Sibel Ozcelik

ROUGH DRAFT – NEW RESEARCH

TRADING PROFITS FOR HEALTH: A LOOK INSIDE THE TPP

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‘Healthy’ Trade Agreements

When you think of trade policy, what first comes to mind? Quotas? Tariffs? Exports and

imports of agricultural and industrial goods? While that may have been what trade policies

looked like in the twentieth century, today’s trade policies expand well beyond these to include

many other features like investor policies and protections and sanitary and phytosanitary

measures. These additions aim to address modern-day challenges to trade, in hopes of creating

economic growth and making trade ‘fair’.

Yet, these provisions, if not thoughtfully structured, have the high risk of doing just the

opposite. The assumption that economic development brings improved health is tenuous in the

case of non-communicable diseases (NCDs), which may be exacerbated by development, as

urbanization leads to increased reliance on cars, less green space for recreation and rising

incomes lead to increased consumption of tobacco, alcohol and calorie laden foods. Thus, in a

world characterized by increasing economic globalization, it is vital to understand how trade

operates in ways that may be detrimental to health so as to resolve these negative consequences.

For without greater understanding and mechanisms to create safeguards for health, the risk and

the reality of adverse impacts on population health caused by trade grow exponentially, as

predicted will result as a consequence of the Trans-Pacific Partnership Agreement.

The Trans-Pacific Partnership

On October 4th, 2015, the United States finalized negotiations for the Trans-Pacific

Partnership (TPP), a far-reaching free trade agreement, with 11 other countries including Japan,

Brunei, Australia, Canada, Malaysia, Chile, Mexico, Peru, Vietnam, Singapore, and New

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Zealand (3, 17).1 After seven years of secretive talks,2 the next month, the public, Congress and

the press finally gained access to the TPP’s full text3. U.S. Sen. Elizabeth Warren joked about its

unethical and undemocratic secretive method of creation, "From what I hear, Wall Street,

pharmaceuticals, telecom, big polluters and outsourcers are all salivating at the chance to rig

the deal in the upcoming trade talks. So the question is: Why are the trade talks secret? You'll

love this answer. Boy, the things you learn on Capitol Hill. I actually have had supporters of the

deal say to me, 'They have to be secret, because if the American people knew what was actually

in them, they would be opposed’ (25).” One supporter, however, may come as a surprise (18,

19)…

On February 3rd, 2016, President Obama released a statement before signing the TPP, in

which he declared the agreement a “forward-looking trade deal” that set high standards for

investment and trade, “a new type of trade deal that puts American workers first,” and an

agreement which allows America, not “countries like China, write the rules of the road in the

21st century (18).” All this praise from the President makes the TPP sound like a policy made

from social justice heaven (and highly question Senator Warren’s sources)! Yet, these lofty

statements are just that – statements, carrying little to no evidence to support them.4 In fact,

1 Together, this mix of rich and middle-income countries control close to 40% of the global

economy (3).

2 The U.S. joined the negotiations five years ago (16).

3 Some chapters were leaked through Wikileaks (58).

4 The only reports concluding that the TPP will result in increased jobs and wages were by the

Peterson Institute for International Economics (PIIE) (for example, see (21). The Global Trade

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within the TPP’s 6000-plus pages are provisions which greatly empower foreign corporations

(not the worker) and constrain governments’ abilities to protect population health. 5

In this paper, the effect of the TPP on health and the ability of governments to mitigate

against the TPP’s negative impacts will be examined to present the importance of including

global health frameworks when creating trade agreements. This report considers the following

areas of the TPP on a thematic basis to present how the TPP’s provisions have great

consequences for population health: Trade in goods, Technical barriers to trade (TBT), Sanitary

and Phytosanitary (SPS) Issues, Dispute Resolution, and Intellectual Property.

Trading Goods or Trading Unhealthy Habits?

Trade policies can drive a government’s economy, power and resources, greatly altering

its people’s working and daily living conditions. These trade-induced environments can then

inform health-related behaviors and preferences; thereby, it is safe to conclude that trade

Watch, along with a team at Tufts, found many faults with these papers’ economic analysis.

Even with its faults, the studies still predicted 53,000 U.S. jobs would be displaced per year

during the TPP’s first decade (22-26)! Moreover, the Global Trade Watch showed that “the

projections [of the PIIE imply that, as a result of the TPP, the country will be as rich on January

1, 2030 as it would otherwise be on April 1, 2030” (22).

