The quote from the American public health speaker and writer Midy Aponte “If you don’t have a seat at the table, bring your own chair” brings to mind one of the Just William stories. William and his friends meet as usual in the old barn in high spirits, which fall very quickly on seeing that the tempestuous Violet Elizabeth is waiting for them. The boys sit in a circle trying to exclude this tiresome child. Violet Elizabeth promptly joins them. William eventually confronts her, demanding to know “who asked you to come here?” Six year old Violet Elizabeth responds with great dignity and her trademark lisp: “I athed myself.”
At the UK Public Health Network’s meeting in October 2016 on making the most of Brexit, a much-needed presentation on trade and lessons for public health soon generated the question of why haven’t we been part of the discussion before now. The new generation of trade and investment agreements appears to hand powerful multi-national companies all the cards. Ever-stronger intellectual property rights, for example, enable industry to challenge health-protecting moves on product labelling. The fear of trade violations can delay or even paralyse regulation and policy development. Dispute resolution panels do not necessarily base decisions on public health and wellbeing, often preferring the weight of evidence, interpreted by non-health experts, to adopting the precautionary principle. But, whilst trade offers new opportunities to strengthen global and domestic economies, the “engine” of economic growth, as the WHO Commission on Macroeconomics and Health has stated, is a healthy population – surely the capital asset that the UK needs most of all.
The UK is about to open a new chapter in its trading relations. If forthcoming trade and investment agreements are to protect and improve the health and wellbeing of the public, then the public health system needs to be part of the discussion. In order to initiate a wider conversation across the whole country, the UK Public Health Network has published the first iteration of a suite of resources. These include a summary briefing and a basic introductory guide to trade that look at trading impacts on some of the issues that are of greatest public health concern – alcohol, environment, food, gambling, and tobacco included. It is hoped that these papers, along with round-table discussions, will achieve two things: raise awareness of the potential impact of trade and investment agreements on the public’s health and wellbeing and result in a stronger voice for public health in trade negotiations.
Despite the aspirations of trade and investment agreements to raise living standards, protect the environment and work to a sustainable future, there is not a good track record of the public health system being involved from the outset of negotiations. However, if health really is to be the new wealth, then we may well need to bring our own chairs and invite ourselves to the table because, as WHO DG Margaret Chan has said, if we are not at the negotiating table, we will be on the menu.