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INTERNATIONAL TRADE AND WORLD HEALTH POLICY: HELPING PEOPLE REACH THEIR FULL POTENTIAL（1） |
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INTERNATIONAL TRADE AND WORLD HEALTH POLICY: HELPING PEOPLE REACH THEIR FULL POTENTIAL（1）
Phillip Countryman [FN1]
Copyright © 2009 Pace University School of Law; Phillip Countryman
Globalization is a consequence of increased mobility, enhanced communications, greatly increased trade and capital flows, and technological development. Globalization opens new opportunities for sustained economic growth and development of the world economy, particularly in developing countries. Globalization also permits countries to share experiences and to learn from one another's achievements and difficulties. It promotes a cross-fertilization of ideals, cultural values and aspirations. At the same time, the rapid processes of change and adjustment have been accompanied by intensified poverty, unemployment and social disintegration. [FN2]
I. Introduction
Since its inception, the World Trade Organization (WTO) has received heavy criticism, some fair and some unfair, for its seemingly anti-human rights position. [FN3] The latest round of negotiations, known as the Doha Round, has faced its own set of dilemmas, and it is hard not to wonder if the legitimacy of the WTO has been weakened as a result. [FN4] In light of the long running criticisms of the WTO and the recent dilemmas with its Doha Round of negotiations, it is time for the WTO to reevaluate *242 some of its policies and consider updating some of its positions. [FN5] A good place for the WTO to start is to evaluate and change its position in regards to international human rights standards. [FN6] Specifically, the WTO must address health issues that have a direct impact on international trade. The WTO must recognize the role human rights plays in influencing business, economic activity, and an individual State's economic development. [FN7] Conversely, economic realities and the effect economics has on the condition of human life cannot be ignored by the WTO. [FN8] In recognition of the interrelationship between economics, specifically international trade and human rights, the WTO must require its member States to be parties to the major international human rights treaties. The WTO must also enforce those treaty obligations through the use of its dispute settlement system and trade sanctions. By taking such steps, the WTO will be improving its short-term credibility, enhancing its long-term legitimacy and viability, and more importantly, will be helping to ensure the safety and welfare of our international community.
A. Health and Poverty
Health and poverty are intertwined issues. [FN9] Health problems and poverty are related degradations that keep a substantial percentage of our world's population from reaching its full potential. [FN10] As such, poverty must be reduced and global *243 health conditions must be improved. [FN11] Since there is a direct link between poverty and health-related problems, we can improve global health conditions by reducing poverty. [FN12] Diminishing health-related problems removes barriers to economic growth and gives people a better opportunity to tackle their poverty-related issues. [FN13] Improvements in health will allow people the opportunity to participate in economic activity, thus helping to reduce poverty. [FN14]
B. Trade and the Role of the World Trade Organization
Trade can reduce poverty by acting as a catalyst for economic growth, which in turn can lead to an increase in health-related resources. [FN15] As the main international trade organization, the World Trade Organization (WTO) - through trade - has the power to reduce international poverty and improve global health conditions. [FN16] The WTO must take a more proactive approach in protecting health rights within member States. To accomplish this goal, the WTO should mandate that its member States sign and ratify the human rights covenants that compose the International Bill of Rights. [FN17] Further, the WTO must penalize member States who violate the International Bill of Rights. This can be done through the use of trade sanctions and the WTO's dispute settlement system. Together, such measures will not only improve how the WTO confronts poverty and health-related concerns, but will also enhance the WTO's credibility, reestablish the WTO as a fundamental international body, and enhance the long-term legitimacy of the WTO.
*244 C. Outline of Discussion
Section I introduces some ideas regarding the connection between international trade, health concerns, and the role of the WTO. Section II provides a background on the problem of poverty and its effect on health. Section III discusses the three major covenants that together form the International Bill of Rights. The role that health plays in each of the covenants is highlighted. Section IV provides a brief history of the WTO and its current position on human rights and health. Section IV also documents strategies that the WTO can implement in order to take a more proactive approach when addressing poverty, human rights, and health issues. Section V explains how the WTO can utilize its own resources to improve the health and human rights issues of its member States, with the end goals being both improved quality of life for all people and reinforcement of the long-term legitimacy of the WTO.
