UNDP. These voices cannot be ignored.

We urge, then, that existing WTO agreements be subject to a full environmental review, as has been called for by several countries 19); as well as to a "health inequalities assessment." This latter term was adopted by the recent UK Acheson Report on Health Inequalities 20). It builds upon methodologies developed for environmental impact assessment, and applies them to population health status around the question: Does this policy (this WTO agreement) increase or decrease the relative health status between different population groups, within and between nations?

The current Millenium Round of WTO discussions cannot, in itself, deal with the methodological complexities of such reviews or assessments. These should be left to collaborations between the WTO, UN agencies, technical and academic experts, and appropriate peak organizations from civil society. A proposed "Working Group on Coherence" could form the structural vehicle through which UN agencies and their remits are introduced into the WTO. 21)

The politics surrounding how (and if) enforceable WTO agreements should accommodate largely unenforceable social and environmental agreements (Table 1) are highly charged.

  • UN Universal Declaration of Human Rights
  • International Covenant on Economic, Social and Cultural Rights
  • International Covenant on Civil and Political Rights
  • Rio Summit Agenda 21
  • International Declaration on the Rights of the Child
  • Beijing Summit on Women
  • Copenhagen Summit on Social Development
  • ILO Convention on Labour

Table 1: Key UN Social and Environmental "Common Good" Agreements

Trade negotiators and officials generally oppose the added complexity of integrating economic agreements with social/environmental accords. Many developing nations are fearful that incorporating "social clauses" (such as labour or children's rights) within WTO agreements will lead to a back-door protectionism by wealthier countries with much greater economic and democratic capacities to abide by such clauses. Given the reluctance of developed countries to remove tariffs on textiles and agricultural goods where developing countries have competitive advantage, the "south's" suspicion of the "north" is probably warranted.

Any national regulation of market activities for social welfare (health, education, income transfers and so on) or environmental goals is, by definition, protectionist. It protects certain non-economic "goods" from erosion due to economic activities. It "protects" or discriminates in favour of those jurisdictions, businesses or practices that comply with the regulations. To the extent that this discriminates in favour of wealthier nations with both the economic capital and the democratic history to create such regulations (and whose wealth historically was based, in part, on domination and exploitation of now poorer nations), it is unfair. Here our global village with its nascent global governance structures faces a choice: Undo common good protectionism favouring wealthy nations (which appears to be the direction of WTO agreements) or create income and technology tranfers that allow poorer nations to catch up. Thus, we accept the concern of developing nations that attempts to incorporate social and environmental clauses within trade and investment agreements should not be to their trade or economic development disadvantage. But we do not believe that the potential for "backdoor protectionism" or imposition of Western-style welfare regimes upon developing nations should preclude this incorporation. Rather, differential compliance measures and other policy instruments should be used to avoid discrimination against poorer countries.

Our overriding concern is that most current multilateral social and environmental agreements for the common good are presently unenforceable. (There have been some notable exceptions where the "stick" of trade sanctions has hastened compliance with important multilateral accords, e.g. the Montreal Protocol on Ozone-Depleting Substances.) While the moral suasion used by the various UN agencies charged with their oversight has been important, movement on these is often slow, driven by short-term economic interests. More importantly, many of these common good accords are actually undermined by trade and investment agreements:

These are only a few of our concerns with existing WTO agreements and rulings. More fundamentally, we are concerned that enforceable trade and investment agreements weaken the abilities of national governments to regulate internally for the social and environmental common good.

A Summary of Our Position


  • We oppose any efforts to introduce discussions to liberalize trade in investments, trade in services, expansion of trade in environmental goods such as water, or agreements on government procurement.

  • We encourage action on agreements on liberalized trade in textiles (the Marrakech Agreements and Decisions) and on agriculture that benefit developing nations.

  • We encourage a review of agricultural agreements from the viewpoint of food security and rural livelihoods.

  • We encourage amendments to the TRIPS agreement to prohibit the grant of patents on any and all life forms.

  • We encourage exemptions to the TRIMS agreement prohibiting local content requirements if such requirements are used to develop the capacity of local firms in economically disadvantaged regions.


