By Zoltán Massay-Kosubek, @EU_ZMK, Policy Coordinator for Healthy Trade and Health Equity, EPHA

EPHA believes that greater transparency is vital to ensure proper democratic and public debate about the impact of trade policy on population health, following Greenpeace Netherlands’ release of classified TTIP negotiating documents

The following key public health aspects of the leaked texts merit further attention from EU trade negotiators:

Transparency is essential to ensure decisions about health standards are made democratically, particularly regarding policies such as TTIP which influence public health. As Greenpeace has stated, there has been worldwide criticism, including from the European Ombudsman, about the ongoing refusal to reveal what is being negotiated under TTIP. Whilst some EU documents are disclosed, US negotiators disclose almost nothing at all.

While Commissioner Malmström has argued in her latest blog in reaction to the leak that the consolidated texts are not the final text in TTIP, EPHA still maintains its concerns regarding how those texts will be negotiated into the final, legally binding treaty. To allay public and civil society concerns, the documents need to be made freely available.

While the main focus is on non-tariff barriers and the right to regulate, there are still significant tariffs on some health-harmful goods including tobacco and processed foods high in salt, sugar and fats. We must not miss the point that removal of tariffs on health-harmful goods will also further accelerate the epidemic of chronic diseases in Europe, such as type-2 diabetes, cardiovascular diseases, respiratory diseases and cancers. So far the Commission has neglected to evaluate the health impact, but no doubt it would offset a significant portion of the purported economic benefits of TTIP.

Concerning the public health relevance of the 13 leaked documents, particular attention should be paid concerning the following sections:

Regulatory cooperation: While the reference to public health impact assessment is welcome, the consolidated document maintains worrying elements such as ‘Transparent Development of Regulation’, ‘Trade effects’, ‘Retrospective Review of Regulations’, ‘Regulatory Impact Assessment’ which may delay, weaken or prevent further regulation. Greenpeace link - http://ttip-leaks.org/hektor/doc9.pdf

• EU-US revised Tariff offers on products – such as tobacco, refined sugar, chocolate, meat and food preparations, where consumption is linked to the increase in Non-Communicable Diseases (NCD) - are particularly critical for health and are notably excluded from the EU-US offers. Greenpeace link - http://ttip-leaks.org/kalchas/doc8.pdf

Government Procurement - It is problematic that the chapter would make local procurement more difficult for local providers while it is not clear if appropriate safeguards on health service providers (eg. Hospitals) will be built in in the text. Greenpeace link http://ttip-leaks.org/odysseus/doc5.pdf

Cross Border Trade in Services – Public services essential for population health (social, healthcare, education, water and sanitation) are not generally excluded - like the film and music industry. To assess the impact on health systems the content of the Annexes is key. Greenpeace link - http://ttip-leaks.org/menelaos/doc3.pdf

Investment Dispute Settlement – It is worrying that this does not appear to include appropriate safeguards for the right to regulate for public health in the proposal and interestingly, there is no general exception of tobacco control measures ( ‘tobacco carve out’). EPHA is calling for a public health carve out instead of a tobacco carve out. Greenpeace link - http://ttip-leaks.org/serpedon/doc15.pdf

Sanitary and Phytosanitary Measures - While the final safeguards should be checked, it is worrying that there is no recognition of the latest EU proposal on antimicrobial resistance (tackling drug resistant infections) in the text. Greenpeace link http://ttip-leaks.org/andromache/do...

Agriculture - As well as our concerns regarding the link between increased trade of agricultural products and diet-related chronic diseases, it is particularly worrying that the EU proposal on Wine and Spirits in this chapter does not mention either reducing alcohol related harm, health-specific aspects of labelling or health NGO involvement. Greenpeace link http://ttip-leaks.org/patroklos/doc2.pdf

Technical Barriers to Trade – While the incorporation of the WTO Agreement on Technical Barriers to Trade raises some questions, the impact of the chapter on public health regulations remains to be seen http://ttip-leaks.org/priamos/doc10.pdf

Throughout EPHA’s campaign for a healthy trade agreement, we have highlighted seven key areas of concern for the ongoing negotiations:

1. TTIP should support the Sustainable Development Goals (SDG) - Today’s main public health challenges both in the EU and the US are chronic diseases, overweight and obesity, largely avoidable and linked to unhealthy food, tobacco and alcohol, as well as the rising threat of drug-resistant infections (antimicrobial resistance) which could undermine all the progress made against infectious diseases around the world in recent decades. TTIP cannot be sustainable if it fails to address the public health aspects of trade. We call for a Public Health Sustainable Development chapter in TTIP, to ensure that trade agreements actively support healthier societies.

2. TTIP must reinforce the global Framework Convention on Tobacco Control (FCTC) – Given the deadly impacts of tobacco consumption around the world, TTIP should not be neutral in relation to tobacco. It must not increase the availability, affordability or attractiveness of tobacco products. TTIP must be brought into line with the FCTC, meaning tobacco lobbyists must be actively excluded from influencing the trade negotiators in both the US and EU. Governments must be actively encouraged to introduce stricter tobacco control policies such as plain tobacco packaging.

3. TTIP must take a responsible stance on alcohol – Like tobacco, alcohol is a commodity where increased availability and lower prices are likely to have a negative impact on public health, society and economy. When negotiating the ’Wine and Spirits’ Chapter, which is a priority for the EU, negotiators should take into account the findings of a recent OECD report on alcohol related harm.

4. Consider health impacts of removing tariffs on unhealthy food – There are still significant tariffs on unhealthy processed foods from the US that TTIP may seek to remove. Increased consumption of unhealthy food (processed foods high in saturated fat, sugar and salt) is not beneficial for the consumer nor the country as a whole, as high rates of diseases related to malnutrition, overweight and obesity impose a threat to economic productivity. While public interest civil society organisations raised concerns about Agriculture as a sensitive issue, the European Commission has not yet assessed the significant health impacts of tariff reductions on unhealthy food or looked at measures to mitigate harm to health.

5. TTIP should aim to make medicines more affordable - While there is no discussion yet of ’Pricing and Reimbursement’ measures in TTIP which would undermine governments’ ability to make policy decisions, TTIP should tackle the different forms of abuses of patent protection which make essential medicines unaffordable for many. The negotiations on regulatory cooperation on pharmaceuticals aiming at eliminating duplications in trials and testing, should aim to make medicines cheaper. Medicines price evolution should be monitored by the Commission to ensure this is the case.

6. Investment protection must not undermine public health legislationNeither an Investor-to-State Dispute Settlement (ISDS) nor a parallel Investment Court System (ICS) are necessary in TTIP as both the US and the EU are stable democracies, with mature established Court systems and legislatures. Nevertheless, any investment protection system should not allow claims questioning public health legislation (eg. those tackling key causes of disease such as alcohol, tobacco or unhealthy food).

7. Horizontal chapters on Regulatory Cooperation and ’Good Regulatory Practices’ must not restrict future public health policy - Regulatory Cooperation should not limit the health policy space available for governments to protect and improve public health. Regulatory autonomy is required for governments to tackle today’s main public health challenges: chronic diseases, overweight and obesity, and drug-resistant infections.

Last modified on May 3 2016.