Senedd Cymru | Welsh Parliament
Ymateb gan: Iechyd Cyhoeddus Cymru | Evidence from: Public Health Wales
Public Health Wales is the national public health agency in Wales and exists to protect and improve health and well-being and reduce health inequalities for people in Wales.
Public Health Wales recognises that trade and trade policy can have an impact on population health and well-being both positively and negatively. For example, the terms of the UK’s international trade agreements have the potential to affect what food is available in Wales as well as the cost and standard of it, employment in Wales, the environment locally in Wales as well as at a global scale, and the money available to invest in Welsh public services – including the health and social care system. All these factors can impact on people’s physical and mental health and well-being and are known as the determinants of health — the conditions in which people are born, grow, live, work and age. These impacts are unlikely to be felt equally across the Welsh population, with some people benefitting while others are disadvantaged. This can create and/or exacerbate health inequalities.
More information on the links between trade and health, and what this could mean for the people of Wales is in our recent report (2021): What could post-Brexit trade agreements mean for public health in Wales?
The purpose of this consultation response is to highlight the public health and well-being impacts of trade agreements and the wider implications of the UK’s withdrawal from the EU. This response draws upon Public Health Wales’ publications, such as those listed above and below. The work and response focusses upon the potential and not actual impacts of trade agreements on Wales specifically, both positive and negative. Public Health Wales have not carried out any direct work to date on the specific details of the Trade Cooperation Agreement (TCA); the information provided therefore focuses upon the broad connections between trade and health and well-being. In responding to this consultation Public Health Wales hopes to raise awareness of the links between trade, equity and population health with the hope for more intentional consideration of health in future amendments to both new and existing trade agreements.
Through its work on trade, Public Health Wales hopes to encourage and enable the UK and Welsh Government to seek trade policy and agreements that protect and promote health, well-being and equity in Wales and the UK. This approach would enable the legislative requirements of the Well-being of Future Generations (Wales) Act 2015to be met. The Act sets out seven well-being goals that make up a vision for a better future for Wales and puts a duty on public bodies in Wales, including Welsh Government, to maximise their contribution to all seven goals in all their decisions.
The UK Government has reserved powers for international trade, meaning it has exclusive responsibility for signing new trade deals. Meaning that any new trade deals will bind the whole of the UK, including Wales and the Welsh Government. This involves areas such as tariffs can now be implemented by the UK Government, which would impact devolved administrations. UK Parliament state that the repatriation of powers from the EU gives rise to new areas in which UK (e.g. trade negotiations) and devolved (e.g. agriculture) competence overlap. This leads on to looking at the Internal Market Bill and its importance in devolved administrations in relation to trade which is referred to in more depth later in this response.
The direct impacts of trade on health, well-being and equity, as well as the indirect impacts through ‘regulatory chill’ (hesitancy or unwillingness to propose, enact or implement evidence-based public health policies), have the potential to affect Wales’s ability to achieve those well-being goals, which have been enshrined in law, as well as Welsh Government’s Programme for Government.
Public Health Wales are also guided by the Faculty of Public Health’s ‘blueprint for healthy trade’, which calls for public health to be given a seat at the table in trade policy discussions among its six key recommendations, due to the impact that trade has across public health.
In 2019, Public Health Wales published The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach. The report highlighted the importance of post-Brexit trade arrangements to population health and well-being. It recognised the need for the public health sector in Wales to become better able to engage with trade policy, and for health and well-being to be at the forefront of both the UK and Welsh Governments’ approach to trade discussions and advocacy. The possibility for conducting a review of this HIA is being explored, in order to analyse the predicted impacts and evaluate which continue to have the biggest impact on the Welsh population since the UK left the European Union (EU) in 2020.
In 2023, Public Health Wales published The health, well-being and equity impact of the Comprehensive and Progressive Trans-Pacific Partnership (CPTPP) Agreement on Wales– only the second such analysis ever conducted on a trade agreement in the world. The report offers a consideration of how accession to the CPTPP could play out in the short-term but also the longer-term, highlighting the potential and not actual impacts of the CPTPP on Wales specifically, both positive and negative. Although not focusing upon an EU-UK trade agreement this report highlights potential health and well-being impacts that are applicable across all trade agreements. The report also demonstrates HIA as a valuable tool which the UK and other Governments could use to capture the potential impacts of the CPTPP and other trade agreements across the social determinants of health and equity at different stages of the negotiation process to inform and enable inclusive discussion and decision-making.
