International Trade Agreements

ICN Position:

International trade agreements affect health services and the personnel who deliver them. The International Council of Nurses (ICN) urges national nurses associations (NNAs), governmental and non-governmental agencies to closely monitor the development and impact of international trade agreements that affect health and social policy.

Access to health services, employment opportunities of health personnel, and professional regulation are of particular interest and relevance to nurses. Privatisation and commercial development of the health sector need to be monitored and controlled within a framework that guarantees a population’s access to health services. ICN, as the voice of nurses and nursing, promotes policies that improve the delivery of health services, including sound labour policies, financing structures and regulatory mechanisms. ICN denounces policies that have a negative impact on the quality of care provided.

As professional organisations, ICN and NNAs endorse the principle of equity in the delivery of health services (i.e. Health for All). ICN condemns attempts to facilitate the international mobility of health personnel at the expense of patient safety (e.g. creating pressure to lower professional accreditation standards or threaten their consistent application).

ICN protects and promote the nursing profession’s right to coherent self-regulation. ICN, therefore, encourages the creation of nursing legislation or regulatory policies as a fundamental tool to define education and practice standards for international comparison and provide the regulatory framework in International Trade Agreements (ITAs) dealing with professional services (e.g. mutual recognition agreements).

The delivery of quality care depends on a safe working environment and optimal working conditions. International trade agreements must therefore include labour and environmental standards that foster quality care and provisions related to their enforcement. NNAs must be a social force in international trade negotiations and be given access to relevant information.

In addition, ICN and member associations must work strategically with others in health care so as to influence international trade agreements having an impact on patient, family and public health, health sector human resources, and health care delivery systems in general.

Background

International trade agreements have traditionally focused on the trade of goods and commodities. The scope of these agreements has now expanded to include international trade in a broader range of services, including health services. A new generation of regulatory, labour, competition and quality assurance issues needs to be addressed.

The health sector is increasingly influenced by national and international economic policies and agreements (e.g. North American Free Trade Agreement, Asia Pacific Economic Co-operation, General Agreement on Tariffs and Trade). Internationally negotiated instruments generate opportunities as well as challenges. A real concern, however, is the extent to which such agreements weaken and/or restrict governmental input, professional regulatory mechanisms and the maintenance of non-profit, public social and health services.

The rapidly changing balance between public and private input in the health care sector affects equity, quality of care, access to health service delivery and labour relations. The impact of trade or economic interests on health sector reform needs to be monitored (e.g. substitution of qualified staff or the de-professionalisation of care providers, migration of health care workers).

Nurses are major providers of health services. The care delivered by nurses as well as their working conditions are affected by international trade agreements. They must have access to information and decision-making bodies at all levels.

Adopted in 1999

Last review 2004