  • We encourage the WTO Seattle Round to table discussions on what should be the goal(s) of increased global trade and liberalized investment, i.e. how increased global trade and investment permits the achievement of social and environmental goals.

  • We encourage the WTO round to develop a plan whereby existing agreements might be fully assessed for their ability to:

    • Enable, rather than disable, the capacity of developing nations to improve their economic position with respect to developed nations (global equity).

    • Remove ecologically unsound forms of subsidies, rather than allow challenges to subsidies that are environmentally protective (environmental sustainability).

    • Strengthen, rather than weaken, the capacities of national governments to regulate markets for common good welfare goals (social justice).

Background: Our Interest in Economic Globalization

It is increasingly accepted that among the most powerful predictors of population health are how equitably wealth (income) is distributed within the population; and how sustainable is the use of natural resources 25). The pathway between income inequalities and individual health status is complex, involving both "materiality" (material conditions) and "meaning" (the psychosocial and physiological effects of how individuals interpret socioeconomic inequalities, generally, and their place on the social hierarchy, specifically). Overlaying this are the mental and physical health effects of under- or unemployment and economic insecurity, the impact on employability of low educational attainment under conditions of increased labour market competitiveness, and the role of unsupportive/un-nourishing early childhood environments on poorer adult health and social status. Parallel concerns exist with respect to a decline in many environmental stocks such as fish, other food sources, wood and fossil fuels, and the effects of greenhouse warming, ozone layer depletion and climate change. The decline in natural capital is notwithstanding cyclical patterns of overproduction and falling commodity prices, such as currently effects many farmers, with ensuing population unhealthy problems associated with worsened income inequalities (poverty). There is also evidence slowly accumulating that those countries which invest in public and environmental programs and regulatory infrastructures that mitigate these "health determining" conditions also perform better economically. 26)

"Free" Global Trade and Investment: What it Means for Health

Much current evidence suggests that global economic de-regulation are worsening conditions for population health. One recent example suffices to make the linkages:

Brazil [has] experienced the withdrawal of "hundreds of millions of US dollars a day" by "skittish portfolio investors" (The Globe and Mail, January 2, 1999.) This rapid capital outflow (preceded by a rapid inflow of speculation) sent Brazil's currency into frenzied fluctuation. The government threw all its currency reserves into unsuccessful efforts to stabilize it. The IMF and other lenders sent Brazil $41 billion US in additional emergency aid, but with very big strings attached: Cut debt. Reduce public spending. Privatize government services. Restore investor confidence by making Brazil "safe" again for foreign investors. The same Canadian newspaper, on the same day, carried a separate story describing how Brazil's IMF rescue package requires the government to reduce spending on environmental programs by 2/3rds. As a result, Brazil is losing tens of millions of dollars in support from other countries for a "centrepiece" project to help save what remains of the Amazon rain forest. Trees help to fix carbon and reduce the effects of greenhouse warming. Further destruction of the Amazon rain forest will likely only worsen what, in yet a third disparate article, the newspaper reports as 1998's "freakish weather worldwide." 27)

We might add to this a later controversy over Brazil's central bank governor, who was found to have earned personal millions by converting his Brazilian funds to US dollars shortly before implementing a 40% reduction in the value of Brazilian currency. Seconded to his public post from the private sector, his defense was that, as a businessman, he was obliged to seize advantage when presented with it.

Globalism and Social (In)Justice

Income inequalities in many countries have reached record levels, partly the direct and indirect result of neoliberal fiscal policies emphasizing market de-regulation and welfare state "minimalism." Globally, income inequalities more than doubled over the past 10 years and is accelerating rapidly 28). The 1999 UNDP Human Development Report described the rapidly growing gap between rich and poor (between and within) nations as reaching "grotesque proportions." A small class of super-rich people has appeared: The net worth of the world's richest 358 people in 1997 was greater than the combined net worth of the world's poorest 2.3 billion people 29). By 1998, the gap had grown further so that the richest 200 individuals had net incomes surpassing the world's poorest 2.5 billion people 30). These trends can be traced directly to liberalized trade and speculative investment practices. Poverty rates more than doubled in the two years after the Mexican peso collapse a few years ago, for example, with more than half the population now in "deep poverty," even as the collapse boosted the fortunes of Mexico's 20 odd billionaires 31). Privatization and free market development in the previous Soviet Union has led to the most rapid escalation of income inequalities on record, with dramatic and direct health effects: Life expectancy fell between 1989 and 1995 in 7 of 18 new republics by as much as 5 years. Supports for health, welfare and education (particularly kindergarten and other early childhood development programs) have eroded or disappeared, with long term health implications for the population of the entire region 32). These trends also have direct global health consequences: A small 1% tax on the world's wealthiest 200 persons would fund primary education programs for all of the world's children currently lacking such access. The short and long term health and economic benefits of such education-from increasing economic self-reliance to reducing unsustainable population growth-are well documented.