II. The Link Between Poverty and Health
"The biggest enemy of health in the developing world is poverty." [FN18]
Statistics provide a good starting point for assessing the impact of poverty on human health. [FN19] For example, starvation kills 24,000 people every day [FN20] and chronic hunger affects the lives of over 800 million people. [FN21] In 2003 alone, AIDS killed 3 million people, [FN22] with the AIDS pandemic decreasing the life expectancy rate in Botswana by 31 years. [FN23] Additionally, over one billion people live in slums, [FN24] where half of the developing *245 world's population lacks access to basic sanitation. [FN25] Two and a half billion people, 40% of the world's population, live on less than $2 a day; [FN26] one-fifth of the world's population lives on less than $1 a day. [FN27] Tragically, over 10.5 million children die each year from preventable ailments [FN28] before their fifth birthday. [FN29] For example, measles killed almost 500,000 children in 2004 alone. [FN30] The administration of a simple measles vaccination would have prevented the deaths of those innocent, young children. [FN31]
Many countries, including those experiencing exponential economic growth, such as China and India, continue to face serious health-related problems. [FN32] In India, malnutrition "affects half of the country's children," [FN33] and despite the prevalence of vaccine availability, only "42% of children are immunized." [FN34] The wide gap between rich and poor in China marks numerous health disparities that relate to a wide range of issues, including child mortality. [FN35] Unfortunately, such issues are not isolated to the developing world. As the divide between the rich and poor grows, so do poverty and health-related problems facing those in developed countries. The problems above are only a few of the health-related issues the international community faces. [FN36] As such, the countless health-related atrocities that our world is facing cannot be ignored. [FN37]
A. Defining Poverty
As the statistics indicate, poverty is a global problem that affects billions of people all over the world. [FN38] Even in a developed, *246 wealthy nation such as the United States, poverty is a significant issue and is largely responsible for many social and economic problems. [FN39] While poverty has significant effects on populations, "poverty" is curiously difficult to define. [FN40] Traditionally, poverty has been defined by the lack of sufficient income upon which to survive. [FN41] Now, poverty is more broadly defined within the context of human rights. [FN42] Instead of merely assessing monetary wealth, the definition of "poverty" has developed to encompass educational levels, physical well-being, and "lack of dignity, self-respect, freedom, or access to power." [FN43] In effect, the concept of poverty has taken on a human rights-based framework, [FN44] which is fitting now that poverty is recognized in international documents such as the Universal Declaration of Human Rights (UDHR), the International Covenant on Economic, Social, and Cultural Rights (ICESCR), and the International Covenant on Civil and Political Rights (ICCPR). [FN45]
*247 There is undoubtedly a legal imperative to stop poverty and disease, [FN46] since both are responsible for many of the world's problems. [FN47] Poverty is the foundation for a lack of fulfillment regarding economic, social, and cultural rights (ESCR). [FN48] Poverty is a vicious cycle that is difficult to break from generation to generation. Without money, it is difficult to obtain food, housing, water, a decent standard of living, and health care. [FN49] Inevitably, poverty is the result of a lack of education and education is one of the keys to eliminating poverty. [FN50] The right to education and a realization of that right is a multiplier right, in that, with success, it inevitably improves access to other human rights. [FN51] As such, the international community must help those stuck in this trap, so they can help themselves. [FN52] While States have pledged to reduce worldwide poverty, they must do more to combat this international problem. [FN53] More importantly, in the context of international trade and the goals of the WTO, the reduction of poverty will help improve economic activity. [FN54]
Poverty is associated with several indicators of poor health. Individuals in lower socioeconomic classes have higher rates of chronic disease and death. [FN55] Individuals with lower income levels are "more likely to report negative health habits" than those in higher income brackets. [FN56] Poverty-stricken individuals *248 have higher smoking rates than those in higher socioeconomic classes. [FN57] Those stuck in poverty experience poor living conditions, malnutrition, and overcrowding, all of which adversely affect health. [FN58] Poverty carries with it other factors that negatively affect health such as higher crime rates, unemployment, "greater exposure to physical hazards," and accidents. [FN59] Education is often viewed as an equalizer that helps individuals ascend out of poverty, but the great irony is that individuals in poverty are often faced with inadequate opportunities for education. [FN60]
Poverty also has other, perhaps more obvious, but equally serious, health-related effects. Namely, individuals living in poverty are forced to "live in environments that make them sick." [FN61] These individuals often lack basic essentials such as clean water, adequate nutrition, and basic sanitation. [FN62] Poverty is also associated with a lack of access to health resources, which exacerbates the negative impact poverty has on health. [FN63] What makes this lack of access even more serious is the fact that the negative health effects of poverty have the greatest impact on children. [FN64] When all factors are considered together, poverty clearly affects basic health measures that are essential to the well-being of populations.