5 Only six of the thirty chapters are explicitly about trade itself! Moreover, the Obama

administration’s only major study, issued by the Department of Agriculture, showed that the TPP

would have 0.00% increase in U.S. growth (“zero or small positive effects on members’ real

gross domestic product (GDP)…There are no measurable effects on U.S. real GDP in 2025

relative to the baseline scenario” (19)).

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influences population health. In theory, trade liberalization leads to improved economic growth

and with that, alleviates poverty and improves living conditions and the health of populations (4-

7). However, history shows that recent free trade agreements exacerbated imbalances in health

inequality, as well as resource distribution, income inequality and power within and between

countries (8-15, 20, 27-36).

The TPP seeks to liberalize trade on most if not all goods, including alcohol, tobacco and

processed foods. Through this promise to eliminate tariffs completely, these goods increase in

accessibility and availability while they decrease in prices. Depending on the demand, this

trifecta of availability, accessibility and affordability creates a high risk for consumption of these

highly addictive, harmful, unhealthy products (9-16). By treating tobacco, alcohol, and highly

processed foods as conventional commodities, rather than as exceptions, the TPP will impact

health detrimentally if the consumption of these goods increases (29-35). The increased supply in

products in combination with their lower costs create opportunistic havens for NCDs to develop

and flourish, as can be evidenced by theory and reflection of previous free-trade agreements’

(FTAs’) effects on health.

Theoretical Potential for Greater NCD Development

In the United States, consumer expenditure on alcoholic beverages and tobacco over the

past six years increased or decreased, depending on the population assessed. While Americans

who earned between $1,000 to about $70,000 total income per year decreased spending on

alcoholic beverages and tobacco, those who earned more than $70,000 increased spending on

these products. As prices increased for these products over the last ten years, lower income

populations spent less while higher income populations could afford the price increases.

Furthermore, within higher-income populations, a smaller number of individuals consumed these

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goods (e.g. smoked): Populations living below the poverty level have a prevalence of 26.3% in

2014 (down from 27.7% in 2010) while those at or above poverty level have a prevalence of

smoking at 15.2% (down from 19.6% in 2010). Among men who quit smoking, those at or above

the poverty level were three times as likely to quit as those below the poverty level! In other

words, demand exists within populations below the poverty level, even though they may not be

able to afford as many goods (60).

After the TPP and its elimination of tariffs, including those on tobacco which currently

has tariffs as high as 350%, low income populations will be enabled to purchase more of these

reduced-price, high-in-supply goods…low income populations who may not be able to afford the

later healthcare costs that come with these risky

behaviors (65)!

Similarly, as seen in the graphs on this page,

sugar consumption among adults and consumption of

sugar sweetened drinks are highest among lower

socioeconomic groups,6 who are more price sensitive

consumers (45-48, 50). Consequently, this near

elimination of sugar tariffs may disproportionately

increase lower socioeconomic groups’ sugar

consumption, widening health inequalities once more.

Historical Reflection: Previous Free-Trade Agreements and Increased Levels of NCDs

6 High sugar foods greatly make up the cheapest foods (43).

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Historically, the creation of open markets for harmful products led to greater NCD

prevalence. For example, take a look at what happened to obesity rates in Mexico after the

creation of the North American Free Trade Agreement. As U.S. firms exported more processed

foods and increased FDI in these areas, the public’s nutrition and health took a turn for the

worse. Today, Mexicans consume a startling 300 liters more of soft drinks per capita per year

(the highest consumption globally). This high soda consumption reflects in NCD prevalence: In

2011, 32.4% of Mexican adults were obese…and this trend of higher and higher rate of obesity

is present anywhere soft drink companies have a large foreign direct investment. In fact, similar

to tobacco and alcohol companies’ strategies, soft drink companies target markets in developing

countries, as their citizens have a higher likelihood of being unaware of high soda

consumptions’ negative health effect (49). It may come to little surprise that Coca-Cola heavily

invested in sales and production in Mexico ($5 billion) (51, 64).

To see another stark example of increased NCD prevalence after the creation of an open

market take a look at Asia’s rates of smoking prevalence. After threatening trade sanctions, the

U.S. government (supported by a large lobby group, the U.S. Cigarette Export Association)

forced South Korea and Japan to open their markets to U.S. tobacco products. One year later,

smoking prevalence in Japan doubled to 32% just as the smoking prevalence did among South

Korea’s adolescent males. In both countries, adolescent girls had the highest growth rate. It may

once again come to no surprise that tobacco companies deliberately (and shamelessly) targeted

these young women (53-56).