In brief, the current globalization process is unevenly "global" in terms of trade and investments. Trade liberalization is projected to marginalize further the poorest nations in which economic growth may be considered more relevant for poverty reduction. Least developed countries, with 10% of the world's people, account for 0.3% of the world trade, only half of their share two decades ago when the push to global trade first began in earnest 33). Foreign investments, frequently cited as engines for growth, take place mostly between North America, Europe and Japan, which together, with China, receive more than 90% of foreign direct investments. The rest of the world, with 70% of population receives less than 10%. Despite estimates of global income growth of almost $500 billion between 1995 and 2001 due to liberalized trade and investment, all of this will go to wealthy countries. Lesser developed countries will lose an estimated $600 million over their current levels of income (Asia, parts of Latin America). Sub-Saharan Africa is estimated to lose over $1.2 billion 34). For developing countries (excluding China) the average trade deficit in the 1990s was higher than in the 1970s by 3 percentage points of GDP while average growth rate was lower by 2 percentage points 35). The 1999 UNDP Human Development Report noted that those developing countries most integrated into global trading markets are actually faring worse economically. As many southern countries complain regularly at the WTO, the most tariff-protected sectors, the ones for which liberalization continues to be postponed, are agricultural products and textiles--the very sectors where poorer countries hold the greatest economic advantage over the wealthier north 36). Those agreements favouring the wealthy north, such as trade in services, intellectual property rights and global investment and competition policy, have resulted in action and committees and agreements at the WTO. Those favouring the south, such as technology transfer, capacity building and debt relief, have not. In a more particular case, the WTO prohibited preferential treatment by the EU for banana imports from former Caribbean colonies, where production tends to be small and farmer-owned, in contrast to the U.S.-based Chiquita corporation (who led the U.S. challenge) whose labour and environmental practices in Latin American plantations compare very poorly with those of independent Caribbean producers. The issue is not globalism itself, but whose globalism?

Such agreements will not only further skew global wealth inequalities; they will also increase economic inequalities within countries. Consider the case of Canada, until recently the only OECD country not to experience any significant rise in income inequalities over the past two decades. This was not the "magic" of free markets and the promise of "a rising tide lifting all boats." It was the result of deliberate government policies to redistribute wealth through a variety of tax transfers and social spending programs 37). Canada, like most nations, is now reversing many of these programs to make its economy "more globally competitive," partly in response to the liberalized trade and investment agreements it has entered into. Post-market income inequalities are now at their worst in 23 years, and the growth in the low-income population is 6 times greater than the average population growth 38).

Global Agreements and Ecological (Un)Sustainability

Initial environmental rulings under the new WTO and NAFTA also indicate a move in a population unhealthier direction. The US government used GATT/WTO agreements to force open Thailand markets to US tobacco companies, even as it was legislating against tobacco use within its own borders. Thailand was able to retain a ban on advertising, but the recently suspended MAI would have overturned even this legislative initiative 39). A recent WTO ruling prohibited a Japanese health policy to tax at a lower rate domestic spirits with lower alcohol content than imported spirits on the grounds that it discriminated against foreign competition. Another recent WTO ruling allows hormone-treated beef imports to the European Union, despite EU policies banning hormone treatments on health/safety grounds. The WTO demanded scientific certainty that hormones caused cancer or other adverse health effects, eviscerating the "precautionary principle" now adopted by many environmental health researchers and epidemiologists due to inherent methodological (if not ethical) difficulties of establishing such proof. The "shrimp-turtle" case challenge to U.S. Endangered Species Act ruled against import bans of shrimp products harvested in unsustainable or species-threatening ways. One of the first WTO rulings allowed imports of gasoline products into the US from Venezuela and Brazil that did not meet US environmental standards. The US had a choice: Allow the imports or pay compensation to these countries of $150 million/year. It has since re-written its Clean Air Act to allow dirtier gasoline, with both short and long term negative respiratory health consequences 40).

