Public health implications of world trade negotiations
Authors: Jean-Pierre Unger, Pierre De Paepe, Patricia Ghilbert, Tony De Groote
Journal: The Lancet (2004)

We agree with the main sentiments of Allyson Pollock and David Price (Sept 27, p 1072).1Pollock A Price D The public health implications of world trade negotiations on the general agreement on trade in services and public services.Lancet. 2003; 362: 1072-1075Summary Full Text Full Text PDF PubMed Scopus (41) Google Scholar Moreover, the effect of world trade negotiations on the general agreement of trade and services (GATS) could have serious implications for developing countries, where healthcare systems are characterised by weak administrations and the coexistence of public and private sectors. Since 1990, the aid policies of industrialised countries has tended to restrict the public sector's functions to mere disease control. On the grounds of the private sector's supposed higher efficiency, this policy recommends marketing of curative care together with prioritisation of disease control within the public sector.2Commission of European Communities Communication from the Commission to the Council and the European Parliament: health and poverty reduction in developing countries.http://europa.eu.int/eurlex/en/com/cnc/2002/com2002_0129en01.pdfGoogle Scholar GATS article 1.3.c. makes this recommendation compulsory: "a service supplied in the exercise of governmental authority means any service which is supplied neither on a commercial basis, nor in competition with one or more service suppliers". It could be invoked by powerful health services companies in countries with a weak bargaining position, to prevent publicly oriented services from receiving government subsidies or oblige subsidised public services to limit their activities to disease control. As a consequence, access to general care will further suffer in areas where private providers are scarce (60% of the population of low-income developing countries live in rural areas), or will become too expensive for most (82·6% of south Asians live on less than US$2 per day3World Bank Global economic prospects 2003. Chapter 1: global and regional poverty trends.http://www.worldbank.org/prospects/gep2003/chap1.pdfGoogle Scholar). Article 1.3.c. could also hamper disease control—the paradigm of contemporary international aid in health. It provides the legal basis to preclude integration of disease control with general practice. Nevertheless, many commentators stress the convenience of integrating programmes into health facilities to achieve a reasonable prospect of successful disease control.4Unger JP de Paepe P Green A A code of best practices to disease control programmes to avoid damaging health care services in developing countries.Int J Health Plann Management. 2003; 18: 27-39Crossref PubMed Scopus (92) Google Scholar Such integration requires structures with patients, as journalists noticed while analysing causes of the severe acute respiratory syndrome (SARS) epidemic in China.5Muldavia J China's poor left behind.International Herald Tribune. May 8, 2003; Google Scholar These patients, consulting for various symptoms, represent a pool of users that disease control programmes need for early case detection and sufficient coverage. Subsidies to publicly oriented services owned by ministries of health, city councils, and non-governmental organisations could be barred on the ground of GATS article 1.3.c. Politicians who endorse it carry a heavy moral responsibility.