European perspectives on global health: a policy glossary

2. Europe must include global health in all fields of policy
e-Health ), consumption of services abroad ( patients
who travel abroad for medical treatment ), commercial
presence ( establishment of health facilities in the
country concerned ), and presence of natural persons
( foreign doctors or nurses who seek to practice
in other countries ). Informed and evidence-based
approaches are needed to manage any future efforts
to liberalise health-related services so as to ensure
greater access to affordable, better-quality, and
effective services, leading to increased choice for
consumers and greater equity in health outcomes.
In the past, most services were not considered to be
tradable across borders. Much has occurred to alter
the tradability of services, including health services.
Advances in communications technology, including
the development of e-commerce, as well as regulatory
changes in many parts of the world have made it
easier to deliver services across borders. In many
countries, changes in government policy have left
greater room for the private sector – domestic as well
as foreign – to provide services. Partly as a result,
services have become the fastest-growing segment
of the world economy, providing more than 60 % of
global output and employment.
Such changes led governments to include services in
trade negotiations, resulting in the GATS at the end of
the Uruguay Round. GATS takes a gradual approach to
trade liberalisation allowing member states to include
or exclude services such as health insurance and care.
So far, the liberalising effects have remained limited
as most WTO Members have made relatively few
commitments that go beyond existing levels of access.
However, many fear that opening up health markets in
developing countries could lead to foreign companies
“cherry picking” the most profitable sectors, to the
disadvantage of local health services.
It goes unnoticed that GATS also provides for the
control of the international movement of staff for the
provision of services. As the latest World Health Report
2006 points out, the migration of health workers to
rich countries is a fundamental cause of poor health
and health care in resource-poor countries. Yet at
present this provision has not yet been applied to the
recruitment of health staff from developing countries
to rich regions such as Western Europe. Instead, a
weaker form of control is applied through conventions
and bilateral agreements that have been very
ineffective in stemming the flow of health professional
migration.
The TBT Agreement on technical barriers to trade
can also be relevant to health. WTO rules which
govern technical barriers to trade applied for reasons
of protecting human health are covered by either the
TBT Agreement or the SPS Agreement. Countries face
challenges in ensuring compliance with the disciplines
of SPS and TBT. This is particularly the case in the
areas of food safety, diagnostic devices and medicines’
quality, safety and efficacy, respectively, in which
the trade agreement creates obligations to draw up
regulations based on science, conduct required risk
assessments, and implement international standards
through independent and effective national regulatory
authorities.
All members have the right to restrict trade for
“legitimate objectives” under the TBT Agreement.
These legitimate objectives include the protection of
human health or safety, the protection of animal or
plant life or health, the protection of the environment,
national security interests, and the prevention of
deceptive practices. The TBT Agreement aims to ensure
that product requirements, and procedures that are
used to assess compliance with those requirements,
do not create unnecessary obstacles to trade. The
Agreement applies to product requirements that
are mandatory ( “technical regulations” ) as well as
voluntary ( “standards” ). It covers such requirements
developed by governments or private entities, whether
at the national or the regional level.
The TBT Agreement strongly encourages the use of
international standards, such as WHO standards,
and where appropriate for these to be adopted as
national standards or technical regulations. Members
may depart from such international standards if they
consider that their application would be ineffective or
inappropriate for the fulfilment of certain legitimate
objectives. In such cases, Members are free to set
standards at a level they consider appropriate, but
have to be able to justify their decisions if requested
by another Member to do so.
The SPS Agreement contains specific rules for
countries which want to restrict trade to ensure food
safety and the protection of human life from plantor
animal-carried diseases ( zoonoses ). Its objective
is two-fold : it aims to ( i ) recognise the sovereign
30 <strong>European</strong> Foundation Centre – <strong>European</strong> Partnership for Global Health