Based on the above statistics, it is easy to recognize that poverty and health are intimately intertwined. Individuals in lower socioeconomic classes have poorer overall health than their more affluent counterparts. [FN65] The specific reasons for this disparity, however, are not always clear. Popular notions concerning the "why" behind the negative impact of poverty on health include the effects that poverty has on the individual behavioral level and on the societal public health level. For instance, poverty is associated with higher rates of illness and *249 chronic disease, [FN66] which points to the behavioral individual level. Poverty is also associated with lack of opportunity for education, sanitation, clean water, and adequate shelter, which implicate the societal public health level. [FN67] While the mechanisms through which poverty affects health may be unclear, the outcomes are impossible to ignore. High levels of poverty mean high incidence of health problems. [FN68]
B. Addressing Poverty through International Trade
A victory over poverty is crucial, not only for the realization of basic human rights, but also for a country to experience economic prosperity. [FN69] Poverty is often present where basic human rights are not. [FN70] Decreased access to food and housing, along with increased susceptibility to disease and health care problems are all related to poverty, [FN71] but also inhibit a country's ability to be economically active. [FN72] For example, without access to health care clinics, vaccines, and medications, people who become ill or injured are unable to work and are therefore unable to produce. [FN73] Without a stable and productive workforce, no chance of economic growth is possible. [FN74] When means exist to combat such problems, the governments have a responsibility to its people to eradicate such problems. [FN75]
International trade is central to reducing the health-related problems facing the people of our world, [FN76] and improvements in our international trading system will help combat global poverty. [FN77] Economics and health policy are two areas *250 that are not only interrelated, but also interdependent. [FN78] This is illustrated by the fact that many of the health atrocities inflicted upon our international brothers and sisters arise primarily from States that have serious economic problems. [FN79] These issues are not limited to economically impoverished States. Economically developed States, such as the U.S., [FN80] have faced serious health-related problems as a direct result of unenforced health standards in its international trade activity. [FN81] Part of the problem is that development and enforcement of effective health policies is hampered by inadequate international trading regimes. [FN82]
Undoubtedly, health policy and the realization of health rights can be improved and achieved through an increase in availability of financial resources to all countries. [FN83] While health policy and the realization of health rights may be hampered by an inadequate international trading regime, [FN84] a well-structured, balanced international trading regime can drastically improve global health policy. [FN85] Through participation in international trade and the financial resources that become available through such participation, [FN86] international trade can help individuals attain and realize health rights. [FN87] International *251 trade then, is a key factor States can utilize in order to help address their health problems. [FN88]
By increasing participation of States in international trade and increasing the funds they have available, States can better combat their health issues and ultimately improve the lives of their people. [FN89] With this in mind, when a State is trying to develop in a manner that allows for the advancement of all its people, a State must codify basic human rights, starting with a fundamental national health policy, in its economic framework. [FN90] For example, if a State was to implement policies that were overly stringent, its citizens and companies would have difficulty in adhering to those policies, slowing economic growth and hampering social improvements. [FN91] Conversely, if the implemented policies set standards too low, social improvement will not occur or will be slow to develop. [FN92] However, when a balance is found and appropriate policies are implemented, inefficiency can be avoided, economic activity can be fostered, and social improvement can become a reality. [FN93] Sound policies and standards are "conducive to both trade and better health outcomes." [FN94] Thus, economic and health policies must be developed together. [FN95] If States neglect to do this, horrid social depravations, like those in China, will continue to occur. [FN96]
[FN1]. LL.M. Candidate, Universidade Católica Portuguesa, Lisbon, Portugal, Dec. 2008.
