Indeed, although there are many who are still critical of free trade in general, there is a trend towards campaigning against what is seen as hypocrisy by developed countries in using protectionism against the poorest countries, especially in agricultural products, while requiring them to leave their own producers without protection. The Trade Justice Movement in the UK was the first formal coalition of groups to use the term "trade justice" partly because in the UK, " fair trade " usually refers to Fairtrade certification and is a consumer model of change rather than an overtly political movement calling for government action.

The term trade justice has been widely adopted internationally by campaign groups, for example by the over national platforms of the Global Call to Action Against Poverty where it is one of the four main demands. In many countries " fair trade " is used as well as or instead of "trade justice".

Campaigners also lobby their own governments with the intention of creating pressure on them to prioritise poverty reduction when making international trade rules. In trading blocs such as the European Union EU , the campaigns seek to influence policy across a number of member state governments. They contrasted "fair trade" with 'unfair' international trade practices. It is associated particularly with labour unions and environmentalists , in their criticism of disparities between the protections for capital versus those for labour and the environment.

The use of the term has expanded beyond campaigns to reform current trading practices, and the major institutions such as the World Trade Organization which embody them. Now it has become a movement to allow consumers to choose not to participate in these practices. Fairtrade labelling or "Fairtrade certification" allows consumers to identify goods especially commodities such as coffee , that meet certain agreed standards of fairness. Academics such as Thomas Alured Faunce argue that the insertion of a constructive ambiguity such as valuing innovation in bilateral trade agreements and then according normative and ongoing lobbying power to such textual negotiating truces by formally linking them with non-violation nullification of benefits provisions may undermine democratic sovereignty with regard to construction of domestic policy, particularly in areas such as the environment and public health.

When developing countries export to developed country markets, they often face tariff barriers that can be as much as four times higher than those encountered by developed countries. Most trade justice campaigners focus in some way on the agricultural subsidies of rich countries that make it difficult for farmers in poor countries to compete.

For example, they argue that the European Union's agricultural export subsidies encourage overproduction of goods such as tomatoes or sugar , which are then sold cheaply or 'dumped' in poor countries. Local farmers cannot sell their goods as cheaply and go out of business. The campaign points to the treatment of agriculture at the WTO, which has institutionalised these injustices. In the few instances where developing countries have used the complex and expensive WTO process to declare subsidies e.

It has already inflicted enormous damage.

During and , the South African government faced the constant threat of trade sanctions from the USA. The copies cost less than one-half of the patented versions. The threat of trade sanctions has played a pivotal role in the development and implementation of the new WTO regime. Countries such as India, Egypt, and Argentina, all of which have strong generic-drugs industries, have been among the prime targets.

The next generation of front-line drugs which could treat major killers such as malaria, pneumonia, and diarrhoea which collectively claim almost seven million lives a year and tuberculosis 16 million cases a year , will be patented. There will be no inexpensive generic versions available until after patent expiry - which under WTO rules is at least 20 years from the filing date.

Past evidence on price differentials between patented and generic drugs suggests that the effect on prices will be dramatic. In Thailand, the introduction of a generic competition reduced the cost of drugs for the treatment of meningitis by a factor of Generic drugs for the treatment of resistant shigella, a major cause of bloody diarrhoea, are sold in India at one-eighth of the price of patented equivalents.

Increased prices resulting from patent protection will intensify the pressures faced by the poorest households in dealing with sickness. The central problem with the agreement on patents negotiated at the WTO is that, in its implementation, It is placing corporate profit before human welfare. Governments of the industrialised world - including those in the EU - have colluded in developing a set of trade rules which threatens to further restrict the access of poor people to medicines.

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This will lead to greater sickness, suffering, and premature death on a massive scale. Their actions raise fundamental questions about global governance, and about democracy and accountability in multilateral organisations such as the WTO. They also rest uneasily with pious declarations about internationally agreed health targets.

But the costs of ill-health do not stop at the household. Widespread sickness acts as a brake on economic growth, and denies children the opportunity to realise their potential in education. While poor households will bear the brunt of these costs, the consequences will extend beyond national borders.

