By Alicia Nicholls
Ministers, as well as delegates from partner organizations, gathered in Barbados on June 14-16, 2023 for the Small Island Developing States (SIDS) Ministerial Conference on Non-Communicable Diseases (NCDs) and Mental Health. The conference was a collaboration by the Government of Barbados, the World Health Organization (WHO) and the Pan-American Health Organization (PAHO). The launch of the 2023 Bridgetown Declaration on Non-Communicable Diseases and Mental Health was a key outcome. This SRC Trading Thoughts considers the role that trade policy could help in achieving the goals of this Declaration.
Globally, NCDs kill 41 million people per year and account for 74% of all deaths, according to WHO data. In some SIDS, NCD deaths could be as high as 80% or 90% of total deaths according to World Bank data. Influenced by easier access to high-sugar and high-sodium processed and ultra-processed foods, many SIDS have a high prevalence of obesity among their populations, a risk factor for NCDs. The World Obesity Federation’s data shows that Pacific SIDS top global rankings for obesity in their populations, with 59% of Nauru’s population being classified as obese.
Increasingly, and especially in the wake of the COVID-19 pandemic, mental health has received greater policy attention at the global level. The WHO in its 2022 World Mental Health Report notes that one in eight people globally lives with a mental health disorder. According to PAHO, mental health conditions afflict 15.2% of the population in the Caribbean and 11.2% in the Pacific. Internationally, suicide is also becoming a leading cause of death among young people, particularly young males. Fiscally constrained SIDS, some of which have publicly funded health care systems, expend significant money on public health funding, including treatment costs. However, as recognized in the Bridgetown Declaration, mental health receives just a small amount of funding in national health budgets.
Climate change, an existential threat to SIDS, also has NCD and mental health impacts. Given the strain this triple threat is placing on their limited budgets, as well as the wider socio-economic implications, addressing NCDs and mental health are a policy imperative for SIDS.
The Bridgetown Declaration
Submitted in preparation for the SIDS Ministerial, the Bridgetown Declaration aims to be a SIDS-specific agenda created by SIDS for SIDS, cognizant of these countries’ lived realities, challenges and needs. Under the Declaration and in light of the statistics above, SIDS reaffirmed their commitment to take bold SIDS-specific action to reduce by one third premature mortality from NCDs through prevention and treatment and promote mental health and well-being by 2030. This is in line with target 3.4 of SDG 3 (healthy lives and well-being) under the 2030 Agenda for Sustainable Development. Annex I of the Bridgetown Declaration on NCDs and Mental Health outlines the actions SIDS will undertake in line with their national priorities and which fall under five broad headings: engage, accelerate, invest, align and account.
The Bridgetown Declaration was spearheaded by the Governments of Barbados and Fiji with valuable inputs from other SIDS and civil society organisations worldwide. It was presented to the WHO by Barbados’ Ambassador and Permanent Representative to the United Nations and other International Organisations in Geneva, His Excellency Matthew Wilson and Ambassador of Fiji, Luke Daunivalu in advance of the meeting. The SIDS Ministerial was a follow-up meeting from the SIDS High-level technical meeting on NCDs and mental health held in January and the virtually-convened WHO SIDS Summit for Health held in June 2021.
Trade and public health nexus
There has been lively debate in the academic literature and policy circles on the extent to which trade could advance or inhibit public health goals. Townsend and Schram (2020) deem trade and investment agreements structural drivers of NCD risk factors, noting that they could limit the scope for public health regulation. Reduction or elimination of tariffs on goods, regardless of whether or not they are healthy, could make them cheaper and help drive the consumption of unhealthy food with further implications for public health. Indeed, such a link is also noted in the Declaration which references the constraints posed by SIDS’ “high dependence on imported food, medicine and diagnostic devices, commercial influence and trade-related challenges” in not only ensuring health diets but effectively responding to the NCD challenge. Moreover, a WHO 2021 Policy Brief and a later 2023 study on NCDs and mental health in SIDS found that unhealthy diet, a risk factor for NCDs was a challenge for many SIDS because of their dependence on imported foods which are more likely to be processed. This is a contributing factor to the high rates of obesity and diabetes in some SIDS and this also includes among adolescents.
But could trade also be an answer? Taxes on unhealthy food could reduce their consumption. Barbados introduced an excise tax of 20% on sugar-sweetened beverages (SSBs) which one study by Alvarado et al (2019) has found has had some success in reduction sales of SSBs. Barbados has announced that it will ban the importation of foods containing trans-fats. Under the ‘accelerate’ heading of Annex I, it speaks to regulation and fiscal measures to address the main risk factors for NCDs.
The Declaration also speaks to devising “effective, feasible, graphic, easily understood front of package labelling policies in SIDS”. This would be accompanied by providing assistance to small producers to meet front of package labelling (FOPL) standards to highlight to consumers foods which are high in sugar, sodium and/or saturated fat. FOPL could help consumers make better informed food choices and discourage the consumption of unhealthy foods. Additionally, the Declaration speaks to strengthening regional and national regulatory mechanisms for the “production, pre-qualification and trading of essential medicines and technology”. Therefore, the Declaration clearly sees a role for trade policy in the fight against NCDs and mental health.
As customs duties remain important sources of revenue for many SIDS, their governments are often reluctant to reduce these duties due to concerns about the impact on their economies’ fiscal health. Customs duties are also often used for policy purposes, such as to protect food security and to protect local industries. Similarly, they could be used for public health purposes by facilitating access to goods and services, including medications and medical equipment and healthier food alternatives and reducing access to unhealthy options. SIDS can increase tariffs on unhealthy imports once they do not exceed their bound rates and reduce duties on healthy alternatives, such as sugar-free or low sodium options. SIDS could explore the feasibility of removing import duties on things such as fitness watches which people increasingly use to measure their daily step count, their cardiovascular performance and their caloric intake as a way to promote healthy behaviours and health-consciousness. Medical professionals also increasingly encourage the use of these devices for patients to monitor their own health. Trade policy can therefore be used to encourage healthier behaviours.
In summary, by aligning their trade policies with their health and wellness goals is one way in which SIDS could confront the triple threat of climate change, NCDs and mental health by achieving the goals under the Bridgetown Declaration.
Alicia Nicholls is the Junior Research Fellow with the Shridath Ramphal Centre for International Trade Law, Policy & Services of The University of the West Indies, Cave Hill. Learn more about the SRC at www.shridathramphalcentre.com.