By Zoltan Massay-Kosubek

The authzmkor, who is Policy Coordinator at the European Public Health Alliance (EPHA) argues that trade liberalisation policy can both support public health goals and undermine them. The potential for economic growth and higher incomes enable wider access to healthier lifestyles, while increased availability of cheaper processed foods, tobacco and alcohol can promote further growth in diseases and conditions such as cardiovascular diseases, respiratory diseases, cancer and diabetes as well as obesity. There is therefore a need to mainstream public health objectives in trade agreements to achieve better synergies with other, health relevant international agreements that aim to address the growing transatlantic burden of chronic Non-communicable diseases (NCDs).

In order to understand the link between trade policy and public health, we have to take into account that trade negotiations are taking place in a context of the high and growing burden of chronic non-communicable diseases (NCDs), such as cardiovascular disease (CVD), diabetes, cancers, chronic respiratory diseases as well as obesity. These conditions constitute the largest health burden in the EU and the US.

Economic and societal burden of NCDs

The World Economic Forum and the Harvard School of Public Health predicts that NCDs will result in a cumulative loss in global economic output of $47 trillion, or 5% of GDP, by 2030, principally through heart disease, stroke, alcohol misuse and depression in high-and upper-middle-income countries.[1] The predicted cumulative losses of 5% of GDP would be even larger if the economic value and utility that people attribute to health were adequately captured. Sustainable growth cannot be achieved without addressing that burden, and TTIP should reflect that.

Global declarations, targets and goals on NCDs

The scale and threat of NCDs are recognised globally through the adoption of policy declarations and goals and targets to be achieved, including the legally binding sustainable development goals (2015), to reduce by on third premature mortality from NCDs by 2030 and the political declaration of the High-level Meeting of the General Assembly of the UN on the Prevention and Control of Non-communicable Diseases (2011), to reduce premature mortality from NCDs by 25% by 2025

NCD risk factors

60% of the NCD burden is due to common risk factors, notably tobacco, poor diet, alcohol, environmental factors and lack of physical activity. In the EU, tobacco is responsible for almost 700,000 deaths every year,[2] while in the US, more than 480.000 people die each year from cigarette smoking and exposure to second-hand smoke. [3] Harmful consumption of alcohol is damaging to health. A recent OECD report from 2015 shows that alcohol negatively affects OECD countries’ socioeconomic performances as productivity losses associated with harmful alcohol use are in the region of 5% of GDP in most countries.

Overconsumption of certain foodstuffs, namely those high in fat, salt and sugar (HFSS) leads to overweight, obesity and a range of NCDs. Obesity is estimated to be responsible for 1% to 3% of total health expenditure in most countries (5% to 10% in the United States), and costs will rise rapidly in coming years as obesity-related diseases set in.[4] Tobacco, foodstuffs and alcohol are widely traded goods.

International legal instruments and political documents on NCD risk factors

A number of international political documents set out goals and commitments that the EU and its Member States have taken to limit the ill effects of tobacco, alcohol and unhealthy food and recommendations to governments how to regulate them. These include a legally binding treaty in the field of tobacco: the famous Framework Convention on Tobacco Control (2005) and its protocols. The FCTC has been ratified by both the EU and all of its Member States while the US has only signed it without ratification. In the field of alcohol and unhealthy food, international documents provide strategies and action plans on NCD risk factors. Those include the following agreements:

Diet and nutrition

 – World Declaration and Plan of Action for Nutrition (1992)

- The Global Strategy for Infant and Young Child Feeding of the World Health Organization and the United Nations Children’s Fund (2003)

- The Global Strategy on Diet, Physical Activity and Health of (2004)

- Rome Declaration on Nutrition (2014) and the Rome Framework for Action on Nutrition (2014)


- Global Strategy to reduce harmful use of alcohol (2010)

- The World Health Organization Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children (2010)

Policy coherence between trade and public health policies

Trade liberalisation policy can in fact both support public health action and undermine it. Positive impacts include the potential of economic growth, higher incomes, greater employment opportunities, more stable supply of products and services.

Negative impacts could increase the availability of products causing poor health (mainly alcohol, tobacco and unhealthy food), obesity and NCDs. It is essential that the both the EU and its Member States and the US and States can preserve and expand policy space for action on NCD prevention and management, and that there are governance mechanisms in place for public health policies to be developed and enacted. Recognizing these global public health concerns is therefore essential to create coherence between WHO and WTO policy aims and to meaningfully protect the right to regulate in order to protect and improve public health.

Conclusions and recommendations

In the light of the above, there is a need for mainstreaming public health in TTIP. This may be achieved by making reference to international legal instruments and policy declarations adopted and endorsed by the US, the EU and all 28 EU Member States as well as by including appropriate wording in preambles, goals and objectives as well as in the legal texts of relevant chapters in TTIP.

EPHA is a EPHA-logochange agent: Europe’s leading public health umbrella NGO advocating for better health. EPHA is a member organisation of TACD


[1] Bloom, David et al. (2011), ‘The Global Economic Burden of Non-communicable Diseases’, World Economic Forum, Geneva

[2] Impact assessment of the Tobacco Products Directive (2014/40/EU) 

[3] Tobacco Free Kids – Toll of Tobacco in the United States of America 

[4] OECD Obesity Update 2014