By Dean M. Harris, J.D. , email:

The Transatlantic Trade and Investment Partnership (TTIP) is a potential free trade agreement under negotiation between the EU and the US. In theory, the primary goals of the proposed agreement are to reform regulatory processes and promote economic growth. In reality, TTIP could create serious risks to public health, by reducing access to health services and drugs, reducing safety and quality, and reducing transparency of clinical trial data. TTIP could also threaten the ability to obtain care of good quality (both nationally and in cross-border healthcare).

TTIP could have the effect of replacing the EU’s “precautionary approach” to regulation with the US approach of requiring prior evidence of harm and using cost-benefit analysis. Also, TTIP might include an Investor-State Dispute Settlement (ISDS) system, which could allow foreign corporations to bypass national courts. (Instead, they could pursue claims against a government in an investment tribunal that might be confidential and have no effective means of appeal.) Finally, TTIP could threaten the ability of each EU Member State to make its own decisions about the operation and regulation of its health system.

International agreements such as TTIP are designed to reduce barriers to trade. For-profit corporations often view health regulations and government health services as barriers to trade. Big pharmaceutical companies in Europe and the US support TTIP. However, TTIP is strongly opposed, in whole or in part, by many public health advocates, researchers, medical and civil society organizations, healthcare providers, labour unions, and some political parties. Also, complaints have been made about lack of transparency and influence of industry organizations.

The European Commission (EC) has defended the proposed agreement, and denies that TTIP would have negative effects on health or regulation. The European Parliament approved recommendations that generally support the EC’s negotiators, but Parliament adopted a compromise that would replace ISDS. The EC has proposed a new Investment Court instead of ISDS, but some critics are skeptical and it is unclear whether the US will agree to replace ISDS.

Many stakeholders in the UK have raised concerns that TTIP would require further privatisation of the National Health Service (NHS), and would prevent future efforts to reduce the role of the private sector. The EC and other supporters of TTIP have argued that this type of agreement routinely provides exemptions for “public utilities” and “services supplied in the exercise of governmental authority.” However, commentators have responded that the definitions of those terms are very restrictive. Therefore, health systems like the UK’s NHS might not be exempt from TTIP obligations.

Under these circumstances, a more explicit exclusion should be negotiated to protect health systems and preserve the right of national governments to regulate their health systems. Also, we should continue to monitor the negotiations about the ISDS system.


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