Paradigm Shift: New Ideas for a Structural Approach to NCD Prevention; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

It is a well-documented fact that transnational corporations engaged in the production and distribution of health-harmful commodities have been able to steer policy approaches to address the associated burden of non-communicable diseases (NCDs). While the political influence that corporations wield stems in part from significant financial resources, it has also been enabled and magnified by what has been referred to as global health’s neoliberal deep core, which has subjected health policy to the individualisation of risk and responsibility and the privileging of market-based policy responses. The accompanying perspective article from Lencucha and Thow draws attention to neoliberalism in the NCD space and the way it has historically structured patterns of thinking and doing that foreground economic interests over health considerations. In this commentary, we explore how shifting from a focus on material power to discursive power creates space to see the NCD agenda as a battle of economic ideas as well as dollars, and consequently the importance of public health engagement in the next vision for the economy

Public health over private wealth: rebalancing public and private interests in international trade and investment agreements

The emerging global trade and investment regime is a site of ongoing contestation between states, powerful industry actors and civil society organisations seeking to infuence the formation of legal rules, principles, practices and institutions. The inclusion of major transnational tobacco, alcohol and ultraprocessed food companies seeking to influence governments in these processes has resulted in the expanded distribution and consumption of unhealthy commodities across the globe, overshadowing many of the positive impacts for health hypothesised from liberalised trade. The growing number of pathways for market actors to exert undue influence over national and international regulatory environments provided by agreements, such as the Comprehensive and Progressive Agreement for Trans-Pacific Partnership, has given many cause to be concerned. In the context of continued commitment by states to international trade and investment negotiations, we present several avenues for public health scholars, advocates and practitioners to explore to rebalance public and private interests in these deals

Trade and public health

As the number of new negotiations of regional trade and investment agreements has grown in recent years, evidence is mounting about their implications for population health.A linked CMAJ article by Barlow and colleagues is the latest to examine trade and investment policy as a plausible causal driver of diet-related health outcomes through high-sugar, high-fat and high-sodium food products. The authors found that even the minor reductions in tariff rates brought in by the North American Free Trade Agreement (NAFTA) on products such as high-fructose corn syrup, a common additive to sugar-sweetened beverages and other highly processed food products, were strongly associated with the increased supply of such commodities into Canada

The Trans-Pacific Partnership agreement and public health: Why we should be concerned

In October 2012, Canada became a negotiating member of the Trans-Pacific Partnership (TPP) agreement along with 11 other Pacific Rim countries. Widely touted as "a model for 21st-century trade agreements,"1 it extends well beyond traditional trade issues into domestic policy, creating a number of concerns about its implications for public health. These concerns include potential increases in pharmaceutical costs, the undermining of Canadian patent law, and strengthened investor rights over public health regulations to limit the consumption of products harmful to health. The Comprehensive Economic and Trade Agreement (CETA) currently being negotiated between Canada and the European Union has already been forecast to increase Canadian drug costs by between $850 million and$1.6 billion annually by extending patent protection; leaked text of the TPP suggests that its provisions would increase these costs further.2 (See also Box 1.) The TPP's draft chapter on intellectual property rights goes beyond CETA, allowing the patenting of new forms and uses of old drugs regardless of efficacy, and introducing the patenting of diagnostic, therapeutic, and surgical methods. Although the rationale for extending patents is that it will lead to increased research and development spending in Canada, brand-name pharmaceutical companies have failed to comply with similar commitments in the pas

The TPP Is Dead, Long Live the TPP? A Response to Recent Commentaries

One of President Trump’s first actions on assuming office was to formally withdraw the United States from the Trans-Pacific Partnership (TPP), ironically an agreement driven more by American business interests than by those of the other 11 signatory countries. But the issues raised in our health impact assessment (HIA) of the TPP, and the insightful commentaries it generated, have not died alongside the agreement. Regardless of the unpredictability of global politics during the Trump presidency, especially in terms of global trade relationships, the importance of ongoing analyses of the health impacts of trade has not abated. If anything, as several commentators note, it requires expansion, not diminishment