Why Care? 2030’s Predicted 55 Million Annual Deaths from NCDs

The TPP itself provides new market opportunities for U.S. exporters, expanding demand

among over 500 million consumers in partner TPP countries. The USDA estimates that by

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eliminating tariff rate quotas (TRQs) and tariffs among these partners, the percentage increase in

the value of intraregional trade will be largest for rice, sugar, and “other meat” (which includes

animal fats and oils). In absolute value terms, the highest increase will be for bovine meat (which

includes beef and mutton), “other foods” (which includes processed foods and feeds), and

poultry meat.

As populations consume larger amounts of these products (specifically, animal meat,

vegetable oils, sugar and more energy-dense, unhealthy foods), the risks for obesity and it co-

morbidities rise. NCDs (diabetes, heart disease, chronic lung disease and cancer) and their shared

risk factors (physical inactivity, unhealthy diets, tobacco use, and alcohol abuse) caused almost

70 percent of the world's 56 million deaths in 2012. That number is about six times as many

deaths as those caused by HIV/AIDS, malaria, and tuberculosis combined. Furthermore, the

burden of disease is expected to grow over the coming decades, causing great worry. Another

cause of worry lies in the safety of the goods themselves: With more goods to trade, regulatory

challenges increase.

Technical Barriers to Trade (TBT)

Within the TPP, the chapter on Technical Barriers to Trade (TBT) creates greater

restrictions on how much consumers know (or have the right to know) about what makes up their

food. The TPP includes a new annex on “Proprietary Formulas for Prepackaged Foods and Food

Additives.” Annex 8-F, Article 3 states:

When gathering information relating to proprietary formulas in the preparation, adoption

and application of technical regulations and standards, each Party shall: (a.) ensure that

its information requirements are limited to what is necessary to achieve its legitimate

objective; and b. ensure that the confidentiality of information about products

originating in the territory of another Party arising from, or supplied in connection with,

the preparation, adoption, and application of technical regulations and standards, is

respected in the same way as for domestic products and in a manner that protects

legitimate commercial interests (52).

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This “necessity test” (a.) combined with confidentiality protections (b.) create new regulatory

problems for U.S. states and foreign governments. Many states in the United States are creating

innovative food information7 labels to nudge consumers to make healthier choices; will these be

challenged as unnecessary8? Will proposed junk food warnings and ‘proprietary’ food additive

formula descriptions ever exist? Food and Drugs Administration (FDA) Deputy Director of Food

Michael Taylor warns that “We [already] simply do not have the information to vouch for the

safety of many of these chemicals [the thousands of food additives in processed foods] (28).”

While U.S. states create label laws, the USTR continues to challenge other governments’

food label policies. For example, when Chile proposed a food label law on foods exceeding high

thresholds for saturated fats, sodium, sugar, and calories with a stop sign-shaped label, the USTR

7 Hundreds of state food labeling requirements already exist. California, Vermont, and Maine

have mandatory GMO labeling laws (and seventeen states have similar proposed legislation).

Many states have laws on seafood and farmed fish labels. Requirements vary depending on the

state; for example, labels may require whether the fish is farmed, wild-caught or imported, if

artificial colors were added, if fish were genetically-modified, or if the label must use scientific

versus common names. New York requires “imitation cheese” to be labeled. New Hampshire,

Vermont and New York require “maple syrup”-labeled foods to be free of additives. Several

state laws exist on honey and olive oil products. Lastly, many states have traceability

requirements. All of these statutes were hard-fought against industries and all are vulnerable to

international trade agreements’ standards.

8 For example, California, Vermont and New York introduced bills to require safety warnings on

sugary drinks.

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opposed the proposal as a barrier to trade.9 This TPP annex makes it harder to inform consumers

in fear of offending international law10, putting trade over health. Nutrition details, where and

how food was produced, GMO ingredients, and health warnings are all at risk, both at the state-

level and internationally; it seems that at the end of the day, corporate interests trump

consumers’. Strong consumer protections (both state and globally) may fade away as trade deals

take away’ powers to regulate11 (78-83).