-Areas of UK-EU cooperation covered by the TCA, and areas that are not covered
-Areas of the TCA that are not fully implemented, such as UK participation in EU programmes or mutual recognition of professional qualifications
Through our work on Brexit and public health, including specific work around infectious disease, and illicit trade in addition to international trade agreements and the well-being of future generations act, Public Health Wales have identified the following as areas of concern:
Food safety, standards and access
The EU is considered to have some of the world’s highest environmental and food standards, and its approach to trade agreement negotiations aim to ensure these are maintained. As a member of the EU, the terms under which the UK traded with non-EU countries was determined by the agreements negotiated on its behalf by the EU. Since the UK’s withdrawal from the EU Public Health Wales have identified potential risks and opportunities to food safety, standards and access associated with free trade agreements.
There is a potential risk that new free trade agreements have the potential to impact food security, access to nutritious, affordable food through disruption to supply chains or through making fresh food, like vegetables, more expensive. However, a report from the European Union Committee ‘Beyond Brexit: food, environment, energy and health’notes that the TCA provides tariff-free trade, avoiding costly impact to the agriculture sector, which would have been passed on to consumers. Concerns have however still been raised around the delays associated with new customs procedures under the TCA and the impact that disrupted supply routes have had, particularly upon the availability of fresh produce.
Similarly, Public Health Wales have raised concerns regarding reductions to the protections around health-promoting marketing and labelling of food and goods, has the potential to increase access to poorer quality, unhealthy foods. Welsh Government’s ‘Healthy Weight: Healthy Wales’ strategyaims to reduce obesity in Wales, involving making it easier to buy healthy food as well as bringing in new rules on advertising and food formulation – all of which could be affected by the terms of trade agreements. Food production may also be impacted with a reduction to sustainable food production practices and standards; increased competition may also harm local food producers and a reduction to governments and civil society organisations’ ability to inform or scrutinise trade agreement discussions may reduce the ability of local governments to legislate in the best interests of their populations. This is particularly important to Wales as, relative to the UK, farming is more important to the Welsh economy which may mean Wales and the UK have a different perspective on what a good trade agreement looks like when it comes to farming.
The TCA does allow the UK freedom to do things differently on a range of areas, including food safety and composition; when health is considered within such discussions there is an opportunity to maximise the positive health and well-being impacts and mitigate the negative consequences.
Public Health Wales have also identified positive impacts of considering health and well-being when regulating food safety and standards, including the potential to increase choice, variety, or availability of affordable food; this could be particularly helpful in Wales given that Welsh Government is already making grants available to tackle food poverty in local communities. Further positive impacts include the ability to establish/maintain safe and evidence-based food marketing and nutrition labelling policies as well as opportunities for Welsh food to reach new markets allowing farms to grow and expand with the right support.
Illicit Trade
Brexit has changed the way in which the UK and Wales can participate in the detection and prevention of illicitly traded alcohol, tobacco, and drugs. This has implications for the health and well-being of people in Wales and beyond. This is of particular relevance to Wales currently as drug deaths have reached their highest ever levels in Wales. Alcohol deaths are also worryingly high, and smoking remains the leading cause of preventable death in Wales. Illegally traded drugs, alcohol and tobacco have a damaging impact on population health and well-being that exceeds the risk already posed by their legal forms, making the detection and prevention of illicit trade in these goods vital. Individuals from the worst-off areas of the UK and Wales are more likely to experience negative health outcomes from the use of illicit products, including deaths and hospitalisations.
Since the UK’s withdrawal from the EU the UK does not have the same access to several EU databases for identifying criminals and illicit activity across Europe as it did before Brexit, potentially reducing its ability to detect and prevent illicit trade in the UK and Wales.