[FN2]. World Summit for Social Development, Mar. 6-12, 1995, Copenhagen Declaration on Social Development and Programme of Action, P14, U.N. Doc. A/ CONF.166/9 (Apr. 19, 1995).
[FN3]. See Robert D. Anderson & Hannu Wager, Human Rights, Development, and the WTO: The Cases of Intellectual Property and Competition Policy, 9 J. Int'l Econ. L. 707, 708-09 (2006).
[FN4]. See Ernesto Zedillo, Director, Yale Ctr. for the Study of Globalization, Keynote Address at the Columbia University WTO Conference: The WTO's Biggest Problem at 10: Surviving the Doha Round (Apr. 7, 2006).
[FN5]. See generally Ernst-Ulrich Petersmann, Addressing Institutional Challenges to the WTO in the New Millennium: A Longer-Term Perspective, 8 J. Int'l Econ. L. 647, 658 (2005) [hereinafter Petersmann, Institutional Challenges].
[FN6]. See generally id.
[FN7]. See generally U.N. Development Programme [UNDP], Human Development Report 2005: International Cooperation at a Crossroads: Aid, Trade and Security in an Unequal World, 2 (2005), available at http://hdr.undp.org/en/media/hdr05_ complete.pdf [hereinafter HDR 2005].
[FN8]. See generally Ernst-Ulrich Petersmann, The 'Human Rights Approach' Advocated by the UN High Commissioner for Human Rights and by the International Labour Organization: Is It Relevant for WTO Law and Policy?, 7 J. Int'l Econ. L. 605, 612-14 (2004) [hereinafter Petersmann, Human Rights Approach].
[FN9]. Ann L. Owen & Stephen Wu, Is Trade Good for Your Health?, 15 Rev. Int'l. Eco. 660, 660 (2007).
[FN10]. U.N. Econ. & Soc. Council [ECOSOC], The Millennium Development Goals Report 2006 (2006), available at http:// mdgs.un.org/unsd/mdg/resources/static/products/progress2006/MDGReport2006.pdf [hereinafter MDGR].
[FN11]. U.N. Population Fund, Population and Poverty: Achieving Equity, Equality, and Sustainability, 1-3, U.N. Doc. 8 (2003) [hereinafter UNFPA].
[FN12]. See id.
[FN13]. See U.N.D.P, Annual Report 2007: Making Globalization Work for All, 5-9.
[FN14]. WTO Secretariat, WTO Agreements & Public Health, 23, P 3, (2002) [hereinafter WTO & WHO, Agreements].
[FN15]. Id. at 23, P 2.
[FN16]. See generally Thomas Pogge, World Poverty and Human Rights, 19.1 Ethics & Int'l Aff. 1 (2005).
[FN17]. The International Bill of Rights consists of the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, and the International Covenant on Civil and Political Rights. These human rights documents will be discussed in greater detail later in the article.
[FN18]. WHO & World Bank, Dying for Change, 2 (prepared by Rebecca Dodd & Lise Munck), available at http://www.who.int/hdp/publications/dying_change.pdf [hereinafter WHO, Dying].
[FN19]. Even though statistics can be misleading, biased, and do not always tell the whole story, they can be helpful and provide insight. Statistics provided through studies conducted by various international organizations, are helpful in giving us a basic understanding of what is going on in the world regarding poverty and health.
[FN20]. See Ana Gonzalez-Pelaez, Human Rights and World Trade: Hunger in International Society 1 (Routledge 2005).
[FN21]. MDGR, supra note 10, at 5.
[FN22]. HDR 2005, supra note 7, at 3.
[FN23]. Id. at 4.
[FN24]. U.N. Human Settlements Programme [U.N.-HABITAT], Annual Report 2005, Responding to the Challenges of an Urbanizing World 5-6 (June 2006) (compiled by Rasna Warah) [hereinafter UNHSP].
[FN25]. MDGR, supra note 10, at 18.
[FN26]. HDR 2005, supra note 7, at 4.
