Health Affairs, 23, no. 3 (2004): 136 doi: 10.1377/hlthaff.23.3.136 © 2004 by Project HOPE	New Online   New Issue: China & India   Obesity In China   Pay Cuts For Medicare Docs   Access To Care Woes

This Article Extract Reprint (PDF) Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My Personal Archive Download to Citation Manager Reprints & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content

Agreements

PROLOGUE

International Agreements And Health

Then the piper came calling. The "giant sucking sound," first articulated by H. Ross Perot in 1992, was heard in the new millennium as manufacturing jobs steadily flowed from high-wage, environmentally regulated countries like the United States to areas where the opposite was true in the quest for competitive advantage. The most recent incarnation of this phenomenon is the widespread practice of "offshoring" jobs, many of which were previously thought insulated from relocation.

The impact of this reality check on globalization has been palpable. More significant than its practical effect on the economy as a whole is the battering that international free trade has taken in political discourse. Fearing a public backlash during a presidential election year mired in a "jobless recovery," politicos of all stripes seem to be reaching a consensus that views free trade with skepticism. In the health sector, many have begun to question why Americans should be forced to endure the costs associated with globalization while being prevented from reaping its benefits through, for example, importation of cheaper drugs.

In this context, the papers that follow explore the impact of international agreements and covenants on domestic health policy decision making, development and cost of prescription drugs, and efforts to improve global health. First, Leah Belsky and colleagues address the emerging controversy surrounding the effect of the General Agreement on Trade in Services (GATS) on U.S. freedom to redefine its own health care system. Next John Barton considers the impact of the 1995 Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement and subsequent covenants on the ongoing debate over how best to provide adequate incentives for the development of drugs that are relevant to developing countries while ensuring affordable access. Amir Attaran wades deeper into these waters by presenting data debunking conventional wisdom attributing drug access barriers to patent restrictions. Finally, Lesley Magnussen and colleagues assess the effect of departing from Alma Ata on efforts to ameliorate preventable disease in the developing world.

                      What's this?