Evolving global norm/policy on the interface between trade and health: An insight into the WHO FCTC negotiations by the Conference of the Parties

Background: Trade-health interrelationship has become embedded in global health governance since the 1980s when United States Trade Representative used trade arguments under the General Agreement on Tariffs and Trade to open tobacco markets in Asia. While literature on this discourse continues to grow, little is known about how issues have evolved over a decade of existence of the WHO Framework on Convention and Tobacco Control (FCTC). Therefore, we aim to examine the evolution of norms/ideas to address trade-health relations to inform global governance and advocacy initiatives. 

Methods: Using process tracing approach, we triangulate observations of FCTC Conference of the Parties (COP) meetings, interviews, and archival documents retrieved through snowball method. We analyze data to identify major decision-making venues for trade-health and themes underlying decisions.

Results: Beginning with 2002 WHO-WTO's report during the FCTC negotiations to reconcile trade rules with public health, there have been sustained efforts within WHO and UN to address the issue, culminating in COP resolution on Trade and Health issues during the 6th meeting in 2014 in Moscow, Russia. This has led to increasing convergence around three core ideas: 1) minimization of tobacco industry use of trade/investment agreements against tobacco control; 2) multi-sectoral collaboration; and 3) health impact as integral part of trade/investment negotiations.

Conclusion: Deemed in early 2000s as mutually exclusive, nation-states have continued to negotiate the trade-health issue, leading to convergence on the need to incorporate health impact in trade/health negotiations. This bode well for the protection of health policies against tobacco industry threats.