[FN27]. Id. at 3.
[FN28]. MDGR, supra note 10, at 10.
[FN29]. Id.
[FN30]. Id. at 11.
[FN31]. See id. at 11.
[FN32]. HDR 2005, supra note 7, at 4.
[FN33]. Id. at 30.
[FN34]. Id. at 31.
[FN35]. Id. at 63.
[FN36]. Id.
[FN37]. See generally World Health Org. [WHO], Working for Health: An Intro. to the WHO, at 10, (2007) [hereinafter, WHO, Working].
[FN38]. Pogge, supra note 16, at 1.
[FN39]. See generally Dominicans for Justice at the United Nations, States Must Address Poverty With Utmost Urgency, Say UN Independent Experts, Dec. 11, 2006, available at http://www.un.op.org/en/node/1268 [hereinafter Justice].
[FN40]. J. Timmons Roberts & Nikki Demetria Thanos, Trouble in Paradise: Globalization and Environmental Crisis in Latin America 105 (Routledge 2003).
[FN41]. WHO, Human Rights, Health and Poverty Reduction Strategies at 10, WHO/ETH/HDP/05.1 (2005) (prepared by Penelope Andrea), available at http:// www.who.int/hhr/news/HHR_PRS_19_12-05.pdf.
[FN42]. Id.
[FN43]. Id.
[FN44]. In the light of the International Bill of Rights, poverty may be defined as a human condition characterized by sustained or chronic deprivation of the resources, capabilities, choices, security and power necessary for the enjoyment of an adequate standard of living and other civil, cultural, economic, political and social rights. While acknowledging that there is no universally accepted definition, the Committee endorses this multi-dimensional understanding of poverty, which reflects the indivisible and interdependent nature of all human rights.
U.N. Econ. & Soc. Council [ECOSOC], Comm. on Econ., Soc., and Cultural Rights, Substantive Issues Arising in the Implementation of International Covenant on Economic, Social and Cultural Rights: Poverty and the International Covenant on Economic, Social, and Cultural Rights, P 8, U.N. Doc. E/C.12/2001/10 (2001), available at http:// huachen.org/english/bodies/cescr/docs/Statements/E.C.12.2001.10Poverty-2001.pdf.
[FN45]. See International Covenant on Civil and Political Rights, G.A. Res. 2200A (XXI), at 53-56, U.N. Doc. A/6316 (1966) (entered into force Mar. 23, 1976), available at http://www.unhchr.ch/html/menu3/b/a_ccpr.htm; International Covenant on Economic, Social, and Cultural Rights, G.A. Res. 2200A (XXI), at 49, U.N. Doc. A/6316 (1966) (entered into force Jan. 3, 1976), available at http://www.unhchr.ch/html/menu3/b/a_cescr.htm; Universal Declaration of Human Rights, G.A. Res. 217A (III), at 71, U.N. Doc. A/810 (Dec. 1, 1948) available at http://www.unhchr.ch/udhr/lang/eng.htm.
[FN46]. See Janet Dine, Companies, International Trade and Human Rights 1-3 (Cambridge Univ. Press 2005).
[FN47]. The Secretary-General, In Larger Freedom: Towards Development, Security and Human Rights for All, P 23, delivered to the General Assembly, U.N. Doc. A/59/2005 (Mar. 21, 2005) [hereinafter UN, Freedom].
[FN48]. See generally Justice, supra note 39.
[FN49]. See generally Office of the High Commissioner for Human Rights [OHCHR], Human Rights in Development, Draft Guidelines: A Human Rights Approach to Poverty Reduction Strategies (Sept. 2002), available at http:// www.unhchr.ch/pdf/povertyfinal.pdf (prepared by Paul Hunt, Manfred Nowak and Siddiq Osmani) [hereinafter UNHRD].
[FN50]. Id. at P 125.
[FN51]. Id.
[FN52]. See Evan Smith, Jeffrey Sachs: The End of Poverty, Yale Econ. Rev., available at http://www.yaleeconomicreview.com/issues/2006_summer/sachs.html.
[FN53]. See generally Justice, supra note 39.