As the UK no longer participates in the Single Market or Customs Union goods may be subject to additional checks at UK borders which could be advantageous for tackling illicit trade. However, new international trade agreements and proposals for freeports in the UK and Wales, create new opportunities, which criminals may seek to exploit to smuggle illicit goods into Wales and the UK.
Poor mental health and financial stress, both identified by Public Health Wales as likely results from Brexit and the COVID-19 pandemic are both risk factors for increased consumption and/or misuse. This makes concerns around illicit trade and the demand for illicit alcohol, tobacco and drugs more of a concern to the health and well-being of the population of Wales.
Infectious diseases
Brexit has shifted the landscape in which Wales and the UK operates to tackle global infectious disease prevention, preparedness and responsethrough international collaboration. It has also seen the UK develop new international partnerships. The COVID-19 pandemic has given a glimpse of how some of these new and changed arrangements work in practice, however many post-Brexit agreements, including the TCA, were still in development during this time.
International collaboration is important to infectious disease preparedness, prevention and response. Data and information sharing ensures threats are identified quickly and that an effective, coordinated response can be developed and reviewed to reflect the changing scenario. Trading of medicines and medical goods means that resources get from the nations that produce them to where they are needed, when they are needed. Collaborating on prevention and preparedness, including through trade agreements, supports research to better understand and treat infectious diseases, and shapes healthcare workforce expertise and regulatory standards. Although Brexit has necessarily meant a loosening of the collaborative ties between the UK and the EU, it has also opened doors to new collaborations with countries outside of the EU. The importance of these collaborations should not be overlooked.
A population where everyone has the opportunity to enjoy the best possible health and well-being will be more resilient to future threats of infectious disease, in whatever form they may take. This should be at the forefront of considerations as Wales looks to adapt post-Brexit and, like the rest of the world, create a fair and sustainable recovery from the COVID-19 pandemic.
Climate
Historically, environmental policy has been strongly influenced by the EU. Since Brexit, many of EU laws and standards have been incorporated into UK law through the Withdrawal Act, maintaining these standards. However, there is scope in the future for the UK Government to reconsider its stance on these issues.
For the first time in a trade agreement, environmental targets have been embedded into the TCA text - setting a precedent for future trade agreements. A ‘non-regression’ mechanism within the text prevents either the UK or the EU from weakening their existing environmental standards through future trade agreements. In addition, the TCA requires both the UK and the EU to take sufficient action to reach the desired targets, or the agreement could be suspended or terminated.
There is opportunity for the UK to go further than these negotiated agreements by continuing the advocate for high environmental standards in the UK’s future trade agreements, such as those within the UK and US’s ‘One Health’ approach. This could also help to reduce the risk of new zoonotic infections that would be at a risk of increasing as a result of lowered environmental and food standards.
Trade is a major driver of airfreight, lorry and naval journeys from across the world delivering goods, people and products to nations. These journeys are not without cost to the environment and are widely acknowledged as drivers of climate change through the release of carbon emissions. There is a potential for Wales’ carbon footprint to increase if new trade agreements result in more of the goods being consumed coming from further afield. It would also worsen air pollution; a major contributor to stroke, chronic respiratory disease and others. Human health and well-being goes hand-in-hand with that of the planet. Public Health Wales recently published an in-depth report looking into the details of how climate change affects public health.
Employment/NHS Workforce
Being in good quality, secure work improves well-being, whereas unemployment can damage health at an individual, family and community level. Trade agreements could create jobs in Wales if they open new markets to the export of Welsh goods, but could lead to job losses if Welsh businesses are unable to compete with foreign imports. Trade agreements can also include new rules on who is permitted to live and work in Wales. This may disrupt the job market by increasing competition for certain roles or could mean that otherwise vacant roles are filled. For example, if this added needed skills and capacity to the Welsh health and care workforce, it could help bring wider benefits for public health.
