Blog post

Are Free Trade Agreements Trading Away Our Health?

Published 11 September 2023

Lessons Learned from Public Health Wales’s1 Health Impact Assessment of the Comprehensive and Progressive Agreement for Trans-Pacific Partnership

The inextricable link between trade and health

There is a concern that the unequal distribution of potential economic benefits from trade - and a lack of attention to the many other ways in which the terms of trade agreements can affect our lives - means that trade deal negotiators may be inadvertently ‘trading away’ our nation’s health and well-being.

International trade flows, and through them international trade agreements, are key commercial policy determinants of population health and well-being. They aim to bring opportunities for greater prosperity to the UK and Wales by expanding markets, encouraging foreign investment, and increasing employment opportunities. This has the potential to bring with it benefits for population health and well-being.

However, opportunities are unlikely to be shared equally across the UK or Wales. Some parts of the population may even be disadvantaged by the terms of trade agreements.

That is because, as well as aiming to boost international trade, the terms of international trade agreements can also influence our access to healthy food, medicines, and health care, as well as working conditions, alcohol and tobacco regulation, and environmental protections. All these factors can impact our physical and mental health and well-being and are known as the determinants of health—the conditions in which we are born, grow, live, work and age.

Those already living in poverty are most likely to experience disadvantages, bringing further health harms and amplifying existing health inequalities in Wales and the UK (differences in health status between individuals and populations).

The UK’s first health impact assessment (HIA) of a free trade agreement

The UK concluded negotiations to join the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) on 31 March 2023 and signed the Protocol of Accession on 16 July 2023. This is one of the largest free trade agreements (FTAs) in the world and includes a wide range of Pacific-Rim countries (Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, and Vietnam). Official entry into the CPTPP will take place once the UK and current members finish their legislative processes, which is expected to happen in 2024.

In July 2023, Public Health Wales (PHW) published a Health Impact Assessment (HIA) of the CPTPP on Wales - only the second such analysis ever completed globally.

Using peer-reviewed academic literature, grey literature (including policy documents and reports), evidence gathered from stakeholder interviews and workshops, and the Community Health Profile of Wales (including health statistics and demographic data), PHW assessed the potential positive and negative impacts of the CPTPP on the determinants of health across different population groups in Wales.

Through the HIA, PHW identified potential positive economic impacts for some population groups in Wales through expanded market access and employment opportunities. Other potential positive impacts include an expanded health and social care workforce due to mobility provisions; and access to new medicines and treatments due to increased research and development.

A range of potential negative impacts were also identified, with those in Wales on low incomes, suffering from long-term chronic conditions, or working in the agricultural sector more likely to experience these. Potential negative impacts included poorer diet and nutrition through reduced food standards or lower tariffs on unhealthy foodstuffs; challenges to enacting and implementing environmentally friendly and net zero policies; increased risk of alcohol and tobacco use; decreased access to health care services and medicines, and the increased cost of these.

Thinking long term

The HIA looked at potential short-, medium-, and longer-term impacts and noted that short-term assurances given by current ministers may be overridden by future governments. The CPTPP sets a minimum standard required for member states in areas such as the environment, food, and labour. If regulations in the UK or Wales were downgraded any time after joining the CPTPP, for example, then the agreement may prevent them from being restored or improved on by future governments. This is because they may face legal challenges from other CPTPP members through the agreement’s Investor State Dispute Settlement (ISDS) mechanism if the regulations are seen as hampering trade or investments.

The identified health and equity impacts of the CPTPP on Wales are potential rather than actual at this time. The impacts may change or be observed over the implementation period or as governments and their priorities change. Now that the full text has been published, the HIA can be reviewed and amended.

Furthermore, it remains to be seen whether the ISDS mechanism within the CPTPP can and/or will mean that foreign investors take legal action against new public health policies enacted by the UK or Welsh Governments if they see them as having a negative impact on their business. However, even just the fear of legal challenges, and the expense of fighting them, can lead to ‘regulatory chill’, where governments are deterred from pursuing progressive public health policies in the first place. Food, alcohol and tobacco regulations by Wales, the UK and others have created significant public health benefits, and it would be concerning if further progress in these areas was constrained by the terms of international trade agreements like the CPTPP.

Making the case for public health

PHW’s HIA calls for more transparency around the details of trade agreements and negotiations at early stages and further research into the links between trade provisions and health. It also highlights the value of using HIA – a well-established, evidence-based public health tool in other policy areas – to assess the potential impact of trade agreements on health, well-being and equity. PHW has pioneered the use of HIA to analyse the potential impact of a trade agreement on Wales in this case, with this being only the second such analysis ever conducted globally - but hopefully, it is just the beginning. By using HIA to anticipate the potential impacts of trade agreements, like the CPTPP, on health, well-being, and equity, policymakers can identify how to mitigate potential risks and maximise opportunities, now and into the longer term.

The HIA has also sparked discussion with trade and health experts in Wales and the UK about what a free trade agreement would look like in a well-being economy, where measures beyond GDP are considered in evaluating the potential benefits of a free trade agreement. It is hoped that sharing the findings of this analysis will encourage consideration of health, well-being, and equity during the scrutiny period of the CPTPP and in future trade agreement discussions.


  1. Public Health Wales is the national public health agency in Wales and exists to protect and improve health and well-being and reduce health inequalities for people in Wales.

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