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Poverty, other forms of social inequality and human impacts on the environment are increasingly recognized as important, perhaps fundamental, health determinants. These determinants, in turn, are largely conditioned and constrained by economic practices, and by government legislation that regulates such practices or seeks to mitigate inequalities that arise from them. Over the past two decades the ability of national governments to intervene in economic practices has been reduced by two interrelated phenomena: the dominance of a neoliberal economic orthodoxy, which emphasizes free (unregulated) markets and a ‘minimal’ welfare state, and the growth in regional and global free trade and investment agreements. There is mounting evidence that policies based on neoliberal economic theory, including free trade/investment agreements, may seriously undermine public health by increasing social inequalities, depleting natural resources and increasing environmental pollution. This evidence has sparked a call among many public interest non-governmental organizations (NGOs) and policy ‘think tanks’ for appending strong ‘social clauses’ to global trade and investment agreements to ensure that such agreements are socially just and environmentally sustainable. This paper proposes creation of a strong public health lobby, both nationally and internationally, to join with other public interest NGOs in the social clause campaign. It begins by defining and critiquing some of the basic tenets of neoliberal economic orthodoxy which underpin the push towards global free trade and investment agreements. It then describes the current status of these agreements, and provides examples of how such agreements might imperil public health. The paper then discusses the social clause initiative, and concludes by advancing a proposal for a public health lobby presence at those fora where trade and investment agreements are negotiated and monitored.

Healthy Public Policy and the World Trade Organization: A Proposal for an International Health Presence in Future World Trade/Investment Talks