Draft Legal Review of the General Agreement on Trade in Services (GATS) from a Health Policy Perspective
(2005; 263 pages)


The General Agreement on Trade in Services (GATS) is one of the most important multilateral trade agreements to emerge from the Uruguay Round negotiations that created the World Trade Organization (WTO). GATS constitutes the multilateral legal framework through which WTO members will approach the progressive liberalization of trade in services, including health-related services. Health policy is an important social endeavor that faces both opportunities and challenges from GATS. Many factors, including the complexity of GATS, the lack of empirical data on international trade in health-related services and on the health effects of liberalized trade in services, and inequalities in resources and power between developed and developing countries create a difficult environment for people in public health and health care who want to understand the actual and potential impact of GATS on their activities.

The World Health Organization (WHO) commissioned this Legal Review of GATS from a health policy perspective as part of its efforts to bring the relationship between GATS and health into better focus.

Controversies about the impact of GATS on public services, such as health and education, have arisen; and a debate has developed on GATS and health that further complicates discerning how health policy communities should view this WTO agreement. This debate centers on the impact of GATS on the policy flexibility of WTO members in the realm of health.

A considerable body of literature has raised concerns about how GATS might affect the ability of a WTO member to pursue public policies, such as health. This literature expresses fears that GATS restricts the policy space of WTO members procedurally, structurally, and substantively.

Pro-GATS counterarguments often stress the flexibility of GATS, which allows WTO members to determine whether and how to liberalize international trade in services. From the flexibility perspective, GATS supports rather than undermines health policy.

As the two previous paragraphs suggest, the GATS and health debate often reads like a “tale of two treaties”—it is the best of treaties; it is the worst of treaties. The Legal Review is designed to provide WHO with a detailed legal reading of GATS for purposes of informing health policy about the liberalization of trade in health-related services

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