As a result of the end to free movement between the UK and EU, EU nationals no longer have the right to freely work in the UK. Following the UK’s withdrawal from the EU the UK saw numbers of EU nationals joining the UK healthcare workforce decrease, whilst an increase was reported in the number of new international, non-EU staff. As a result, the UK Government has introduced a new Health and Social care visa, which it hopes will support more medical professionals to come to work in the UK. However, it is argued that some frontline health workers, and most care workers, will not qualify for the visa as they do not meet the qualifications and salary threshold criteria. This has the potential to exacerbate existing staff shortages in the health and care sector.
Upskilling the Welsh population has also been identified as a long-term opportunity post-Brexit to address understaffing issues, and to move away from reliance on foreign workers to maintain sufficient staff within the Welsh NHS.
Education
The Erasmus scheme is the EU's programme to support education, training, youth and sport in Europe. With the UK no longer a member of the EU and opting not to take part as an associated third country in the new Erasmus+ programme 2021-27,students in the UK and Wales will have radically reduced access the associated funding. To fill this gap, the UK Government introduced the Turing Scheme, which aims to continue to offer students the opportunity to study abroad. Welsh Government have also introduced an International Learning Exchange Programme (called ‘Taith’), which has similar objectives to the Turing Scheme and Erasmus. The new scheme will allow UK students the opportunity to study or work in potentially any country in the world. The UK Government expects the scheme to bring investment into the UK, facilitate the transfer of skills and knowledge, and reinforce global ties with international partners. New rules introduced by the UK Government also mean that, as of July 2021, all international students studying in the UK will be allowed to continue to work and live in the UK for a period following their course: three years for PhD students, and two years for those completing an Undergraduate or Master’s degree. With regard to visas, the UK Government has introduced a new Global Talent visa, which allows leaders in their field a five year stay in the UK.
A EU committee report, Beyond Brexit: trade in services, notes that the TCA includes a framework allowing regulators and professional bodies to negotiate recommendations for Mutual Recognition Agreements (MRAs) on a profession-by-profession basis, which must then be submitted to the Partnership Council for approval. As a result, there is the possibility for UK professionals to miss out if their qualifications are not recognised in the EU. The current rules on mobility for creative professionals would serve to stifle creative innovation in both the UK and EU. Without access to the Erasmus+ programme, the opportunities available to students and universities are restricted. All these mutual challenges, and many more besides, will require that that the UK and the EU continue to work together while recognising their new relationship.
Summary
In 2020 the UK Internal Market Act (UK IMA) was introduced to regulate UK’s ‘internal market’ following Brexit. The act governs internal trade across the four nations and replaces the EU Treaty framework on the free movement of goods, services, persons and capital which previously provided a set of common rules that bound the UK and devolved administrations. The act generated fierce debate about its impacts on devolved law; both the Senedd and the Scottish Parliament refused consent for the Bill, but the UK Government chose to pass it without this consent and it became law in December 2020.
The Act dictates that if a product can be legally sold in one part of the UK then, under the UK IMA, it can be sold in another even if it does not comply with the law of that nation. Similarly, the UK IMA prevents one part of the UK from changing its rules around advertising, licensing or the transportation of goods if it could discriminate against products from other parts of the UK. In practice, this means Welsh Government cannot prevent products that do not meet its regulatory standards from being sold in Wales if they are permitted in other parts of the UK. It also means that if Welsh Government wanted to pass tighter regulations around how goods are made, transported or advertised they would likely only apply to goods made or imported first into Wales, not to goods coming into Wales from the rest of the UK. This has the potential to seriously undermine the effectiveness of certain public health policies including food standards and environmental initiatives as raised above.
An example of this is the ongoing action to ban single use plastics across the UK and the environmental and public health implications this has. Regulations are being introduced across the four nations detailing how organisations responsible for packaging must carry out their recycling responsibilities. In addition to this there is also additional upcoming Welsh single-use plastic legislation. The UK IMA introduces uncertainty about whether devolved administrations are able to introduce bans on products which are permitted to be sold in other parts of the UK. This limits Welsh Government’s ability to introduce environmental and public health policies and puts restrictions upon devolved law. It is hoped that the upcoming single-use plastic legislation will provide a practical example to support the Welsh Government’s ongoing legal challenge to the Internal Market Act.
