Methods and Approaches for Measuring the Impact of Trade Agreements on Public Health

Part of the Palgrave Studies in Public Health Policy Research book series (PSPHPR)


This chapter reviews key research methods used to interrogate trade and health relationships organised under seven categories: ‘Big Trade’ studies that rely on large data sets; country case studies which dig deeper into specific trade-related pathways; natural experiments which compare health outcomes between matched countries following new liberalisation measures; health impact assessments which use findings from multiple studies to suggest how trade measures are likely to affect health; economic impact assessments which estimate aggregate welfare gains (income, gross domestic product); qualitative comparative analysis which examines how liberalisation interacts with different public policies to affect health outcomes; and legal research that focuses on specific treaty provisions and dispute panel decisions. The strengths and limitations of each type of study design are discussed with examples from the published literature.


Trade and health research Quantitative methods Case study design Health impact assessments Qualitative comparative analysis 


  1. 1.
    Laya AG. Here’s why it’s time to ditch our obsession with trade deficits. World Econ Forum [Internet]. 2018 May 1 [cited 2019 May 21].
  2. 2.
    Dreher A. Does globalization affect growth? evidence from a new index of globalization. Appl Econ. 2006;38(10):1091–110. Scholar
  3. 3.
    Gygli S, Haelg F, Potrafke N, Sturm J-E. The KOF Globalisation Index—revisited. Rev Int Organ. 2019;
  4. 4.
    Potrafke N. The evidence on globalisation. World Econ. 2015;38(3):509–52. Scholar
  5. 5.
    Cuevas García-Dorado S, Cornselsen L, Smith R, Walls H. Economic globalization, nutrition and health: a review of quantitative evidence. Glob Health [Internet]. 2019 [cited 2019 Feb 20];15(1):[15 p.].
  6. 6.
    Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol and tobacco. PLoS Med. 2012;9(6):e1001235. Scholar
  7. 7.
    Mendez Lopez A, Loopstra R, McKee M, Stuckler D. Is trade liberalisation a vector for the spread of sugar-sweetened beverages? A cross-national longitudinal analysis of 44 low- and middle-income countries. Soc Sci Med. 2017;172:21–7. Scholar
  8. 8.
    Burns DK, Jones AP, Suhrcke M. The relationship between international trade and non-nutritional health outcomes: a systematic review of quantitative studies. Soc Sci Med. 2016;152:9–17.CrossRefGoogle Scholar
  9. 9.
    Barlow P, McKee M, Basu S, Stuckler D. The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis. Glob Health. 2017;13(13)
  10. 10.
    Thow AM, Hawkes C. The implications of trade liberalization for diet and health: a case study from Central America. Glob Health. 2009;5(5):15 p.
  11. 11.
    Cassels S. Overweight in the Pacific: links between foreign dependence, global food trade, and obesity in the Federated States of Micronesia. Global Health [Internet]. 2006 [cited 2011 May 11];2(10).
  12. 12.
    Sahal Estimé M, Lutz B, Strobel F. Trade as a structural driver of dietary risk factors for noncommunicable diseases in the Pacific: an analysis of household income and expenditure survey data. Glob Health. 2014;10(1):48. Scholar
  13. 13.
    Schram A, Labonte R, Baker P, Friel S, Reeves A, Stuckler D. The role of trade and investment liberalization in the sugar-sweetened carbonated beverages market: a natural experiment contrasting Vietnam and the Philippines. Glob Health. 2015;11(41):13. Scholar
  14. 14.
    Barlow P, McKee M, Stuckler D. The impact of U.S. free trade agreements on calorie availability and obesity: a natural experiment in Canada. Am J Prev Med. 2018;54(5):637–43. Scholar
  15. 15.
    Barlow P, McKee M, Basu S, Stuckler D. Impact of the North American Free Trade Agreement on high-fructose corn syrup supply in Canada: a natural experiment using synthetic control methods. Can Med Assoc J. 2017;189(26):E881–7. Scholar
  16. 16.
    Lexchin JR, Gleeson D. The Trans Pacific Partnership Agreement and pharmaceutical regulation in Canada and Australia. Int J Health Serv. 2016;46(4):597–613. Scholar
  17. 17.
    Labonte R, Schram A, Ruckert A. The Trans Pacific Partnership: is it everything we feared for health? Int J Health Policy Manag. 2016;5(8):487–96.CrossRefGoogle Scholar
  18. 18.
    Hirono K, Haigh F, Gleeson D, Harris P, Thow AM, Friel S. Is health impact assessment useful in the context of trade negotiations? A case study of the Trans Pacific Partnership Agreement. BMJ Open. 2016;6(4):E010339. Scholar
  19. 19.
    Ruckert A, Schram A, Labonte R, Friel S, Gleeson D, Thow AM. Policy coherence, health and the sustainable development goals: a health impact assessment of the Trans-Pacific Partnership. Crit Public Health. 2017;27(1):86–96.CrossRefGoogle Scholar
