Current process-based approaches to regulation are no longer fit for purpose

Abstract Objective: To examine changes in sales of highly processed foods, including infant formulas, in countries joining free trade agreements (FTAs) with the US. Design: Annual country-level data for food and beverage sales come from Euromonitor International. Analyses are conducted in a comparative interrupted time-series (CITS) framework using multivariate random-effects linear models, adjusted for key confounders: gross domestic product (GDP) per capita, percent of the population living in urban areas and female labor force participation rate. Memberships in other FTAs and investment treaties are also explored as possible confounders. Setting: Changes are assessed between 2002 and 2016. Participants: Ten countries joining US FTAs are compared with eleven countries without US FTAs in force; countries are matched on national income level, world region and World Trade Organization membership. Results: After countries join a US FTA, sales are estimated to increase by: 0·89 (95 % CI 0·16, 1·6; P = 0·016) kg per capita per annum for ultra-processed products, 0·81 (95 % CI 0·47, 1·1; P < 0·001) kg per capita per annum for processed culinary ingredients and 0·17 (95 % CI 0·052, 0·29; P = 0·005) kg per capita under age 5 per annum for baby food. No significant change is estimated for minimally processed foods. In statistical models, large unexplained variations in country-specific trends suggest additional unmeasured country-level factors also impact sales trends following entry into US FTAs. Conclusions: These findings strongly support the conclusion that joining US FTAs can contribute to detrimental changes in national dietary consumption that increase population risk of non-communicable diseases.

Mitigating and adapting to the extraordinary threats posed by climate change will require dynamic responses across all elements of human society. Governments face urgent, unprecedented challenges in this regard, including with respect to regulating foreign investment. The international investment regime was not designed to take account of this reality, however, either substantively or with respect to the settlement of disputes. This article proposes a new approach to foreign investment regulation designed to rectify this systemic failure, in the form of an innovative bilateral investment treaty drafted by a multidisciplinary team of internationally renowned experts. The approach proposes a balanced, reciprocal set of obligations for both investors and host states consistent with the Paris Agreement. To incentivize transformation, moreover, the article argues for investment treaties that demand good governance by investors, establish sufficient policy space for host states (via a sectoral approach that specifically addresses areas such as climate change, water, agriculture, human rights, indigenous peoples and public health), and adopt a flexible, fair, accountable and transparent approach to dispute settlement, including enhanced standards for arbitrators and a Code of Ethics—among other innovations.

Building on Tangcharoensathien and colleagues’ description of four tactics used by the tobacco, alcohol, processed food, and breast milk substitute industries to interfere with the development and implementation of health policies, we present a fifth tactic: trade and investment disputes. We describe recent examples of trade and investment claims filed by the tobacco industry to challenge plain packaging legislation, which may serve as a model for future claims by this and other industries. Next, we clarify specific areas of potential conflict between non-communicable disease (NCD) control policies and trade and investment agreement (TIA) commitments, identifying possible vulnerabilities that may be exploited by industry to challenge the legality of these policies. We conclude with ideas to strengthen the position of health policies vis-à-vis commitments in TIAs.

OBJECTIVE:To investigate the relationship between joining the World Trade Organization (WTO) and the availability of several commodities with both harmful and protective effects for the development of noncommunicable diseases. METHODS:We used a natural experiment design to compare trends in the domestic supply of tobacco, alcohol and seven food groups, between 1980 and 2013, in 21 countries or territories joining WTO after 1995 and 26 non-member countries, using propensity score weights. We applied a comparative interrupted time-series framework, by using multivariate random-effects linear models, adjusted for gross domestic product per capita, the percentages of urban population and female labour force participation. In the tobacco model, we controlled for Member States that had ratified the Framework Convention on Tobacco Control and in the alcohol model, the percentage of the population identifying themselves as Muslim. FINDINGS:Following accession to WTO, member states experienced immediate increases in the domestic supply of fruits and vegetables of 55 g per person per day on average, compared to non-member countries. The analysis showed gradual increases in the geometric mean of the supply of tobacco and alcohol of 6.2% and 3.6% per year, respectively. We did not detect any significant changes in the availability of red meats and animal fats; seafood; nuts, seeds and legumes; starches; or edible oils; and results for sugars were inconsistent across model variations. CONCLUSION:The results suggest that WTO membership may lead to increases in both harmful and protective factors for noncommunicable disease, but further exploration of country-specific variation is warranted.

Supplemental materials for the publication "World Trade Organization membership and noncommunicable disease risk factors: a comparative interrupted time-series analysis, 1980-2013" by Cowling et al., in the WHO Bulletin, 2018. Supplemental items include: - a list of food items included in the different commodity groups and the data completeness for each item - additional regression model output and model fit graphs- further details on sensitivity analyses