Globalisation, Trade and Health R Tayob SEATINI EQUINET theme co-ordinator This paper will analyse the following issues and assess their impact on the sovereign rights a state has to regulate to support equitable health care in the developing countries, drawing from EQUINET/SEATINI work and wider sources. It posits that the International Trading System (ITS) is biased in favour of richer northern states. It argues that greater circumspection is required by developing countries within the ITS if they want to maintain their sovereign right to meet the needs of their people. The inequitable system of “globalisation” is imposed through the ideology of neo-liberalism, which the developed countries present as a “natural” form of globalisation. It is a very particular type of globalisation is being imposed on the world by the major economic powers, i.e. neo- liberal globalisation. This form of globalisation has worsened material conditions in developing countries. Developing countries domestic policy is heavily constrained, or threatened by constraints, by the current systems of globalisation and they have little or no flexibility to address their development needs. Policies that the developed countries used to improve the conditions of their people are summarily being made illegal for developing countries whether these relate to industrial development, intellectual property, and agriculture or services provision. This paper focuses on some of the “trade” issues that have a direct bearing on the material conditions and health of the majority of the people in the developing countries. International Trade regulation, the mainstay of the World Trade Organisation (WTO), is becoming increasing invasive on domestic development policies and now cover issues like intellectual property, the provision of services and, health and, environmental standards. The development policies of the developing countries are conditioned and directed by the World Bank, International Monetary Fund conditionalities and the WTO, regional and bilateral agreements. The WTO specifically covers a host of issues under its ambit of trade and it includes: § Access to drugs: Access to drugs is regulated by Trade Related Intellectual Property Rights (TRIPs) of the WTO and civil society has had mixed results in ensuring meaningful access to drugs for the worlds poorest people. Regional and bilateral agreements, which are permissible under the WTO, endorse and exceed TRIPs standards and countries can face severe sanctions for their violation. § Regulation of Services and the provision of public services: The General Agreement on Trade in Services (GATS) also threatens public and accessible systems for the delivery of health care, water and sanitation, and energy. The GATS undermines domestic regulatory policy sovereignty by setting standards that are market related and not people centred. The GATS along with WB/IMF prescriptions of cost recovery and privatisation undermine a state’s ability to ensure equitable access to services. § Regarding access to food and adequate nutrition: Developing countries have been unable to secure agreements that will allow them to protect their agricultural sectors. This lack of policy flexibility in agriculture has lead to the breakdown of food security systems, resulting in preventable malnutrition. The paper argues that assaults on governments’ sovereign right to regulate trade, and consequently health, should be resisted. Developing countries have been showing resistance to WTO-type liberalisation and globalisation but are increasingly vulnerable to pressures at the International Financial Institutions, regional and bilateral level. By reducing government legislative and policy flexibility in areas critical to the well being of people (water, energy, food and health) these agreements and conditionalities legalise the structural and brutal violence on the majority of the people of the world. Developing countries face major challenges in securing the space to regulate and protect the public provision of health and inter-dependant services on an equitable basis.