----------Forwarded message ----------
Date: Fri, 19 Nov 1999 08:38:45 -0600
From: Ronald Labonte <[log in to unmask]>

Further to Adeline's challenge: I've been mobilizing some "official"
health NGO responses and a Brief on the WTO, trade and health. This now
includes the CPHA, the Canadian Society for International Health, the
International Union for Health Education and Promotion (IUHPE), and the
Canadian Consortium for Health Promotion Research. The IUHPE has board
members in several countries, who are developing letters and circulating a
brief to their political leaders, and particularly to their trade
ministers. Below is a copy of a draft letter prepared for the Canadian
Consortium for Health Promotion Research. I am sending it below if it
might help CLICK4HP members in contexting some of the issues before the
WTO, and some of Canada's already stated intentions.

Besides sending whatever you wish to Pierre Pettigrew (the trade minister)
and the PM, I would suggest copying it to Martin (finance), Rock (health),
Anderson (environment) and Axworthy (foreign affairs); as well as to
opposition leaders and critics to the above portfolios. Their e-mail
addresses can all be found on the Government of Canada web-site, with a bit
of searching.

I'd also suggest sending a copy to Mike Moore, the Director-General of the
World Trade Organization. Use the WTO web-site to find his address. (I
apologize for not having either of the two addresses handy to paste into
this reply; that's why search engines were invented, I suppose.)
______
DRAFT LETTER PREPARED FOR CANADIAN CONSORTIUM FOR HEALTH PROMOTION RESEARCH

The Honorable Pierre Pettigrew
Minister of International Trade

The Canadian Consortium for Health Promotion Research is comprised of 14
university-based centres across Canada, involving hundreds of researchers
from a variety of disciplinary backgrounds. These centres have
collaborated on joint projects for more than 10 years, contributing to the
production and dissemination of knowledge which has given Canada a
prominent international place in health promotion.
Our Consortium members are deeply concerned that current trade and
investment liberalization poses a number of direct and indirect health
threats. We are not opposed to global trade per se. But we believe that
decisions about trade and investment should not be made in isolation of
decisions on social and environmental goals that ultimately create the
conditions for public health.

The scientific knowledge base, to which our Consortium members have
contributed, shows that health status improves with increased economic
growth but, more importantly, this relationship flattens out at a fairly
low level of GDP/capita (roughly US $5,000-$10,000). Beyond this level the
most important determinant of health status is how equitably wealth is
distributed within a population. Market forces may generate wealth, but
they cannot and do not determine the equity of its distribution. This
requires active government intervention through progressive tax/transfer
programs and universal health, education and welfare programs and policies.

The pathway between wealth inequalities and 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. Again, all of these health determining
conditions require active government intervention into market activities
rather than the reverse. There is also evidence slowly accumulating that
countries which invest in public programs and regulatory infrastructures
that mitigate these health determining conditions also perform better
economically.

The scientific evidence tells us that we do not need more economic growth
in wealthy nations to improve public health. This has significant
implications for environmental sustainability. There remains a vastly
disproportionate consumption of environmental resources and toxics
production by wealthy people in wealthy nations. We are witnessing
potentially catastrophic declines in many environmental stocks such as
fish, other food sources, wood and fossil fuels; as well as experiencing
the effects of greenhouse warming, ozone layer depletion and climate
change. Continued economic growth by wealthier nations will only worsen
these trends, as will the market-driven, trade liberalized and
privatized form of economic development in poorer countries fostered by
structural adjustment programs, and now reinforced by WTO trade and
investment agreements.

We wish to re-iterate: We are not opposed to global trade or
investment. Some liberalization proposals now before the WTO for
discussion at the Seattle Round may help environmental protection,
specifically the removal of subsidies that promote unsustainable fisheries,
forestry or agricultural practices. But we are concerned that most WTO
agreements, both past and proposed, will worsen, rather than improve,
social equity and environmental sustainability outcomes.

Our position is that all such trade and investment proposals, and
particularly their liberalization, should be examined before agreements are
made on the basis of how such trade would improve equity in the
distribution of material and financial resources (within and between
nations), and sustainability in the use of natural resources..
We note that Canada has committed itself to many processes that may begin
to move the WTO in this direction, particularly respecting environmental
concerns. We also urge Canada to take the international lead in initiating
a "health inequalities assessment" of WTO agreements. This term was
adopted by the recent UK Acheson Report on Health Inequalities. 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?
We strongly believe that such undertakings require the combined
collaborations of WTO representatives and technical staff, UN agencies
responsible for key social and environmental accords and representatives
from civil society organizations. Our Consortium members would be pleased
to cooperate with your department, and with Health Canada, in this regard.
We also recognize that the WTO has already committed itself to discussion
on a number of trade and investment agreements; and that Canada has
committed itself to certain positions with respect to these
discussions. We thus have several comments on how these discussions should
proceed if they are to maintain or improve public health.