In each of the rulings above, it was one national government, representing domestic business interests, that brought a complaint about another national government's policies. NAFTA is presently the only major multilateral agreement that allows corporations to bring complaints against national governments, effectively according to private companies the same legal status as countries. The first test of this provision saw US-based Ethyl Corporation sue the Canadian government for $250 million (US) in lost potential profit from its ban on the use MMT, a manganese additive, in unleaded gasoline. More recently, a U.S. based water company is using the investor-state provision of NAFTA to sue the Canadian province of British Columbia for $400 million ($220 million U.S.) due to restrictions on bulk water exports legislated by the government. A recent legal opinion has concluded that the declared intent of Canadian federal and provincial governments to prohibit international trade in water (primarily to the U.S.) may be in violation of NAFTA and of current or proposed WTO agreements 41). The CEO of the U.S. water company is quoted as saying, "Because of NAFTA, we are now stakeholders in the national water policy of Canada." 42)

Liberalized Investment Agreements

Estimates vary, but generally claim that roughly $1.3 trillion (US) a day moves between countries chasing short-term investment returns based on currency exchange rates, interest rate variances, stock and bond market fluctuations, and so on. Very little of this investment goes to employment-creating production or trade in goods or services, however ecologically sound or socially just such production and trade might be. The disruptive effects of short term speculative finance on national economies (Mexico, Brazil, Southeast Asia) are well known and became one of the points of contention in civil society objections to the proposed MAI. Even neoliberal economists, who once favoured wide open investment liberalization, are now more cautious in claiming its virtues, particularly since there is general consensus it will not lead to changes in foreign direct investment that might benefit developing nations 43). Rather than de-regulating such investment, we believe that speculative finance capital should be more stringently regulated, as has been attempted (with positive economic results) in Malaysia and Chile. Had the MAI been approved, it would likely have forced Chile to remove its "speed bump" requirements on foreign investment.

Many countries have voiced support for a "financial transaction tax," often called a Tobin tax after the economist who first proposed it. This very small tax would be levied on all tradings in stocks, bonds, currencies, options, futures and derivatives contracts. It would not deter long-term investment, but would become very costly (and so less profitable) to those moving huge sums of "virtual" capital around the planet on a daily and de-stabilizing basis. It would also raise about $150 billion US annually (1995 estimate), which could be used to develop the internal capacities of poorer nations to comply more rapidly with social and environmental accords. Canada became the first country internationally to pass a motion--though only a non-binding statement of intent--urging multilateral implementation of a financial transaction tax.

The Social Clause Debate

A growing international NGO movement exists calling for "social clauses" to be incorporated into trade/investment agreements. Initial clauses are those governing basic human, labour and child rights; and important multilateral environmental accords. The argument is that various UN agencies responsible for the oversight of these accords would have WTO trade sanction penalties at their disposal. NGOs, however, are divided on this strategem. One particular concern is that social clauses could become a "backdoor protectionism." Wealthier countries with the ability to more readily abide by such social and environmental agreements could use trade sanctions against poorer nations lacking the internal resources to do so. This is a legitimate concern, given that current trade and investment agreements favour the rich within wealthy nations over everyone and everywhere else. Social clauses, however, may work, provided the principle of differential compliance is afforded poorer nations; and that the welfare regulatory solutions are not simply to mold these countries in the policy traditions of the north.

