Blog post

Healthy Trade Policy

Published 20 July 2022

Being able to enjoy the highest attainable standard of health is one of the fundamental rights of every human being, an important determinant of life satisfaction, and one of our most basic and essential assets.i And yet, not everybody enjoys the same opportunities for living a long and healthy life.ii

In the UK, for example, males living in the most deprived areas of England can expect to live 18.9 fewer years in ‘good’ health compared with those in the least deprived areas, with the gap at 19.4 years for females.iii Life expectancy differences across countries are also stark, and such differences cannot be explained by genetic differences or income-levels alone.iv There is, instead, a variety of contributors to health inequalities and cross-national differences in health and longevity. They include differences in access to quality care as well as differences in exposure to environments and circumstances detrimental to physical and mental health, such as poverty, pollution, unemployment, and heavy alcohol, junk food, and tobacco marketing.v

The COVID pandemic has galvanized substantial political, media and public attention to these health inequalities and the importance of good health for societal and economic well-being. At the same time, however, trade agreements continue to be negotiated and ratified which intersect with, and influence, many of the underlying drivers of health and health For example, trade agreements can drive increased exports for internationally competitive firms, and so some individuals may stand to gain from a health (as well as economic) perspective because they work in such firms. This can cause their wages to rise, enabling them to afford better quality housing and more nutritious food, or escape the mentally damaging stresses of financial insecurity.ix Alternatively, however, those who lose work because their firms are not competitive can experience increases in financial insecurity and job losses, both of which have a well-established role in harming mental and physical health.x,xi

Our recent systematic review gives myriad additional examples of the socio-economic differences in the apparent health gains and health harms from trade.8 Importantly, some of these can seem counter-intuitive and can only be fully understood if one considers the complex and varying socio-economic effects of trade agreements, on the one hand, and their intersection with the determinants of health and health inequalities, on the other hand. This underscores the need to consider inter-disciplinary perspectives – including health expertise – when assessing and designing trade policies.

For example, one long contested topic concerns the impact of open or ‘liberal’ trade policy on food insecurity.xii Food insecurity concerns an individual’s inability to afford enough nutritious food, on a consistent basis, throughout a given period of time.xiii Liberal trade policy appears to increase national food supplies by promoting trade in food and expanding domestic production.xiv This is a common expectation and squares with some of the expected benefits of trade – i.e. trade policies promote trade in products that cannot be produced on a large enough scale within a given country alone.  But national food supplies do not necessarily translate into widespread increases in food security. Being able to access food sources and afford food are also crucial drivers of food insecurity. As noted above, some families stand to benefit from wage rises when liberal trade policies are implemented – this benefits food security too through increasing food access and affordability. But for those who lose work or experience wage declines, food insecurity may actually increase, because they are less able to afford or access sufficient nutritional food. What, then, is the net consequence for food insecurity?

In our paper in The Lancet Global Health, we sought to determine the answer to this question.xv  Specifically, we analysed the relationship between individual food insecurity and the liberality of trade policy1 in the country in which they lived using a unique global dataset spanning approximately half a million respondents in 132 countries, 2014-2017. We also accounted – to the extent possible with our data – for key alternative explanations for the relationship we assessed, such as the independent relationships between income levels, trade openness, and food insecurity.

We found that the relationship between liberal trade policy and food insecurity varied markedly between countries and across the income distribution within countries. More liberal trade policy was predominantly – but not universally – associated with lower food insecurity in high-income countries. More liberal trade policy also corresponded to increased food insecurity among very poor households in low-income countries.

For example, among households in high-income countries who had incomes larger than $25,430 per person per year, a unit increase in the trade policy index (more liberal) corresponded to a 0·07 percentage point  (95% CI: 0·10 ppt to 0·04 ppt) reduction in the predicted probability of reporting moderate or severe food insecurity. But the relationship was much weaker for individuals lower down the income distribution, and was ultimately non-existent for very poor households. Among households earning less than $450 per person per year (all of whom lived in low-income countries), a unit increase in the trade policy index was also associated with a 0·35 percentage point (95% CI: 0·06 ppt to 0·6 ppt) increase in the predicted probability of moderate/severe food insecurity.

These results must be interpreted with caution as they concern descriptive rather than definitively causal relationships. However, our findings are valuable for underscoring the complex and potentially counter-intuitive health benefits and harms from trade. This underscores the importance of including health expertise as trade policies are being designed, and of carefully scrutinising of the implications for health, health inequalities, and associated policy agendas.


  1. OHCHR. Fact Sheet No.31: The Right to Health. Office of the United Nations High Commissioner for Human Rights. Geneva, Switzerland; 2008.
  2. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099-1104. doi:10.1016/S0140-6736(05)71146-6
  3. ONS. Health state life expectancies by national deprivation deciles, England: 2018 to 2020. the period 2018 to,%2C respectively (Figure 1). Published 2022. Accessed June 20, 2022.
  4. Nelson K, Fritzell J. Welfare states and population health: the role of minimum income benefits for mortality. Soc Sci Med. 2014;112:63-71. doi:10.1016/j.socscimed.2014.04.029
  5. Mackenbach JP. The persistence of health inequalities in modern welfare states: The explanation of a paradox. Soc Sci Med. 2012;75(4):761-769. doi:10.1016/j.socscimed.2012.02.031
  6. Paremoer L, Nandi S, Serag H, Baum F. Covid-19 pandemic and the social determinants of health. BMJ. 2021;372:n129. doi:10.1136/bmj.n129
  7. 7Barlow P, McKee M, Basu S, Stuckler D. The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis. Global Health. 2017;13(1):13.
  8. Barlow P, Sanap R, Garde A, Winters LA, Mabhala MA, Thow A-M. Reassessing the health impacts of trade and investment agreements: a systematic review of quantitative studies, 2016–20. Lancet Planet Heal. 2022;6:e430-437.
  9. Panda P. Does trade reduce infant mortality? Evidence from sub-Saharan Africa. World Dev. 2020;128:104851.
  10. Pierce JR, Schott PK. Trade liberalization and mortality: evidence from US counties. Am Econ Rev Insights. 2020;2(1):47-64.
  11. Deaton A. Income, health, and well-being around the world: Evidence from the Gallup World Poll. J Econ Perspect. 2008;22(2):53-72.
  12. Clapp J. Food Security and International Trade: Unpacking Disputed Narratives. Rome, Italy: United Nations Food and Agricultural Organisation.; 2015.
  13. Ballard TJ, Kepple AW, Cafiero C. The food insecurity experience scale: development of a global standard for monitoring hunger worldwide. Rome FAO. 2013.
  14. Dithmer J, Abdulai A. Does trade openness contribute to food security? A dynamic panel analysis. Food Policy. 2017;69:218-230. doi:10.1016/j.foodpol.2017.04.008
  15. Barlow P, Loopstra R, Tarasuk V, Reeves A. Liberal trade policy and food insecurity across the income distrbution: an observational analysis in 132 countries, 2014–17. Lancet Glob Heal. 2020;395.


[1] Our measure of trade liberality aggregates multiple indicators of trade policy (e.g. tariffs, no. of free trade agreements) on a scale from 1 to 100, where 100 is assigned to the observation with the highest value across the whole sample of countries and years and 1 to the lowest. For example, in 2017 the UK was 1-unit less liberal than Singapore and 10-units more liberal than Canada.

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