AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

Resolution:        __(A-03)

Introduced by:  American College of Preventive Medicine
                        American Association of Public Health Physicians

Subject:           Elevating Health Concerns in International Trade Agreements

Referred to:     Reference Committee ___

_____________________________________________________
Whereas, the U.S. is currently negotiating international trade agreements with significant implications for health care and public health, notably the General Agreement on Trade in Services (GATS), covering all 145 nations belonging to the World Trade Organization, and the Free Trade Area of the Americas (FTAA), covering the 34 nations of the western hemisphere except Cuba; and

Whereas, an important FTAA negotiating session will occur in November, 2003; and

Whereas, the AMA affirms the importance of placing public health priorities over trade and financial concerns (AMA Testimony to the Framework Convention on Tobacco Control, September 24, 2002, viewed on 5/5/05 at: http://www.ama-assn.org/ama/pub/article/6287-6776.html) and notes that under GATS and FTAA any local, state or national laws and regulations that protect health can be superseded if they are interpreted by closed international trade tribunals as barriers to trade and as unnecessary; and

Whereas, with little public notice and no participation by the health care community, nations’ trade representatives are negotiating the terms of GATS and FTAA, which could pose significant threats to public health, the environment, and providers and users of both public and private services; and

Whereas, these rules could severely restrict the ability of federal, state, and local governments to regulate services such as: standards for licensing physicians, nurses and dentists; standards for the performance of health insurance companies; the distribution of alcohol, tobacco and firearms; the ability of governments to determine the purposes for distributing public subsidies, including those for the care of underserved populations and graduate medical education; the licensing of hospitals and health facilities; research and development; privacy and confidentiality of medical information; higher education; and the administration of water and sanitation services; and

Whereas, under existing trade agreements such as the North American Free Trade Agreement (NAFTA) expensive lawsuits have been filed to challenge environmental and other health protections, resulting in the diversion of public funds to defend these suits and to pay penalties, and having a chilling effect on further protections; and

Whereas, there is a pressing need for effective national and international cooperation to address global threats to public health and security, ranging from bioterrorism to SARS, and to assure that vital human services are universally available;

Therefore be it

RESOLVED, that the AMA now strongly advocate that GATS, FTAA and similar international trade agreements recognize that health and public health concerns take priority over commercial interests, and that trade negotiations be conducted in a transparent manner and with full attention to health concerns and participation by the public health community; and be it further

RESOLVED, that the AMA now strongly advocate that any provision that could negatively affect health or health care, safe and sufficient water, and/or other vital human services be excluded from GATS and FTAA; and be it further

RESOLVED, that the AMA assess the implications of trade agreements and negotiations for public health and for the medical profession and report back at A-04 with an AMA action plan.

Fiscal Note: No Significant Fiscal Impact.

RELEVANT AMA POLICY

H-490.964 Impact of Tobacco Exports on the Worldwide Smoking Epidemic

The AMA (1) will work for the enactment of federal legislation or regulations that would prohibit the exportation of tobacco products to other countries. Pending the enactment of such legislation or regulation, the AMA (2) urges the U.S. government to alter trade policies and practices which currently serve to promote the world smoking epidemic; (3) continues to support the following activities: (a) support federal legislation requiring health warning labels in the appropriate native language or symbolic form to be on packages of cigarettes exported and require foreign advertising by the US tobacco producers to be at least as restrictive as types of advertising permitted in the U.S.; (b) labeling on tobacco products manufactured abroad to be at least as restrictive as those which are produced in the U.S.; (c) opposition to efforts by the US government to persuade countries to relax regulations concerning tobacco promotion and consumption; and (d) encouragement of the World Health Organization to increase its worldwide anti-smoking efforts; (4) supports working with the World Medical Association as well as directly with national medical societies to expand activities by the medical profession to reduce tobacco use worldwide; (5) supports establishing close working relations with the World Health Organization to promote more physician involvement in antitobacco activities, particularly in developing and recently developed countries; (6) supports working with the Centers for Disease Control's Office on Smoking and Health to promote worldwide antitobacco activities; (6) supports periodically monitoring the success of worldwide anti-tobacco efforts to control the growing worldwide smoking epidemic; and (7) supports the right of local jurisdictions to enact tobacco regulations that are stricter than those that exist in state statutes and encourage state and local medical societies to evaluate and support local efforts to enact useful regulations. (CSA Rep. B, A-89; Sub. Res. 406, I-95)

H-490.980 Importation of American Tobacco Products by Foreign Countries

The AMA (1) opposes any efforts by the government or its agencies to actively encourage, persuade or compel any country to import tobacco products; and (2) favors legislation that would prevent the government from actively supporting, promoting or assisting such activities. (Res. 120, I-86; Reaffirmed in lieu of Res. 232, I-94)

H-490.925 International Tobacco Control Efforts

Our AMA: (1) supports the international tobacco control efforts of the World Health Organization; and (2) urges the appropriate bodies and persons within the United States government (including Congress, the State Department, the Department of Commerce, and the Department of Health and Human Services) to participate fully in international tobacco control efforts, including supporting efforts to bring to fruition a Framework Convention on Tobacco Control. (Res. 428, I-98)