[FN54]. See Petersmann, Human Rights Approach, supra note 8, at 625-27.
[FN55]. See, e.g., David R. Williams, Socioeconomic Differentials in Health: A Review and Redirection, 53 Soc. Psychol. Q. 81, 91 (1990).
[FN56]. Id.
[FN57]. Id. at 88.
[FN58]. Id. at 84.
[FN59]. Id. at 89.
[FN60]. WHO, Dying, supra note 18, at 26.
[FN61]. Id. at 2.
[FN62]. Id.
[FN63]. Id. at 32.
[FN64]. See J. Lawerence Aber et al., The Effects of Poverty on Child Health and Development, 18 Ann. Rev. Pub. Health 463 (1997).
[FN65]. See Pogge, supra note 16, at 1-2.
[FN66]. See UNHRD, supra note 49, at P 112.
[FN67]. Id. at P 157.
[FN68]. Id. at P 112.
[FN69]. See generally id.
[FN70]. Justice, supra note 39.
[FN71]. See UNHSP, supra note 24, at 6.
[FN72]. See Smith, supra note 52.
[FN73]. See id.
[FN74]. See John M. Taylor, Under Sec'y of Treasury for Int'l Affairs, Raising Productivity, Improving Standards of Living, and Promoting Job-Creating Econ. Growth in Afr., Speech at African Growth and Opportunity Forum, Mauritius (Jan. 16, 2003).
[FN75]. See generally UN, UN Conference on Trade and Development Secretariat, The Least Developed Countries Report 2004: Linking International Trade with Poverty Reduction 219 (2004) [hereinafter LDCR].
[FN76]. See id. at i-iv.
[FN77]. See id. at 179-256.
[FN78]. See U.N. Population Fund, Population and Poverty: Achieving Equity, Equality, and Sustainability, 1-3, U.N. Doc. 8 (2003) [hereinafter UNFPA]; Robert Howse, Comment, Human Rights in the WTO: Whose Rights, What Humanity? Comment on Petersmann, 13 Eur. J. Int'l L. 651 (2002); Steve Charnovitz, International Standards and the WTO, 11 Geo. Wash. Law Legal Studies Research Paper No. 133, (2002), available at http:// ssrn.com/abstract=694346.
[FN79]. See generally MDGR, supra note 10. See generally LDCR, supra note 75.
[FN80]. See Jeff Gerth & Tim Weiner, Tainted Imports - A Special Report: Imports Swamp U.S. Food-Safety Efforts, N.Y. Times, Sept. 29, 1997.
[FN81]. See Gudrun Monika Zagel, WTO & Human Rights: Examining Linkages and Suggesting Convergence, 2 IDLO Voices of Dev. Jurists (Paper Series) 2, 5 (2005) [hereinafter Zagel, WTO & Human Rights].
[FN82]. See Tatjana Eres, The Limits of GATT Article XX: A Back Door for Human Rights?, 35 Geo. J. Int'l L. 597, 601-02 (2004).
[FN83]. HDR 2005, supra note 7, at 38-39.
[FN84]. WTO & WHO, Agreements, supra note 14, at 137.
[FN85]. Id.
[FN86]. See generally Carlos Manuel Vazquez, Trade Sanctions and Human Rights-Past, Present, and Future, 6 J. Int'l Econ. L. 797 (2003); see generally LDCR, supra note 75; see generally HDR 2005, supra note 7.
[FN87]. Anderson, supra note 3, at 708.
[FN88]. Francesco Longu, European Public Health Alliance, Why Trade Isn't Working For Health, http://www.epha.org/a/334 (last visited Feb. 24, 2009).
[FN89]. See generally HDR 2005, supra note 7, at 2.
[FN90]. See generally Gonzalez-Pelaez, supra note 20.
[FN91]. See Charnovitz, supra note 78 (discussing the impact that international standards can have on a country).
[FN92]. Id. Social improvements will occur based on the benefits of such policies, the lack thereof would make such improvements difficult to realize.
[FN93]. Id. at 11-12.
[FN94]. Owen & Wu, supra note 9, at 676.
[FN95]. See UNFPA, supra note 78.
[FN96]. See generally HDR 2005, supra note 7.
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