PHA-Exchange> CAFTA & Health: Letter sent to Congress, USTR

[Ellen Shaffer]

The following letter expressing grave concerns regarding CAFTA's effects on 
health, services, tobacco control, access to medicines and related issues 
was sent yesterday to key Congressional committees and the USTR.  CPATH 
will continue to collect signatures from organizations, so please let us 
know if you'd like to sign on.  (Future copies will be used for ongoing 
education.) We can also provide you with a formatted version in Word on 
request. - Ellen Shaffer, CPATH

PUBLIC HEALTH STATEMENT ON
THE U.S.-CENTRAL AMERICAN FREE TRADE AGREEMENT (CAFTA)

To: U.S. Congress, U.S. Trade 
Representative                                             June, 2004

We are writing to express our grave concerns regarding the US-Central 
American Free Trade Agreement (CAFTA) and similar pending trade agreements. 
CAFTA proposes to establish rules for trade among seven nations (United 
States, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and the 
Dominican Republic).

A number of provisions would lock in threats to public health and health 
care. Provisions of the services chapter could reduce affordable access to 
vital human services including health care, water supply, education and 
energy; and preempt the authority of public officials to protect health 
standards for professional licensing, environmental and occupational 
health, alcohol and tobacco protections, privacy rules, and patients' 
rights. Other CAFTA chapters directly related to health cover intellectual 
property, which could reduce access to affordable medicines; standards for 
the safety of plants and food; and rules on how governments procure goods 
and services, and allocate subsidies. Many of these areas are already 
matters of controversy within the World Trade Organization (WTO).  These 
provisions should not be approved in CAFTA, and should not stand as 
precedents for future trade agreements. Further, public health must have a 
voice in trade negotiations, which increasingly affect health and health care.

Public Health Concerns

1.      There is no formal representation for health care and public health 
in US trade negotiations,
and little if any representation within other countries. While many 
industries sit on Advisory Committees to the U.S. Trade Representative, 
there are no representatives from public health. No impact assessments are 
conducted on trade in health services.

Despite an Executive Order requiring the US Department of Health and Human 
Services to provide advice to the US Trade Representative regarding the 
potential health impact of any tobacco trade-related policy decisions, it 
is not clear whether HHS has been provided with a meaningful opportunity to 
do so.  Costa Rica specifically assigns its Ministry of Health to CAFTA's 
Committee on Technical Barriers to Trade. The US appoints only the USTR.

2.         CAFTA should not pit health and human rights against the rights 
of private foreign corporations. Measures that protect health have been 
successfully challenged under the investors' rights provisions of similar 
trade agreements.  For example, the US Metalclad Company successfully sued 
Mexico for $16 million under the North American Free Trade Agreement 
(NAFTA), when Mexico refused to reopen a toxic waste dump that would 
contaminate people and the environment.

CAFTA Article 21.1.2 (Exceptions) grants nations the right to exempt 
measures that are necessary to protect human, animal or plant 
life.  However, this exception applies only if it is "not applied in a 
manner which would constitute arbitrary or unjustifiable discrimination 
between countries, or a disguised restriction on trade in services." In 
comparison, Article 21.2, Essential Security, gives nations the right to 
exempt any measures they consider necessary for peace and security.  There 
are no qualifications to this right.

3.   CAFTA rules preempt the authority of public officials to protect 
health standards: professional licensing, environmental and occupational 
health, alcohol and tobacco protections, privacy rules, and patients' rights.

Under NAFTA, a private Canadian corporation is challenging an executive 
order by the State of California to remove the additive MTBE from gasoline. 
MTBE is known to leak into ground water, and acts as a carcinogen.

Tobacco companies would be granted the ability to directly challenge 
national and state tobacco control laws under CAFTA's investment provisions.

4.  CAFTA can reduce access to vital services including health care, water 
supply and sanitation, education, and energy.  By covering health care and 
other services under trade rules, CAFTA would facilitate privatization of 
these services, making them less affordable, especially for vulnerable 
populations, and less accountable.  While health is universally recognized 
as a human right, it may become a market commodity if trade agreements 
don't protect affordable universal access to health care.

Doctors in El Salvador have gone on strike twice in the last three years to 
prevent privatization of their public health care system, in order to 
assure access and affordability of health services.  Under CAFTA, 
government spending at scores of Salvadoran hospitals would be open to 
private companies.

5.   CAFTA and similar trade agreements preempt the production and 
humanitarian distribution of affordable lifesaving medicines. They grant 
multinational corporations the intellectual property rights to plants and 
seeds that the majority of the world's poor depend on, undermining 
sustainable, biologically diverse agriculture.

Millions with HIV/AIDS cannot get affordable, life-saving medications due 
to the WTO's TRIPS agreement, which props up prices for drug companies.  At 
the same time, many US residents can't afford needed drugs.  Both CAFTA and 
the Australia Free Trade Agreement present further barriers to affordable 
drugs.

Guatemalan farmers who depend on their knowledge of and access to medicinal 
and nutritional plants could be required to pay transnational corporations 
that patent seeds, undermining their ability to survive.

6. CAFTA Undermines Public Health Objectives of Government Procurement

Local, state and national governments' procurement contracts can specify 
standards for medical and financial privacy, quality and performance, local 
sustainable economic development, environmental protection, public health 
and safety, gender and racial equity, labor practices, and human rights.

CAFTA rules on government procurement undermine these important 
capabilities.  Under CAFTA, government actions to favor local companies or 
service suppliers, or to impose technical specifications, can be challenged 
as barriers to trade.  The U.S. has agreed to include health care services 
in this chapter.

Public Health and Health Care Community: Reframing the Trade Debate to 
Prioritize Health

The Call for Public Health Accountability in International Trade Agreements 
asks Congress and the USTR to  take the following steps to prioritize 
health in international trade negotiations:

1.      Assure that health is not pitted against commercial interests.
2.         Include public health representatives in the negotiating 
advisory process, and promote transparency and democratic accountability at 
all levels of trade negotiations.
3.         Call for an assessment of the impact of trade agreements on 
population health, and assure based on such assessment that these 
agreements do not have an adverse impact on health.
4.         Exclude vital human services such as health care and water, and 
intellectual property rules that affect affordable medications, from trade 
negotiations and challenge under trade agreements.
5.        Support enforceable commitments to advancing population health, 
and to achieving universal access to health care, affordable medications, 
and safe, affordable water in the U.S. and internationally.

American College of Preventive 
Medicine 
American Public Health Association
Center for Policy Analysis on Trade and Health 
(CPATH)
Hesperian Foundation
People's Health Movement, 
USA
Physicians for Human 
Rights 
Physicians for Social Responsibility


Contact: CPATH Ellen R. Shaffer and Joe Brenner, Directors
98 Seal Rock Drive, San Francisco, CA 94121 USA
phone: 415-933-6204 fax: 415-831-4091   email: cpath at cpath.org www.cpath.org

Ellen R. Shaffer, PhD, MPH, Director
Center for Policy Analysis on Trade and Health (CPATH)
98 Seal Rock Drive
San Francisco, CA 94121-1437

phone: 415-933-6204
email: ershaffer at cpath.org
www.cpath.org
fax: 415-831-4091 
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