Center for Policy Analysis on Trade and Health - CPATH

Tobacco & Trade Research Consortium, San Francisco 2013

TPP and Public Health 2016
Public Health on Fast Track: to House W&M 4-22-15
Support Our Work!
Campaign: Public Health Voice in Trade Policy
Tobacco Control and the TPP
CPATH on Leaked TPP IP Text
Mexico, Chile on TPP-Tobacco
Tobacco & Trade Consortium 2013
2012: Health Advocates Assert Carve-Out; U.S. Weak TPP/Tobacco Proposal
TPP Forums Jan 2012
Trans Pacific Partnership
Tobacco and Trade Publications
Trade Advisory Committees December 2010
Key Trade Agreements - CPATH Analysis and Commentary
Special 301 Hearings: Change Course!
CPATH at APHA 2009 Trade Advisory Committees
CPATH EVENT Aug. 26 2009: CAFTA and Access to Meds
Trade and Health Forum Program APHA Nov. 2009
About CPATH - Overview
CPATH Article: CAFTA Impact on Meds, Prices
Press Release: CPATH on CAFTA in Health Affairs
CAFTA aumenta los precios de medicamentos
Congressional Hearing on Trade Advisory Committees
Towards Change: Korea; Peru; Public Health Objectives
Trade & Health at APHA 2008
Global Trade Events at APHA November 2007
Thailand's Compulsory Licenses for Medicines
Globalization and Health Resource Center - Overview
Key Issues
CPATH Publications
Related Resources
CPATH Presentations
CPATH at US Social Forum 2007
Monterey Forum 2005
FTAA Forum
Public Health Summary Statements on Free Trade Agreements
Sign-On Statements
Terms of Use
More About CPATH


The Center for Policy Analysis on Trade and Health (CPATH) and the Center for Tobacco Control Research and Education (CTCRE) at the University of California-San Francisco convened a consortium meeting in San Francisco on Feb. 19, 2013, to reinvigorate strategies to advance tobacco control in California and the U.S., and to strengthen public health and medical voices to inform trade policy. The event was supported by the Tobacco Related Disease Research Program.

Diverse stakeholders represented the Cancer Society, Heart Association, CCLHO, and CTFK, and other California and national experts in public health and the law, science, government and advocacy, including prominent researchers from the University of Michigan and USC. The group assessed the nexus between tobacco control, global trade, and tobacco industry influence, and discussed present efforts to negotiate the Trans Pacific Partnership, including the Fast Track proposal that would effectively shield the controversial trade pact from democratic review even by Congress.

CPATH, CTCRE and others have documented how trade agreement rules empower tobacco corporations to supersede the rights and ability of domestic governments at the local,state and federal levels to regulate in the interests of the public and of public health. Tobacco companies are increasingly using trade rules to attempt to delay and reverse tobacco control measures in the U.S., Australia, Uruguay, Norway, and Ireland.

Tobacco use is the leading preventable cause of death worldwide.Tobacco control measures are critical to reducing tobacco-related death in California, the nation, and the world.

This page provides links to a summary of the proceedings, the Power Point presentations, and background documents.

Click here to download Consortium Statement below




This statement reflects views and recommendations that emerged from a consortium meeting convened by the Center for Policy Analysis on Trade and Health (CPATH) and the Center for Tobacco Control Research and Education (CTCRE) at the University of California-San Francisco on February 19, 2013, in San Francisco. Participants identified strategies to advance tobacco control in California and the U.S., and to strengthen public health and medical voices to inform trade policy.

Public health and medical organizations in the U.S. and internationally are increasingly engaged in addressing the nexus between tobacco control and global trade.  Trade rules and trade agreements, including present efforts to negotiate the Trans Pacific Partnership (TPP), present challenges to tobacco control, at local, state, and national levels.  Tobacco companies have recently accelerated their use of trade rules to attempt to delay and reverse tobacco control measures in the U.S., Australia, Uruguay, Norway, and Ireland.  In negotiating the TPP, a new agreement for the 21st century, the United

States is presented with the opportunity to be a leader to safeguard public health and reduce the enormous burden of disease related to tobacco use.

The following proposals articulate concerns, goals, and key strategies to achieve them, that were discussed during the consortium meeting. Many have been consistently advanced by the medical, health care, and public health communities.