The case of child labour stands as an example. Several developing countries, particularly those with large textile plants, argue that enacting International Labour Code policies on child labour could force children away from their parents working in factories and onto more dangerous and unsupervised streets. But mechanisms for disbursing trade benefits more equitably within and between nations could make it possible for textile factories, to continue with the example, to gradually implement health and education programs for workers and their families within the factories themselves. These mechanisms would introduce social programs to the constellation of work and social relationships currently existing within economically developing nations, rather than imposing European or North American models from on high. This principle of "differential compliance" for poorer countries is already recognized in many UN declarations, including agreement on the need for wealthier countries to provide economic and technical assistance to poorer nations to help them achieve compliance. This agreement, however, presently remains unenforceable and, at least in trade-related matters, one effect of the WTO has actually been to foreclose "special and differential treatment for developing countries." 44)

Towards a Socially and Environmentally Responsible Regime of Global Trade and Investment

As stated at the outset: We do not oppose global trade and investment. But we maintain that such trade and investment must be harnessed towards social development and environmental protection goals. Current WTO and other multilateral trade and investment agreements are driven by untested, and so far counterfactual, neoliberal economic theories about the social beneficence of economic growth. They have been enacted at the expense rather than enhancement of other multilateral agreements on social and environmental "common good" goals; and of the abilities of national governments to regulate their internal economies towards such objectives.

We believe fundamentally that issues of trade and investment, and agreements thereon, must not be separated from issues of governance (regulatory and redistributive) for common good social and environmental goals.

The precise means for this integration remains moot: Social clauses? Formal linkages between the WTO and UN agencies overseeing social and environmental agreements? Creation of new multilateral bodies for such agreements with similar, but not necessarily identical, enforcement measures to that of the WTO? Specific requirements for environmental impact and health (social development) inequalities assessments of current and proposed trade and investment agreements? Integration of the WTO into the UN?

We do not wish to preclude any of these options from consideration.

Instead, we believe that how this integration might occur must become the agenda of the Seattle and subsequent WTO Rounds; and that until some resolution to this is created structurally (as distinct from simply declarations of intent) that no new multilateral trade and investment agreements be considered.


1 Daly, H. and Cobb, J. (1989) For the Common Good. Boston: Beacon Press. Back

2 Communication from Canada, "WTO and Transparency" October 1/99. Back

3 Shyrbman, S. "A legal opinion concerning water export controls and Canadian obligations under NAFTA and the WTO," 1999; Back

4 Koivusalo, M. (1999) "World Trade Organisation and Trade-Creep in Health and Social Policies," GASPP/STAKES; University of Sheffield. Back

5 Cited in Khor, M. "Experts caution against wrong issues in new round," Third World Network 7/24/99; Back

6 Cited in Grimaldi, J. "Clinton offers critics a seat at WTO event," Seattle Times Washington Bureau 11/4/99. Back

7 Cited in Khor, M. "Experts caution against wrong issues in new round," Third World Network 7/24/99; Back

8 See for example, Khor, M. "G77 Ministers' message to Seattle WTO meet," Third World Network, 9/6/99; Back

9 e.g. Communication from the United States, "Further Negotiations As Mandated by the General Agreement on Trade in Services, (GATS)," July 28/99 Back

10 George, S. "Health care attacked by WTO," Le Monde, July 1999. Back

11 Drager, N. (1999) "Making trade work for public health," BMJ 319:1214. Back

12 Khor, M. "G77 Ministers' message to Seattle WTO meet," Third World Network, 9/6/99; Back

13 Communication from Indonesia, Malaysia, Philippines and Thailand, "Special and Differential Treatment for Developing Countries to World Agricultural Trade and the Mandated Negotiations" September 22/99. Back

14 Koivusalo, M. (1999) "World Trade Organisation and Trade-Creep in Health and Social Policies," GASPP/STAKES; University of Sheffield. Back

15 e.g. Communication from Bolivia, Colombia, Ecuador, Nicaragua and Peru, "Proposal on Protection of the Intellectual Property Rights Relating to the Traditional Knowledge of Local and Indigenous Communities," October 12/99 Back