9 “As much as 80 percent of the $312.4 million of U.S. prepackaged foods exported to Chile

could need to bear at least one warning icon (28).” After meeting with USTR, Chile changed its

proposal: the number of products affected decreased and the warning icon was made smaller and

became green (not red).

10 Fear stems from Investor-State Dispute Settlements (ISDS) which give foreign investors the

right to sue governments for regulatory-caused lost profits in private investment tribunals. Under

ISDS, transnational corporations could sue over lost profit claims caused by food labeling

requirements. Public interest laws ‘violate’ “fair and equitable treatment” of corporations’

investments.

11 Under World Trade Organization (WTO) rules, TBT provisions are already in effect and have

already changed federal food labeling standards. In May 2015, the U.S. “country of origin”

consumer meat labelling standard (COOL) was ruled a technical barrier to trade by the WTO

Appellate Body, violating trade rules. Labels of poultry, beef and pork sold in the U.S. may no

longer disclose the country in which animals were slaughtered, raised and born. Voluntary

“dolphin-safe” tuna labels were also successfully challenged.

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SPS

Another chapter of the TPP addresses sanitary and phytosanitary measures of countries.

A mere 18 pages of the total 6,194, the objective of the SPS chapter is to modify or eliminate

SPS measures that impede agricultural and food trade, measures that must have “sufficient

scientific justification.” If the TPP leads to increased trade of foods, shouldn’t the text at the very

least provide the appropriate levels of sanitary and phytosanitary protections rather than

weakening regulatory standards? Already, 1 in 6 Americans gets sick from foodborne diseases,

128,000 are hospitalized, and 3,000 die per year according to the CDC12. This translates to food-

borne disease related healthcare costs of $93.2 billion annually and this number has increased

over the last decade as the FDA’s food inspection rates drop due to successive budget cuts13. If

the U.S. does not have the regulatory capacity and resources to safely manage current imports,

how will it handle the increased number of imports due to the TPP? With the potential for

weakened regulations, without the capacity to inspect for safety, and with pressure to accept all

exports in fear of ISDS lawsuits from TPP countries, the risks and costs of foodborne diseases

increase exponentially (62-63).

ISDS

Disputably one of the most debated provisions of the TPP is the power enshrined in

Investor-State Dispute Settlement (ISDS) mechanisms. This power allows transnational

12 Only three percent of US food borne illnesses was reported to authorities (usually the ones that

required hospitalization).

13 For example, ninety federal inspectors conducted physical inspections but did laboratory

testing on far less than one percent of 5.2 billion pounds of imported fish in 2011.

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corporations to sue governments that ratify the TPP over policies that ‘damage’ (or perceived to

damage) their investments14. Specifically, whenever a foreign firm feels that their investment has

been treated inequitably or unfairly, taken without compensation (indirect expropriation), or

discriminated against, they may seek ISDS claims against governments. ISDS claims appear

before three-person, unreviewable arbitration panels, which have no requirements to follow

precedents and lack both public accountability and standard judicial ethic values. Legal experts

strongly criticized the TPP’s inclusion of ISDS, warning: “ISDS weakens the rule of law by

removing the procedural protections of the legal system and using a system of adjudication with

limited accountability and review. It is antithetical to the fair, public, and effective legal system

that all Americans expect and deserve” (1-10).

14 An overreaching definition of “investment” has been agreed by all parties that would extend

the coverage of the TPP’s expansive substantive investor rights far beyond “real property,”

permitting ISDS attacks over government actions and policies related to financial instruments,

intellectual property, regulatory permits and more. The definition of “investment” in the text is:

“every asset that an investor owns or controls, directly or indirectly, that has the characteristics

of an investment, including such characteristics as the commitment of capital or other resources,

the expectation of gain or profit, or the assumption of risk” (Article 9.1). The text goes on to

enumerate as examples: regulatory permits; intellectual property rights; financial instruments

such as stocks and derivatives; “construction, management, production, concession, revenue-

sharing, and other similar contracts;” and “licenses, authorizations, permits, and similar rights

conferred pursuant to domestic law.”

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In recent years, the number of disputes increased dramatically and may have even caused

‘regulatory chills’15 on governments. Unfortunately, these disputes have been extremely costly;

an ISDS case defending a challenged regulatory policy totals $8 million an average. Already,

foreign firms have won more than $440 million (in taxpayer money) through ISDS cases under

U.S. FTAs and pending ISDS claims add up to more than $34 billion! What follows are

examples of the numerous investor state attacks on public interest policies to date.