 Tobacco is unique, the only legal consumer product that kills when used as intended. Causing six million deaths a year, tobacco use is the leading preventable cause of death worldwide, and a major contributor to the global pandemic of non-communicable diseases.

 Curtailing tobacco use must be a central element of policies to reduce preventable childhood morbidity and mortality, a key goal of the present U.S. Administration.

 Trade agreements and trade rules offer the tobacco industry powerful tools to undermine and supersede local, state, and national measures to implement and enforce tobacco control measures.

 The closed process of negotiating and adopting trade agreements uniquely privileges commercial interests, without the benefit of democratic public dialogue and debate, and review of evidence. Public health principles and perspectives are shut out.

 Current proposals for a TPP, and a trans-Atlantic U.S.-EU trade agreement, present particular and urgent threats to public health.

Strategies for Creating a 21st Century Trade Agreement:

Incorporating Health-Related Concerns into Global Trade Negotiations and Agreements

We call on the United States to advance a trade proposal in the TPP negotiations that will safeguard public health, advance tobacco control measures that contribute to reducing the enormous burden of disease related to tobacco use, and prevent incursions by the tobacco industry against those measures.


1. Trade agreements must guarantee nations’ rights to protect public health from tobacco use.

   Incorporate reference to the Framework Convention on Tobacco Control (FCTC) in trade agreements.  Acknowledge deference to FCTC principles, as an expression of the international consensus on tobacco control, and affirm the right of nations to protect public health from tobacco and tobacco products in the text of all relevant chapters of trade agreements.

   Incorporate in the text of each regional and bilateral trade agreement the World Trade Organization (WTO) Doha Declaration on countries' rights to protect public health. The 2001 WTO Doha Declaration on the TRIPS Agreement and Public Health affirms that WTO members may use "to the full" the flexibilities in the Agreement on Trade-Related Aspect of Intellectual Property Rights (TRIPS) "to protect public health and, in particular, to promote

access to medicines for all." This right can and should be extended to tobacco control measures.

   Strengthen the primacy of public health principles. Strengthen adoption and implementation of FCTC recommendations within and across nations to protect the public's health from tobacco and tobacco products.

2. The TPP must not undermine the right and ability of participating countries from exercising their domestic sovereignty in order to adopt or maintain measures to reduce tobacco use and to prevent the harm it causes to public health.

  Exclude tobacco control measures from existing and future trade agreements. The medical, health care, and public health community has consistently supported removing tobacco, tobacco products, and tobacco control measures from trade agreements as the most effective solution.

  Remove investor-state dispute settlement (ISDS) provisions.  Eliminate the rights of tobacco and other corporations to contest governments' domestic sovereignty over public health and other policies, and to sue nations directly for financial damages through the global trade arena.

3. We must set trade policy through a transparent process that involves the public.

  Trade agreements and trade rules which may affect public health should be discussed and debated publicly, and in Congress, including preventing disease and death from tobacco.

  Include effective public health representation in setting trade policies at the national, state, and local levels.

We further propose that advocacy for these goals can be strengthened by identifying and communicating with related constituencies concerned with trade:  Labor, environment, access to medicines, sustainable agriculture, sustainable economic development, internet access; policy-makers at the local, state and national levels.



                                       Establishing Endorsements 

Organizational Endorsements:

Action on Smoking and Health, Laurent Huber, MSFD, Director; Chris  
         Bostic, MSFS, JD, Deputy Director for Policy


American Academy of Family Physicians, Julie K. Wood, MD, FAAFP, Vice President, Health of the Public and Interprofessional Activities


American Academy of Pediatrics, Jonathan D. Klein, MD, MPH, FAAP, Associate Executive Director and Director, Julius B. Richmond Center of Excellence


American College of Obstetricians and Gynecologists, Barbara Levy, MD, Vice President for Health Policy


American College of Physicians


American Heart Association, American Stroke Association, Terry Sue Mock, Senior Health Systems Policy Director


American Public Health Association, Georges C. Benjamin, MD, FACP, FACEP (E), Executive Director


Center for Policy Analysis on Trade and Health (CPATH): Joe Brenner, MA, Co-Director;  Ellen R. Shaffer, PhD MPH, Co-Director; Sohil Sud, MD, MA, Senior Fellow, CPATH, Senior Pediatric Resident, UCSF


San Francisco Medical, Society, Steve Heilig, MPH


San Francisco Tobacco Free Coalition


Individual Endorsements:

 Phillip Gardiner, Dr.PH, Program Officer, Policy and Regulatory Sciences, Tobacco Related Disease Research Program*


Stanton Glantz, PhD, Director,  Center for Tobacco Control Research and Education, University of California, San Francisco*

Richard L. Barnes, JD, Health Sciences Clinical Professor; Eric Crosbie; Mariaelena Gonzalez, PhD;  Heikki Hiilamo, PhD; Lauren Lempert, JD MPH


Holly Jarman, PhD, Research Assistant Professor, Center for Law, Ethics & Health / Department of Health Management & Policy, University of Michigan School of Public Health*


Wendy Max, PhD, Professor of Health Economics, Co-Director, Institute for Health & Aging, University of California, San Francisco*


Michael Ong, MD PhD, Associate Professor-in-Residence of Medicine, University of California, Los Angeles*


Marty Otañez, PhD, Assistant Professor, Anthropology Department, University of Colorado, Denver*


Heather Wipfli, PhD, Associate Director, USC Institute for Global Health, Assistant Professor, Department of Preventive Medicine and School of International Relations*


Donald Zeigler, PhD, Adjunct Associate Clinical Professor, University of Illinois at Chicago School of Public Health. Retired Director of Prevention and Healthy Lifestyles, American Medical Association*



* Organizations listed for identification purposes only

Click here to download Conference Background and Overview on Trade and Tobacco Control

"Understanding how the tobacco industry exerts its influence through trade rules and curtailing these loopholes is of the utmost urgency for safeguarding and strengthening the authority of the FDA Center for Tobacco Products, for securing and expanding California measures at the local and state levels to reduce environmental exposure to the toxic effects of tobacco smoke and residue, and to regulate nicotine and tobacco products."

Click here to download en espanol


1. Los acuerdos comerciales deben garantizar el derecho de las naciones a proteger la salud pública en contra del consumo de tabaco.

Incorporar referencias al Convenio Marco para el Control del Tabaco (CMCT) a los acuerdos comerciales. Incorporar en el texto de cada acuerdo comercial regional y bilateral la Declaración de Doha referente al derecho que tienen los países a proteger la salud pública. Fortalecer la primacía de los principios de salud pública.

2. El ATP no debe socavar el derecho ni la capacidad de los países para que ejerzan su soberanía nacional al momento de adoptar o mantener disposiciones para reducir el uso de tabaco y prevenir el daño que ocasiona a la salud pública.

** Excluir de los acuerdos comerciales presentes y futuros las disposiciones para el control del tabaco.

** Eliminar las disposiciones relativas al arreglo de diferencias entre inversor y Estado (ISDS, por sus siglas en inglés).

3. Tenemos que establecer políticas comerciales mediante un proceso transparente que involucre al público.

Los acuerdos y reglas comerciales que podrían afectar la salud pública tendrían que ser debatidos y discutidos públicamente, y en los Congresos, incluyendo la prevención de muertes y enfermedad ocasionadas por el tabaco.

Incluir una representación efectiva de la salud pública al establecer políticas comerciales en los ámbitos nacional, estatal y local.

Click to download Intro Power Point: Shaffer, Sud, Brenner

Click to download Brenner: Lessons from CPATH Successful Campaign on Australia FTA

Click to download Jarman: Trade-Proofing Tobacco Control


Shaffer, Brenner, Houston, Tobacco Control: International trade agreements: a threat to tobacco control

Glantz, Gonzalez: Effective tobacco control is key to rapid progress in reduction of non-communicable diseases

Jarman: When trade law meets public health evidence: the WTO and clove cigarettes

Max, Sung: The Disproportionate Cost of Smoking for African Americans in California

Drope, Lenucha: Tobacco control and trade policy: Proactive strategies for integrating policy norms

Mackey, Evolution of Tobacco Labeling and Packaging: International Legal Considerations and Health Governance

Wipfli, Health Policy: Power of the process: Evaluating the impact of the Framework Convention on Tobacco Control negotiations

Medicine and Public Healh Testimony to Congree on TPP and Tobacco, Dec. 28, 2012

Medicine and Public Health Statement on TPP and Tobacco, May 2012

Bringing a Public Health Voice to Global Trade and Sustainable Development
Ellen R. Shaffer and Joe Brenner, Co-Directors
P.O. Box 29586, San Francisco, CA 94129
phone 415-922-6204