Each of these impacts listed above, both positive and negative, have the possibility to impact upon the achievement of the Well-being of Future Generations (Wales) Act 2015seven wellbeing goals, most specifically ‘A Healthier Wales’, ‘A More Resilient Wales’ and ‘A Wales of More Cohesive Communities’. There is a need for health to be considered throughout discussions around trade and for trade to be recognised as a wider determinant of health in order to promote the potential positive health implications and reduce the negative unintended consequences of future and existing trade agreements.
-Unintended consequences that you have experienced
Public Health Wales have identified numerous potential unintended impacts for health and well-being associated with trade deals following the UK’s withdrawal from the EU. These include:
Public Health Policies
The costs of public bodies and agencies focusing on preparing for the UK’s withdrawal from the EU has resulted in many other policy / implementation priorities being placed on hold or delayed. There is a risk that GDP and economic development may be prioritised over these policy priorities and take precedence over the implementation of the Wales’ well-being goals, the ways of working, and the sustainable development principle. There is a concern that eagerness to enter into trade agreements could encourage negotiators to ‘trade away’ the long-term goal of a healthy and more productive population in exchange for short-term economic advantages. Public Health Wales, in collaboration with the WHO European Office for Investment for Health and Development, has been leading work around advancing the well-being economy approach to policymaking.
Cost
The impact of any possible reduction in economic growth, rising inflation and consequent reductions in public spending due to Brexit and its post withdrawal trade agreements are one set of mechanisms through which health impacts may occur. The evidence clearly shows that such economic downturns significantly affect the determinants of health such as income, employment and living standards, with strong evidence connecting these with impacts on mental health. However, predicting health outcomes is complex and difficult. Evidence from other economic crises suggests that policy interventions such as active labour market programmes, family support, and primary mental health care can help reduce or mitigate impacts on mental health and well-being
Climate change
Climate concerns have already been cited within this consultation response. However, it is necessary to also highlight that focused attention on the UK’s withdrawal from the EU and the resulting trade agreements may lead to a reduced focus on climate change as a policy priority. This unintended consequence could impact upon Wales’ goal to achieve net zero by 2050 and create a greener, stronger, fairer Wales.
-Changes to the UK-EU Relationship you would like to see
Public Health Wales advocates for appropriate exemptions from ISDS to enable the UK and the devolved nations to legislate for healthy public policies relating to, for example, the labelling or advertising of alcohol and food without legal challenge, or the fear of legal challenge that leads to regulatory chill. This can also protect public finances from the risk of expensive legal challenges.
It is essential for details of trade agreements and final treaty texts to be open and transparent in order for analysis to be undertaken regarding the potential health and well-being impacts throughout the process. This enables the UK Government to support stakeholder engagement, scrutiny, and discussion around trade agreements and provide more accurate predictions of both positive and negative population health impacts.
Public Health Wales advocate for health impact assessments (HIAs) as an evidence-based tool to inform policy decisions, including trade discussions and negotiations. By anticipating the potential impacts of trade agreements, like the TCA, on health, well-being, and equity, policymakers can better identify what action may be needed to mitigate potential risks and maximise opportunities, now and into the longer-term.
This enables the adoption of a ‘health in all policies’ approach, recognising that our health and well-being is shaped by much more than the provision of health and social care services. Many of the stakeholders affected by the terms of trade agreements will need to better understand the potential impacts of trade on their environment, society, economy, and health and well-being to effectively advocate for their sectors, communities and interests. HIAs are valuable tools that can be incorporated into trade policy discussions and inform trade negotiations about the potential positive and negative impacts of trade agreements on health, well-being and equity. In a trade context, HIAs can identify the potential risks to public health to support mitigation activity as well as the opportunities the trade policy creates to potentially benefit public health. HIAs also help to identify the breadth of the population groups who may be affected by UK Government trade decisions.
In Wales, the Public Health (Wales) Act 2017puts in place requirements for HIAs to be conducted by Welsh Government and public bodies in Wales when making key decisions. This further supports a shift to putting the consideration of impacts on health, well-being and equity at the centre of decision-making. Welsh Government would therefore be using this approach in their consideration of trade agreements and trade policy.
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