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It has been widely touted that Trans-Pacific Partnership (TPP) talks will lead to “a high-quality, twenty-first century agreement” that will set standards for future trade agreements.  But one proposal coming out of the 19th round of last week’s TPP talks falls far short of “high-quality” or “twenty-first century”, and may well block the export of some of the United States most successful policies against one of the world’s most pressing public health issues: tobacco. 

The proposal put forward by the US Trade Representative (USTR) last week in Brunei would reduce prices for US tobacco in low- and middle-income countries and make it more difficult for these countries to enforce anti-tobacco policies like package warnings and advertising and marketing restrictions.   This proposal would impact the nine TPP countries – Australia, Brunei Darussalam, Chile, Malaysia, New Zealand, Peru, Singapore, Vietnam, and the United States -- six of these fall into the World Health Organization’s Western Pacific Region, which had the highest smoking rate among men in 2009.   

To put the implications of this proposal into perspective, consider these two points:

 Tobacco use caused 100 million deaths in the 20th century.  If current trends persist, it is projected to cause 1 billion deaths in the 21st century.  More than 80% of those future tobacco-related deaths will occur in low- and middle-income countries (LMICs).

 

Many others have spoken out against the US proposal:

Mayor Michael Bloomberg

Coalition Statement from the Campaign for Tobacco-Free Kids, the American Cancer Society, the Cancer Action Network, the American Heart Association, the American Lung Association and the American Academy of Pediatrics.

Harold Pollack on the Incidental Economist blog.

Tobacco use in the United States is steadily declining, due largely to widespread anti-tobacco campaigns and stringent anti-smoking policies – the same kinds of policies that the TPP will make difficult to enforce in developing countries.  

So, why is the US effectively hindering the export of its good anti-tobacco policies to the LMICs that need them most?  A few key issues have risen to the surface during this debate.

A “carve-out” for tobacco – where tobacco would simply be excluded from the terms of the TPP agreement – was proposed by Malaysia and makes sense. But the USTR worries that a carve-out would set a precedent that could be used to block a variety of other US exports on health grounds.

It’s safe to say that other US exports aren’t comparable to tobacco, which the US Department of Health and Human Services has called “a unique product - it is highly addictive, always harmful to human health, and the single most preventable cause of death in the world." This language – and the data to back it up – set a high bar in terms of threat to health that few (if any) other US agricultural export products would surpass.

The TPP proposal will also make it easier for the tobacco industry to use trade and investment agreements to challenges domestic tobacco control laws – both in the United States and other countries.  Susan Liss from the Campaign for Tobacco-Free Kids explains:

The tobacco industry and its allies in governments increasingly use trade and investment agreements to challenge legitimate tobacco control measures… Indonesia filed a World Trade Organization challenge to a U.S. prohibition on fruit- and candy-flavored cigarettes. Tobacco companies and several countries have filed trade challenges to Australia's law requiring that cigarettes be sold in plain packaging, while Philip Morris International has used an investment agreement to challenge Uruguay's tobacco control laws, including its requirement for large, graphic health warnings.

Such lawsuits would set back progress against tobacco-related deaths in the most at-risk low- and middle- income countries, which often can’t afford to fight back.  But they could also impede hard-fought progress against tobacco in the United States. 

Bottom line: At home, the United States has enacted smart policies and made tremendous progress against tobacco-related deaths -- efforts that should be ‘exported’ and replicated around the world.  In fact, more US effort to help LMIC improve their regulatory policies on tobacco would be a huge improvement on the current inattention to the issue in the global health space. For its part, the USTR TPP proposal is a step further back for international US leadership against tobacco. Twitter says the Administration may revisit their position ahead of a next round of talks; let’s hope the result is different this time.