Assessment of the Association of Health with the Liberalisation of Trade in Services under the World Trade Organisation

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Title: Assessment of the Association of Health with the Liberalisation of Trade in Services under the World Trade Organisation
Authors: Umaña Peña, Román Andrés | Franco Giraldo, Álvaro | Álvarez-Dardet, Carlos | Ruiz-Cantero, María Teresa | Gil-González, Diana | Hernández Aguado, Ildefonso
Research Group/s: Salud Pública
Center, Department or Service: Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia
Keywords: GATS | World Trade Organisation | Health | Trade | Public policy
Knowledge Area: Medicina Preventiva y Salud Pública
Issue Date: 31-Jul-2014
Publisher: Public Library of Science (PLoS)
Citation: Umaña-Peña R, Franco-Giraldo Á, Díaz CÁ-D, Ruíz-Cantero MT, Gil-González D, et al. (2014) Assessment of the Association of Health with the Liberalisation of Trade in Services under the World Trade Organisation. PLoS ONE 9(7): e102385. doi:10.1371/journal.pone.0102385
Abstract: Background: The liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators – life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM) - since the WTO was established. Methods and Findings: This was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995–2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995–2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: 20.358 p,0.001; MM: 20.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995–2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services. Conclusions: The favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995–2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.
Sponsor: This study was funded by the Carlos III Health Institute and the Programme for Promotion of Biomedical and Health Sciences ( of the Spanish Ministry of Health and Consumer Affairs (Ref. PI060295).
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0102385
Language: eng
Type: info:eu-repo/semantics/article
Rights: © 2014 Umaña-Peña et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Peer Review: si
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