Urge the #USTR to consider public health impacts of #NAFTA renegotiation

The Trump Administration is planning to renegotiate the North American Free Trade Agreement (NAFTA). The first step in the process is soliciting public comment on the objectives of the renegotiation by Monday June 12, 2017.

Members of the Trade and Health Forum have prepared a comment for its members to submit which reflect the position of the American Public Health Association in its policy statements with regard to trade and health. We urge you to submit the comment below or one of your own using the instructions below.


1. Go to www.regulations.gov

2. Enter “2017-10603” in the “SEARCH for: Rules, Comments, Adjudications or Supporting Documents” search box and click “Search”.

3. Click on the “Comment Now!” button next to “Requests for Comments: Negotiating Objectives Regarding Modernization of North American Free Trade Agreement with Canada and Mexico.”

4. Submit your comment and complete other required fields.



Dear USTR Robert Lighthizer,

The impacts of trade agreements, like the North American Free Trade Agreement (NAFTA), on public health in the United States and partner countries are wide-ranging. While trade agreements can produce economic benefits as well as damages, the health effects of trade agreements must also be considered. Trade agreements can, and often do, limit access to essential medicines; increase the use of tobacco, alcohol, and obesogenic foods and beverages; reduce access to health services; and undermine environmental protections and labour rights. The American Public Health Association has detailed potential public health harms which may arise from trade agreements in its official policy statement, “Ensuring that trade agreements promote public health” (Policy Statement 201512) (https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/12/08/16/04/ensuring-that-trade-agreements-promote-public-health).

U.S. efforts to renegotiate NAFTA present an opportunity to reassess these risks and incorporate measures to ensure the highest attainable level of health for all Americans. I urge you to engage in a transparent renegotiating process that includes public input and accountability and prioritizes the health as well as the economic well-being of the American people.

Incorporating a public health perspective is critical as these concerns were largely excluded from the original NAFTA negotiations and continue to be neglected in the U.S.’s negotiations of more recent trade agreements. Of 28 Trade Advisory Committees (TACs) that advise the Office of the USTR, there is no committee focused on health and only a single member representing health or health care is included in two of the sixteen industry TACs. This absence of a public health perspective on trade is acknowledged by the Government Accountability Office[1] and measures to redress this have been included in proposed Congressional bills that have been the subject of substantial advocacy. In early 2014, President Obama pledged to establish a Public Interest Trade Advisory Committee, which included mention of health expertise in the call for nominations.[2] However, this has yet to be established.

In renegotiating NAFTA with Mexico and Canada, we urge the USTR to:

1.    – Eliminate any Investor-State Dispute Settlement (ISDS) system in order to protect national, state, and local government actions to protect public health from challenges by corporate entities;

2.     -Ensure that trade agreements protect, promote, and prioritize public health over commercial interests, when such commercial interests may undermine or threaten public health, and seek to ameliorate rather than exacerbate health disparities and inequities;

3.     -Support formal exemption of essential public services (e.g., health, education, social services, water, corrections) from NAFTA; and

4.     -Include policies which:

a.      carve out/exclude tobacco and alcohol control measures from all trade agreements,

b.     promote environmental protection and support efforts to curb climate change,

c.      do not undermine national and international labor rights and safe working conditions,

d.     do not promote the downward harmonization of environmental and occupational standards, labor rights, and working conditions.

This list should not be considered exhaustive, but highlights major public health protections that should be observed in the renegotiation of NAFTA. Incorporating such protections for public health will prevent NAFTA from undermining the health of Americans, thereby increasing the efficiency of U.S. health spending and improving policy coherence across different arms of the U.S. government.

Thank you for your consideration.



[1] http://www.gao.gov/new.items/d071198.pdf (page 49)
[2] http://www.regulations.gov/document?D=USTR-2014-0005-0001


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