1851: First International Sanitary Conference aims at balancing the interests of trade with disease control.
1945/6: The International Monetary Fund (IMF) and the International Bank for Reconstruction and Development (IBRD or World Bank) set up as UN specialised agencies to strengthen and add stability to the western economic model. Since then, Structural Adjustment Programmes have been used as conditions for loans pushing developing countries towards greater market liberalisation and reduced government spending. In health care, these policies have led to higher charges for services and consequently more poor people not being able to use them.
1946: Negotiations begin to boost trade by reducing tariffs and dismantling protectionist measures in place since the 1930s.
1947: General Agreement on Tariffs and Trade (GATT) established. Major changes in international trade liberalisation occur through multilateral trade negotiations, or "trade rounds", the Uruguay Round being the latest and most extensive.
1951: The 4th World Health Assembly adopts the text of a new International Sanitary Regulations. The regulations explicitly state that any measure taken should be the appropriate minimum for disease control, with the least possible disruption for health. (Renamed the International Health Regulations in 1969).
1981: The 34th World Health Assembly adopts the Code of Marketing of Breast-milk Substitutes, an important international health agreement in response to a public health threat.
1994: Uruguay Round ends in the creation of the World Trade Organisation (WTO). It differs from GATT in that it is a permanent institution, commitments are full and permanent, it covers trade in goods and services (GATS) and trade-related aspects of intellectual property rights (TRIPS). A dispute settlement system is provided, designed to eliminate world trade blockages. Tribunals comprising three trade experts rule on disputes. The WTO also has provision for standard setting.
1998: The Asbestos Case - a trade dispute taken to the WTO involving asbestos (a well-known carcinogen) affirmed that countries could ban trade in hazardous goods on public health grounds.
1999: The 3rd WTO Ministerial Meeting in Seattle, USA, where anti-globalisation protestors virtually bring proceedings to a halt. During the same year, US non-governmental organisation Consumer Project on Technology (CPTech) begins meetings with AIDS activists to discuss patent and trade issues. Indian generic manufacturer, CIPLA, offers generic substitutes of HIV drugs for US$350 a year per treatment - a small fraction of the price charged by the western firms that hold the patents on the drugs.
European Commission’s DG Trade establishes a Civil Society Dialogue.
2000: Millennium Development Goals agreed by the United Nations, which include goals on poverty reduction, health, education and environmental sustainability. They call for a "non-discriminatory" trading system.
The European Commission launches an extensive review of its trade policy on access to medicines, including a series of meetings with NGOs and drug companies. These discussions fostered the environment that in 2001 led to the WTO’s supportive Doha declaration on public health, essential drugs and the TRIPS agreement.
2001: In South Africa, drug companies based in US and Europe took the government to court over the right to pursue a new essential medicines strategy. Amid huge publicity, the drug companies gave up their case.
The 4th WTO Ministerial Meeting in Doha, Qatar, agrees the Doha Declaration on Public Health. The European Union included NGO representatives on their delegation, including EPHA as a health adviser. DG Trade’s civil dialogue further developed and regularised following the Doha meeting.
2002: The World Summit on Sustainable Development takes place in Johannesburg.
The WTO Secretariat and the World Health Organization (WHO) jointly publish "WTO agreements and public health".
2003: The 5th Ministerial meeting of the World Trade Organization, Cancun, Mexico, 10-14 September.
2004: Drafts of the Framework Convention on Tobacco Control and the International Health Regulations will be presented to the World Health Assembly in May.
Sources:
Weinberg, J. (2002), "Globalisation: An idiots Guide", Eurohealth, Vol. 8 No. 3, Summer 2002;
Love, J. (2002), "Access to essential HIV/AIDS medicines - what made the campaign successful?"
Human Development Report 2002, "Deepening democracy in a fragmented world", UNDP;
"History of WHO and International Cooperation in Public Health", World Health Organization.