1. Eli Lilly v. Canada

Canadian law requires all patent-seekers to meet a utility standard.16 When Eli Lilly &

Company, the fifth largest pharmaceutical firm in the United States, was unable to meet this

standard, it was thereby unable to obtain patents for two of its drugs: Strattera and Zyprexa.

Without these patents, Eli Lilly lost its monopoly protection rights and as a result, Canadian drug

makers were able to produce cheaper, generic versions of Strattera and Zyprexa. Consequently,

in September 2013, Eli Lilly & Company, launched an ISDS claim under NAFTA against

Canada for $481 million. As its claim, Eli Lilly held that the “improper” and “discreditable”

invalidation of its patents constituted a NAFTA-prohibited “indirect expropriation,” violating the

NAFTA guarantee of ‘a minimum standard for treatment’. This case awaits its final decision in a

NAFTA tribunal which will have the power to second guess the Canadian courts’ decisions and

even more shockingly, to determine the legality of Canada’s well-established patent standards!

15 Regulatory chill is defined as the dissuasion of government from initiating or changing

regulations in fear of a claim.

16 In order to maintain or obtain a patent, a patent holder must substantially provide evidence of a

drug’s promised benefits and utility.

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2. Ethyl v. Canada

The US EPA banned the use of MMT in reformulated gasoline; soon after, California

banned it completely. Similarly, Canada wanted to ban its use, worried about its risks on public

health and the environment. When it enacted the ban, Ethyl Corporation, a U.S. chemical

company, retaliated and launched a NAFTA investor-state claim. It sought $251 million to

compensate for its lost profits, caused both by the ban’s impact on MMT production and the

resulting negativity around MMT use. Ethyl argued that the ban constituted a NAFTA-forbidden

indirect expropriation of its assets. At the end of a long process, a NAFTA tribunal favored Ethyl

Corporation and rejected Canada’s arguments; Canada settled with Ethyl Corporation, awarding

the firm $13 million in damages and legal fees. Moreover, the settlement required Canada to

reverse the ban and post advertisements about MMT’s safety. This verdict shows that health and

safety (e.g. the right not to be harmed by industrial toxins) may not trump trade, and if they do,

corporations have the right to be compensated, draining state treasuries.

3. Metalclad v. Mexico

Metalclad, a U.S. company, purchased a hazardous waste landfill in Mexico and was

issued permits from both state and federal authorities. However, the municipal government

denied the permit as locals were getting very sick from previously dumped wastes (so sick that

many were developing aggressive diseases). When unable to operate, Metalclad took to NAFTA

tribunals, claiming breach of NAFTA’s standard of treatment law and indirect expropriation. The

NAFTA tribunal favored Metalclad on all of its claims and awarded Metalclad $16.5 million.

The message here is once again clear: trade trumps health and safety.

With the TPP, Public Citizen foreshadows more of these ISDS claims:

With Japanese, Australian and other firms newly empowered to launch ISDS attacks

against the United States, the TPP would double U.S. ISDS exposure. More than 1,000

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additional corporations in TPP nations, which own more than 9,200 subsidiaries here,

could newly launch ISDS cases against the United States. Currently, under ALL existing

U.S. investor-state-enforced pacts, about 9,500 U.S. subsidiaries for foreign firms have

such powers. Almost all of the 50 past U.S. ISDS-enforced pacts are with developing

nations with few investors here. That is why the United States has managed largely to

dodge ISDS attacks to date. Yet if adopted, the TPP would subject U.S. policies and

taxpayers to an unprecedented increase in ISDS liability at a time when the types of

policies being attacked and the number of ISDS case are surging.

However, there is one provision within the ISDS chapter that may be a step forward for

public health: The Exception chapter of the TPP, in 29.5, proclaims that any TPP country can opt

out of having its laws and regulations around tobacco control subjected to ISDS trade challenges.

Arguably, though, each nation will have to muster the political will to opt out so in order to

safeguard public health – political will that may be easily manipulated by Big Tobacco.

Moreover, the tobacco industry can still use WTO country-to-country dispute procedures to

protest and delay tobacco control measures.

