Dealing with corporate interference in health policy through governance: The Uruguayan Declaration on Trade and Health

Tobacco use is a global health problem, currently accounting for 5.4 million deaths annually and expected to reach one billion total deaths by the end of 21st century. In 2003, 192 countries adopted the WHO Framework Convention on Tobacco Control (FCTC) to deal with this problem. The issue of health vs. trade was raised during negotiations, but not resolved for political reasons. While this issue progressively gained prominence in global health governance and inter-state relations, it came to a head when Philip Morris International (PMI) sued Uruguayan government for trademark violation because Uruguay's graphic health warnings infringed on WTO treaty. In November 2010, Uruguay placed the issue on agenda of FCTC Conference of the Parties (COP-4) meeting in Punta del Este. The delegates contemplated if Uruguay loses, who is next? They felt their sovereignty was under attack by wealthy tobacco companies, resulting in a declaration that made PMI to withdraw the lawsuit. However, the declaration incorporated a clause, public health measures should be “consistent with TRIPS Agreement.” This study triangulates participant observation of COP-4 meeting with participant interviews and archival documents to provide insight into the Uruguayan Declaration. While the declaration was a political victory and identified venues for weak Parties to fight tobacco companies, it also highlights that health-trade conflict has not been resolved. Hence, it is necessary that the public health community advocates for development of FCTC guidelines on health-trade issue, so that Parties can develop innovative tobacco control policies to improve health without fear of costly lawsuits.