16 Communication from Kenya on behalf of the African Group, "The TRIPS Agreement," August 6/99. Back

17 Raghaven, C. "Investment, competition not ripe for negotiation, says US" Third World Network 10/14/99; Back

18 Raghaven, C. "WTO members awaiting new draft text for Seattle" Third World Network 10/17/99; draft Back

19 The United States in particular has argued that it is important "to recognize the right of Members to take science based measures to achieve those levels of health, safety and environmental protection that they deem appropriate-even when such levels of protection are higher than those provided by international standards." (Communication from the United States, "Trade and Sustainable Development" July 30/99). We support this stance, but note the U.S. itself did not accept this position in its successful challenge against the EU ban of hormone-treated beef. We also note that this Communication calls for liberalization of trade in "environmental services and goods," in which developed nations, and particularly the U.S., hold a distinct advantage. There is no mention in this Communication of the Rio 21 agreements for rich nations to assist poorer nations with "green" technology transfers. Back

20 Acheson, D. (Chair) (1998) Independent Inquiry into Inequalities in Health Report London: The Stationery Office. Back

21 Raghaven, C. "WTO members awaiting new draft text for Seattle" Third World Network 10/17/99; draft Back

22 Mander, J and Barker D, "The World Trade Organization: Processes and Rulings" 1999; Back

23 We note here our specific disagreement with Canada's WTO challenge to the EU's stricter standards on asbestos exposure. Back

24 Cited in Koivusalo, M. (1999) "World Trade Organisation and Trade-Creep in Health and Social Policies," GASPP/STAKES; University of Sheffield. Back

25 There is an extensive literature on the economic, environmental and social determinants of health. For recent reports summarizing some of this literature, see National Forum on Health (1997) Canada's Health Action: Building on the Legacy, Ottawa: Author; and Acheson, D. (Chair) (1998) Independent Inquiry into Inequalities in Health Report London: The Stationery Office. Back

26 This research is often subsumed under the construct of "social capital," of particular and recent interest to the World Bank and other international bodies as an instrumental means to economic growth. There is also an older and far richer history of research on various aspects of social life (social networks, social support, community capacity/control) that helps to link health status and quality of life to a combination of economic development (though not necessarily growth) and public regulation/social program investments. Back

27 Labonte, R. (1999) "Health Promotion in the Near Future: Remembrances of Activism Past," Health Education Journal (in press). Back

28 The CCPA Monitor November 1998, p.3; Ottawa: Canadian Centre for Policy Alternatives Back

29 WHO (1997) Health and Environment in Sustainable Development: Five Years after the Earth Summit. Geneva: WHO. Back

30 UNDP (1999) Human Development Report. Toronto: Oxford University Press. Back

31 Wallach, L. (1997) "Impact of NAFTA on the US Economy: Testimony before the International Trade Commission" May 15, 1997; Back

32 UNDP (1999) Human Development Report. Toronto: Oxford University Press. Back

33 UNDP (1997) Human Development Report. Toronto: Oxford University Press. Back

34 Voluntary Services Overseas "Free Trade: For Whom?" 1996, Back

35 UNCTAD Trade and Development Report 1999, cited in Khor, M "South must reexamine trade, investment liberalization," Third World Network, 9/16/99; Back

36 World Trade Organization (1999) International Institute for Sustainable Development Report on the WTO's High-Level Symposium on Trade and Development http://wto-org/hlms/sumhldev.htm Back

37 National Forum on Health (1997) Canada's Health Action: Building on the Legacy, Ottawa: Author. Back

38 Policy Research Committee (1996) Growth, Human Development, Social Cohesion (Draft interim report) Ottawa: Policy Research Committee Back

39 See Koivusalo, M. and Ollila, E. (1998) "Health policies by default: the changing scene of international health policies," Helsinki: GASPP (mimeo; paper presented to World Congress of Sociology, Montreal, 1998); and Public Citizen's Global Trade Watch Backgrounder "The Alarming Multilateral Agreement on Investment," 1997; Back

40 Shrybman, S. "An Environment Guide to the World Trade Organization," Common Front on the World Trade Organization, 1997; Back

41 Shyrbman, S. "A legal opinion concerning water export controls and Canadian obligations under NAFTA and the WTO," 1999; Back

42 Barlow, M. "Global rules could paralyze us," National Post August 31, 1999. Back

43 Khor, M. "Experts caution against wrong issues in new round," Third World Network 7/24/99; Back

44 Hart, M. (1996) "A Question of Fairness: The global trade regime, labour standards and the contestability of markets," Ottawa: Centre for Trade Policy and Law. Back

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