Specifically:

1. We support the Canadian communication (October 1/99) on "WTO and
Transparency," recommending measures to make more public WTO Panel and
Appellate Body submissions.

However: We remain concerned at the exclusion of civil society interests
in these panels, particularly in light of most WTO rulings to date
favouring liberalized trade over social and environmental goals fundamental
to public health.

2. We support the Canadian communication (October 1/99) on "The WTO
and International Economic Policy Coherence," (October 1/99), which argues
for some structural association between the WTO and other international
economic and development organizations.

However: We are concerned that this argument is based on the theory that
trade liberalization improves social welfare by leading to greater wealth
generation, and thus greater government ability "fulfill the social and
public choices of their citizens." We do not find this a convincing
argument on historical and empirical grounds.

3. We support the Canadian communication (October 1/99) on "Trade
Development," calling for increased market access for developing countries,
especially since the data so far indicate that trade liberalization has
been to their detriment, rather than benefit. This includes extending
"special and differential" treatment to such countries.

However: We remain skeptical of the claim that such treatment
should soon give way to a single class of WTO membership. This claim
assumes that poorer nations, whose share of global wealth is decreasing
rather than increasing with liberalized trade, can compete equitably
provided they have sufficient internal capacity to implement WTO agreements.

4. We support the Canadian communication (October 4/99) on "Canadian
Approach to Trade and Environment in the New WTO Round," in which you
commit Canada to an environmental assessment of the upcoming round of WTO
negotiations.

However: This Communication states, in part, that "wealth
generated by improving market access...increases [countries'] abilities to
adopt policies which will achieve economic development, greater social
equity and enhanced environmental protection."

Many aspects of current NAFTA and WTO agreements actually
weaken Canada's, and other nations', abilities to regulate for both of
these outcomes and the past two decades of liberalized trade have seen
decreased social equity and environmental protection.

5. We are pleased that you have announced that health services will
not be included in expanding the GATS agreement. We believe, however, that
no discussions on the expansion of GATS should occur at this Round until a
retrospective assessment of all existing WTO agreements (including GATS) on
equity and environmental outcomes is completed. If such discussions do
occur, however, we recommend that they proceed on a case-by-case basis, and
not in the "top-down" fashion. This allows for a clearer analysis of the
equity and environmental effects of liberalized trade in specific service
sectors. Service agreements, in any case, must not include trade in social
welfare services (health, education, income transfer/supports), the effects
of which cannot be measured simply in economic terms of efficiency and
effectiveness, and the funding of which often constitutes an important
means of geographic redistribution of wealth within nations.

We have joined with several other professional health organizations
(notably the International Union for Health Promotion and Education, the
Canadian Public Health Association and the Canadian Society for
International Health) in bringing our concerns forward to you.
Canada, with its internationally respected history in innovative health
care, health promotion and population health initiatives, is in a unique
position to lead the rest of the world in re-framing trade and investment
negotiations away from simple liberalization, and towards ensuring that
such agreements incorporate common good goals enshrined in many UN
agreements. We include as key agreements the UN Declaration of Human
Rights, the International Covenant on Economic, Social and Cultural Rights,
the International Covenant on Civil and Political Rights, the Rio Summit
Agenda 21, the International Declaration on the Rights of the Child, the
Beijing Summit on Women, the Copenhagen Summit on Social Development and
the ILO Convention on Labour. Ironically, progress on many of these
unenforceable accords is being undermined by enforceable trade and
investment agreements.

We look forward to your response. We reiterate our wish to make ourselves
accessible to your office in the future as social and environmental goals
increasingly enter into trade negotiations, as we believe they must.
In conclusion, we repeat our initial position:

We support trade that is ecologically sound and leads to greater equity in
the distribution of income and other resources within and between nations;
these conditions of equity and sustainability have been repeatedly shown by
scientific studies to be the most important determinants of the health of
populations.

Yours respectfully,

Ronald Labonte, Director
Saskatchewan Population Health and Evaluation Research Unit
Professor, Community Health and Epidemiology
College of Medicine, University of Saskatchewan
107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5
phone: (306) 966-2349
fax: (306) 966-7920
e-mail: [log in to unmask]