Intellectual Property

In Human Rights Obligations of Non-State Actors, Andrew Clapham wrote, “Perhaps the

most obvious threat to human rights has come from the inability of people to achieve access to

expensive medicine, particularly in the context of HIV and AIDS” (59). He was referring to

threats to human rights from intellectual property agreements under the World Trade

Organization, which are often seen as obeying a different – and many would say utterly

incompatible – logic than human rights. The right to health, in the interpretation of the

Committee on Economic Social and Cultural Rights, means that “States Parties … have a duty to

prevent unreasonably high costs for access to essential medicines.”

And yet, the provisions of the Intellectual Property Chapter of the TPP will do just the

opposite, lengthening, broadening and strengthening patent-related monopolies on medicines,

explain in the next five ways. First, the standards of patentability will be weakened, leading to

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more patents…more medicines set at high prices with twenty years of exclusive rights. It will

encourage further periods of exclusivity through secondary patents17. Second, patent terms will

be extended to compensate for delays in granting patents or registering market approval.18 Third,

the TPP gives exclusive rights relating to clinical trial data and an even longer period of

marketing and data exclusivity for biologics, driving up costs for medicines significantly. Fourth,

the TPP will prevent or interfere with generics and their registration; in fear of excess liability,

border seizures and injunctions, generics will likely be deterred from marketing competing

equivalents. Lastly, the TPP will enhance patent infringement remedies as the definition of

protected investments has expanded to include intellectual property (3, 49, 53, 55, 57).

All of these provisions will delay generic competition and sink the world into a deeper

global crisis of escalating drug prices. Health care providers and consumers will have to pay

higher prices on more drugs for longer (many consumers may go without needed treatments).

WHO estimates that deaths of 18 million people, 1/3 of all deaths, are caused by treatable

medical conditions and about 100 million people globally are push below the poverty line due to

healthcare expenditure. Extending patent protection could cause great harm and add to these

numbers.

17 A ‘secondary’ 20-year patent on same drug with minor variation of an active ingredient, new

formulations, dosages, new uses or methods of use and new processes of synthesis and

manufacturing; this process of extending patent exclusivity is called ‘evergreening’

(pharmaceutical companies label this as ‘patent life cycle management’.).

18 On average, in the United States, this will add 3.6 years to period of exclusivity and might

account for nearly 20% of pharmaceutical sales!

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Another concern surrounding access to medicines stems from the Transparency chapter

in which the Annex addresses transparency and procedural fairness for pharmaceutical products

and medical devices. The Annex expressly names the Centers for Medicare & Medicaid Services

(CMS) in its provisions, “with respect to CMS’s role in making Medicare national coverage

determinations19.” Under the TPP, pharmaceutical companies are given opportunities to

intercede in listing for their products; Medicare’s coverage determinations would be subject to

pharmaceutical companies. The Annex constrains future policy reforms, including potentially the

ability of the U.S. government to curb rising and unsustainable drug prices. For example,

companies could use the Annex to compel Medicare to cover expensive products without a

corresponding benefit to public health. The TPP could pose significant costs, enshrine

pharmaceutical company influence in government reimbursement decision-making and reduce

the capability of the government to negotiate lower prices (see U.S. House of Reps. Ways and

Means Committee Hearings on TPP for detailed explanations on these effects).

Trade and Health

The integration of health and trade policies and goals, and the establishment of a formal

structure to monitor and develop that policy knowledge, requires substantial input from the

economic, international relations, legal, and health communities. And while researchers from a

range of disciplines including population health, political science, international relations, and law

have been working together to advance approaches to assessing and monitoring the multiple

19 Medicare’s national coverage determinations include whether Medicare Part A and Part B will

pay for an item or service. Among other things, Part A and B cover drugs administered in a

hospital or a physician’s office, and durable medical equipment.

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direct and indirect pathways by which trade affects, health policy makers and those in an

advisory capacity are rarely included in formal discussions of trade and investment decisions and

only sometimes informally. As a result, treaties like the TPP come to existence and increase risks

for detrimental health outcomes. Rather than perceiving health measures as a constraint to

the objectives of trade (or a barrier to trade itself), the promotion and protection of health

equity and health should be seen as ways to meet those objectives, increasing economic

growth, development, and global security.

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Appendix I: A Little Perspective through Charts and Figures

Figure 1: How does it all relate? (64)

Figure 2: Impact of NCDs (79)

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Figure 3 & 4: Rise in TBT and SPS Notifications

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Figure 5: Expected Growth from TPP

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Figure 6: Imports versus Caloric Intake

Figure 7: More Examples of SPS Concerns

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Figure 8: Health Interventions Meets International Tread Treaties (64)

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