Trade and investment: The re-ordering of healthcare and public health policy?

Trade and investment agreements (TIAs) are an increasingly important part of the neoliberal economic and political architecture, which shapes the distribution of power, money and resources at global, regional and national levels - and, therefore, a wide range of determinants of health. This chapter begins by outlining the development of the contemporary global trade and investment regime, and the changing landscape of trade policy, over the last few decades, situating these developments in the context of broader shifts toward neoliberalism and globalization. It then examines what is known about the implications of TIAs for key determinants of health, focusing specifically on health services, access to pharmaceuticals, and regulation of harmful commodities including tobacco, alcohol and food. Next, it turns the reader’s attention to the power dynamics involved in negotiating TIAs and how these reproduce and exacerbate existing inequalities, with consequences for health. The chapter concludes by discussing the role of social movements and public health advocacy - informed either explicitly or implicitly by critical political economy - in disrupting and delegitimizing these dynamics.