  20. 20.
    Labonté R, Crosbie E, Gleeson D, McNamara C. USMCA (NAFTA 2.0): tightening the constraints on the right to regulate for public health. Global Health [Internet]. 2019 [cited 2019 May 14];15(1):[35 p.].
  21. 21.
    Hirono K, Haigh F, Gleeson D, Harris P, Thow AM. Negotiating healthy trade in Australia: health impact assessment of the proposed Trans-Pacific Partnership Agreement. [Internet]. Sydney: Centre for Health Equity Training Research and Evaluation, part of the Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW Australia; 2015 [cited 2017 March 31].
  22. 22.
    Gleeson D. A health impact assessment of PACER Plus. In:Pacific Network on Globalisation, editor. Defending Pacific ways of life: a peoples social impact assessment of PACER-Plus. Fiji: PANG; 2016. p. 35–52.Google Scholar
  23. 23.
    European Centre for Health Policy. Health Impact Assessment: main concepts and suggested approach. Brussels: WHO Regional Office for Europe; 1999.Google Scholar
  24. 24.
    Parry J, Stevens A. Prospective health impact assessment: pitfalls, problems, and possible ways forward. BMJ. 2001;323(7322):1177–82. Scholar
  25. 25.
    Morrison DS, Petticrew M, Thomson H. Health impact assessment—and beyond. J Epidemiol Community Health. 2001;55(4):219–20. Scholar
  26. 26.
    Harris-Roxas B, Harris E. Differing forms, differing purposes: a typology of health impact assessment. Environ Impact Assess Rev. 2011;31(4):396–403. Scholar
  27. 27.
    Government of Canada. Notice of intent to conduct impact assessments of the Canada-Mercosur Free Trade Agreement negotiations [Internet]. 2018 [cited 2019 May 21].
  28. 28.
    De Schutter O. Report of the Special Rapporteur on the right to food, Olivier De Schutter. Addendum: guiding principles on human rights impact assessments of trade and investment agreements. A/HRC/19/59/Add.5. Geneva: United Nations General Assembly; 2011.Google Scholar
  29. 29.
    Labonté R, Schram A, Ruckert A. The Trans-Pacific Partnership Agreement and health: few gains, some losses, many risks. Glob Health. 2016;12(1):25. Scholar
  30. 30.
    Labonté R, Ruckert A, Schram A. Trade, investment and the global economy: are we entering a new era for health? Glob Soc Policy. 2017;18(1):28–44. Scholar
  31. 31.
    Ciuriak D, Dadkhah A, Xiao J. Better in than out? Canada and the Trans-Pacific Partnership [Internet]. C.D. Howe Institute; 2016 [cited 2019 May 21].
  32. 32.
    Ciuriak D, Dadkhah A, Xiao J. Taking the measure of the TPP as negotiated [Internet]. Ciuriak Consulting; 2016 [cited 2019 Jan 6].
  33. 33.
    Cripps F, Izurieta A, Vos R. The UN DESA Global Policy Model: underlying concepts and empirical illustrations [Internet]. Alphametrics Co. Ltd., for UN DESA; 2010 [cited 2019 May 21].
  34. 34.
    Capaldo J, Izurieta A. Trading down: unemployment, inequality and other risks of the Trans-Pacific Partnership Agreement. Medford, MA: Tufts University; 2016.Google Scholar
  35. 35.
    Ciuriak D. Canada and the Trans-Pacific Partnership: considerations for the ratification debate. Submission to the House of commons standing committee on international trade [Internet]. 2016 [cited 2019 May 21].
  36. 36.
    Befani B, Ledermann S, Sager F. Realistic evaluation and QCA: conceptual parallels and an empirical application. Evaluation. 2007;13(2):171–92. Scholar
  37. 37.
    Mahoney J. The logic of process tracing tests in the social sciences. Sociol Methods Res. 2012;41(4):570–97. Scholar
  38. 38.
    McNamara C. Trade liberalization, social policies and health: an empirical study. Glob Health. 2015;11:42. Scholar
  39. 39.
    McGrady B. Trade and public health: the WTO, tobacco, alcohol and diet. Washington, DC: Cambridge University Press; 2011. 340 pCrossRefGoogle Scholar
  40. 40.
    O’Brien P, Gleeson D, Room R, Wilkinson C. Marginalising health information: implications of the Trans Pacific Partnership for alcohol labelling. Melb Univ Law Rev. 2017;41(1):341–91.Google Scholar
  41. 41.
    Mitchell A, Sheargold E. Protecting the autonomy of states to enact tobacco control measures under trade and investment agreements. Tob Control. 2015;24(e2):e147–53. Scholar
  42. 42.
    Voon T. Third strike: the WTO panel reports upholding Australia’s tobacco plain packaging scheme. J World Invest Trade. 2019;20(1):146–84.
  43. 43.
    Zhou SY. Managing fragmentation between international trade and investment law and global priorities for noncommunicable disease prevention in food and alcohol. QUT Law Rev. 2018;18(2):i–iv. Scholar

Copyright information

© The Author(s) 2020

Authors and Affiliations

  1. 1.School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
  2. 2.School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada

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