Negotiating healthy trade in Australia: Health impact assessment of the proposed Trans-Pacific Partnership Agreement

The Centre for Health Equity, Training Research and Evaluation at the University of New South Wales in Australia has released a report assessing the health impact of the Trans Pacific Partnership. The executive summary is below. Read the full report.



The Trans-Pacific Partnership is a large regional trade agreement currently in the final stages of negotiation and involves countries around the Pacific Rim, including Australia. The agreement is being negotiated under conditions of confidentiality, and consequently negotiating documents are not made public and limited information is available.


Health Impact Assessment (HIA)


During negotiations, an HIA was undertaken on provisions in the TPP, to examine the potential impact on the health of Australians. HIA is an established way of predicting the positive and negative health impacts of a policy or proposal to then make recommendations to improve that proposal.


The structured steps of the standard HIA process (screening, scoping, identification, assessment, recommendations and evaluation) were followed, while also adapting to this unique context. The HIA served as a tool to bring together health advocacy organisations in Australia and academics interested in outcomes of the TPP. The Public Health Association of Australia led this advocacy effort. The HIA assessed existing information in the public domain, supported by consultation with Australian experts. In the absence of official publicly available drafts of the trade agreement, the HIA used leaked texts of potential provisions and formulated policy scenarios in order to conduct the assessment and predict potential impacts.


The scenarios were based on a select number of high priority health policies that could be affected by provisions in the TPP and were used to demonstrate the potential impact on public health.


The HIA focused on four areas of potential health impact:

  • the cost of medicines;
  • tobacco control policies;
  • alcohol control policies; and
  • food labeling.

This report provides an overview of the dimensions of the TPP relevant to health, the process and findings of the HIA – including characterising the potential health impacts based on the literature and stakeholder input – and recommendations to the Australian Government to avoid or mitigate potential harms from the TPP.

We intend for the HIA to inform negotiations and health sector advocacy on the TPP.


Key findings


Using the existing evidence base, principally literature and population demographics, the HIA team developed a causal pathway between each scenario and its potential health impacts for the Australian population.


The HIA found the potential for negative health impacts in each of the four areas under investigation. These are summarised below.



The TPP risks increasing the cost of the Pharmaceutical Benefits Scheme (PBS), which is likely to flow on to the Australian public in terms of increased co-payments (out-of-pocket expenses) for medicines. This may result in medical non-adherence for prescription use and prioritising health costs over other necessities (food, housing, etc.). Vulnerable groups include those from low socioeconomic backgrounds, people with chronic conditions, younger populations, and Aboriginal and Torres Strait Islander peoples. Potential risks to health outcomes include declining health status in the community, increased hospitalisations and increased mortality.




The TPP provisions pose risks to the ability of Government to regulate and restrict tobacco advertising. This could potentially lead to increased tobacco use and smoking prevalence, resulting in increases in tobacco related health harms across the community but particularly for existing vulnerable groups, such as youth and people with low socioeconomic status.




Some provisions proposed for the TPP have the potential to limit regulation of alcohol availability and alcohol marketing, and restrict alcohol control measures such as pregnancy warning labels. This risks increasing alcohol consumption rates and abuse, especially amongst young members of the community. This may lead to increased alcohol related disorders, worsening mental health and social disruption in the community.




There is the potential for TPP provisions to restrict the ability of Government to implement new food labelling policies, limiting reductions in consumption of unhealthy foods. This is associated with rates of overweight/obesity and related health outcomes.


Based on the available evidence, the HIA found the potential for provisions in the TPP to have negative impacts on public health. The following matrix maps out the ways the TPP could impact the policy scenarios and their subsequent health effects.

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