Moving on from NAFTA to the FTAA?: the impact of trade agreements on social and health conditions in the Americas.

1 Instituto de Epidemiología y Salud Comunitaria “Manuel Amunárriz,” Coca, Orellana, Ecuador. 2 Umeå University, Umeå International School of Public Health, Epidemiology and Public Health Science, Public Health and Clinical Medicine, SE-901 85 Umeå, Sweden. Send correspondence to: Miguel San Sebastián, Umeå International School of Public Health, Epidemiology and Public Health Science, Public Health and Clinical Medicine, Umeå University, SE-901 85 Umeå, Sweden; telephone: 46-90 785 33 45; fax: 46-90 13 89 77; e-mail: miguel.sansebastian @epiph.umu.se World trade and foreign investment have grown dramatically over the past 25 years, serving as major drivers for global economic growth (1, 2). This process, often referred to as globalization, involves the integration of various national economies into a single market for goods and services and for capital and investment flows (3). Proponents of this process argue that trade and investment in developing countries bring economic development that leads to higher standards of public health, environmental protection, and human and labor rights (4, 5). However, others contend that the benefits have been unevenly distributed across and within countries and that free trade has imposed significant costs on development. The gap between rich and poor has grown, both within and between countries, and major determinants of health and environmental conditions have been affected (6–8). International trade and investment agreements may seem distant threats to public health, but they promise to shape the future health of the world’s population to a greater extent than many other trends (9). Therefore, there is a need to explore the evidence for the health impact of trade and to feed this evidence into the policy-making process (10, 11). In this paper we will focus on trade in the Americas and discuss some of the main potential public health consequences of the trade agreement currently being negotiated, the Free Trade Agreement of the Americas (FTAA). We will analyze the 10 years of experience that Canada, Mexico, and the United States of America have had with the North American Free Trade Agreement (NAFTA), assess how NAFTA might serve as a blueprint for the FTAA, and discuss the implications of the FTAA.