No country is immune to the spread of infectious disease, or to the consequences of the poverty and inequality generated by ill-health. That is why the entire international community has a responsibility to ensure that world trade rules promote public health.

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This Briefing Paper is organised as follows. Part 1 looks at the global health divide and explains why the price of medicines is of such vital concern to poor people. The fact that most poor people pay for health care directly out of their own pockets is central to the potential threat posed by WTO patent provisions.

It also looks at the undue influence of pharmaceutical companies on the trade policies of industrialised countries and on the WTO. Part 3 reviews some of the broader arguments for and against patents and their application to pharmaceutical products. Part 4 sets out an agenda for reform. The rich can buy health treatment and drugs.

For the poor, drugs are an unaffordable luxury. It means that you will fall into debt. It is hard for us to buy the drugs we need to treat our children when they have a fever. Much of the debate about medicines and patents at the WTO has been dominated by lawyers and economists, many of them working for powerful drugs companies.

The terms of the debate have been highly technical. People - notably poor people - and public-health concerns have been conspicuous by their absence from the agenda. The omission is unfortunate because the global health context in which WTO rules will operate is important. Life-expectancy in developing countries is 13 years shorter than in developed countries, and child mortality rates are ten times higher.

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In much of sub-Saharan Africa, almost one in five children die before the age of five. While health indicators are improving in parts of the developing world, the goal of reducing child deaths by three-quarters will be missed by a wide margin if current trends continue, especially in South Asia and sub-Saharan Africa. Infectious disease threatens everyone, but the poor are most at risk. Communicable diseases account for around two-thirds of premature death and disability in poor countries, compared with some ten per cent in industrialised countries.

Within poor countries it is poor households that are most at risk. Poverty, poor nutrition, and inadequate access to clean water mean that their members are more likely to fall ill - and when they fall ill they have more limited access to treatment. In India, tuberculosis affects 12 million people, but its prevalence is four times as high among the poorest fifth of the population as among the richest fifth.

Rates of acute respiratory infection are twice as high, yet poor people are 20 per cent less likely to seek formal medical care. One reason for this discrepancy is that poor people know that they will be unable to afford the cost of treatment. Evidence from poverty assessments across the developing world shows that the high price of drugs is one of the main factors causing poor households either to avoid seeking treatment or to cut their treatment short.

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This problem, which is rooted in a combination of household poverty, inadequate public provision, and high prices, means that any increase in the price of vital medicines will have the effect of adding to the ranks of those already excluded from access to adequate health care. He would have been horrified by data on the state of the global health system. Each year the world spends seven per cent of its GDP on health, but resources are inversely related to need Figure 4. Poor countries account for over 80 per cent of the global burden of disease, but only ten per cent of health spending.

Sub-Saharan Africa, the region with the highest rates of child mortality and lowest life-expectancy, accounts for one per cent of total health spending. The inequity does not stop there. In rich countries, health-service provision is dominated by public spending, or, as in the case of the USA, by pre-paid private insurance.

In poor countries Figure 5 , people meet the cost of sickness - including the purchase of drugs - out of their own pockets. This is a reflection of the inadequacy of public investment and the inability of poor people to afford private health insurance. There is a paradox at the heart of the global health system in that financial provision is inversely related to need. Rich countries accounting for a small proportion of the global disease burden not only spend much more on their health, but governments account for a much larger proportion of this. Drugs are typically the largest single item in household spending on health in poor countries, representing on average over half of the total.

In effect, limited public spending in poor countries means that the cost of financing medicines is privatised, with households picking up the bill.

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In sub-Saharan Africa almost two-thirds of total spending on pharmaceuticals is made by households, a figure which rises to over 80 per cent in South Asia Figure 6. Spending on medicines absorbs a large share of national and household health budgets. In countries such as Mali, Tanzania, Vietnam, and Colombia, pharmaceuticals account for over one-fifth of total public-health spending. Chronic under-funding is not the only public-health problem facing poor countries.



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