International trade can widen access to food and other goods and create jobs, all important building blocks of health. But not all trade impacts are positive for our health. As the UK negotiates trade agreements, PHS Consultant in Public Health Margaret Douglas explains how a health impact assessment approach can help ensure they maximise health benefits, and minimise harm.

The UK is about to be part of a large trading agreement, having finished negotiations to join the Common and Progressive Trans-Pacific Partnership (CPTPP) trade agreement. This should allow easier trade with countries across the world.

What does this have to do with health?

While international trade can widen access to food and other goods and create jobs, all important building blocks of health, there are other potential impacts to consider.
Understanding how a trade agreement could impact health can help to develop better agreements for everyone. A recent Public Health Wales report helps us to understand how to develop trade agreements that work for improving health.

Public Health Wales identified a number of possible negative impacts of the CPTPP:

Fear of legal challenge to governments

Fear of costly legal challenge from large private businesses can prevent governments from introducing or strengthening regulations which protect our health, such as food standards, environmental standards, climate policy, tobacco and alcohol labelling and controls, workers' rights and data protection regulations.

Investor power to challenge governments

A mechanism called Investor State Dispute Settlement (ISDS) gives investors in other CPTPP countries the power to challenge government regulation of products harmful to our health, including pesticides, other chemicals and tobacco control.

Risk to Community Wealth Building approach

Under CPTPP rules, firms in member countries must be able to compete equally with Scottish firms for procurement of government contracts. The risk this presents to Scotland's ambitions to increase public sector purchasing of local goods and services and the economic benefits that will flow from this, will need to be considered.

Loss of NHS workforce

The NHS, and other sectors, could lose workforce as professionals will have easier access to labour markets in countries like Australia, New Zealand and Canada, particularly given current industrial unrest in the UK. This is an area those working in workforce planning and long-term economic policy should understand and address.

Climate impact

As Scotland is working to reduce its carbon footprint and accelerate action on climate change, the likely increased negative impacts of importing goods from countries further away will need to be considered and acted on.


The effects described above will not be felt equally across the population. Public Health Wales found that the groups most at risk of negative impacts are people on low incomes or in socially disadvantaged groups, people with long term conditions, agricultural workers, health and social care workers, and small business owners and their employees.

Action will be needed to protect these groups in particular from harmful impacts of the CPTPP.

Potential beneficial impacts of the CPTPP include:


The CPTPP is expected to bring a small economic benefit worth 0.08% of GDP.

Trade and employment

There should be increased trading and employment opportunities for Scottish businesses, which gain more favourable access to other CPTPP member countries.

Partnership and research

There could be a potential increase in partnership and research in sectors including healthcare and pharmaceuticals. Opportunities for development and collaboration could help recruitment of staff from other CPTPP countries.

How can we realise the benefits but reduce the harm to health of the CPTPP and other trade agreements?

This is a relatively new area for public health, but it is an important one to develop and its importance will increase as the UK negotiates further agreements. Further research is needed on the impact of trade agreements on health. In future agreements, greater transparency and engagement with sectors like public health would enable risks to be identified and addressed before negotiations are complete.

The Public Health Wales report, which used a Health Impact Assessment (HIA) process , shows the benefit of this approach. HIA is a recognised, structured approach that uses different forms of evidence to identify and assess impacts on health and health inequalities in order to inform decisions about plans, strategies and policies. Applying Health Impact Assessment to all future trade agreements would ensure that these are designed to maximise the benefit for our collective health and wellbeing, and minimise any harm.

With thanks to Neil Chalmers, Health Economist at Public Health Scotland, for his input to this blog.

Image credit: Freepik

Last updated: 18 October 2023