1 Maintaining a Healthy Pacific How might PACER- Plus impact on the health of Pacific Island women? Claire Slatter How might PACER- Plus impact on the health of Pacific Island women? Claire Slatter

2 PACER Plus  Primarily a free trade agreement  Conceived (and is being pushed) by Australia and NZ who stand to benefit most from it  Aimed at liberalizing trade betw PICs & Aust & NZ  Primarily by reducing/eliminating tariffs & other barriers to goods and services supplied by Australian and NZ companies and firms  Australia and NZ are expected to reciprocate by opening their markets to goods and services produced in the PICS  But trade balance is overwhelmingly in favour of Australia and NZ – likely to tip even further in their favour through PACER Plus  Primarily a free trade agreement  Conceived (and is being pushed) by Australia and NZ who stand to benefit most from it  Aimed at liberalizing trade betw PICs & Aust & NZ  Primarily by reducing/eliminating tariffs & other barriers to goods and services supplied by Australian and NZ companies and firms  Australia and NZ are expected to reciprocate by opening their markets to goods and services produced in the PICS  But trade balance is overwhelmingly in favour of Australia and NZ – likely to tip even further in their favour through PACER Plus

3 Likely demands of Australia and NZ under PACER Plus  Market access for goods produced by Australian and NZ companies  Market access for services supplied by Australian & NZ firms/companies (including in the health and education sectors)  Investment access (and access to other resource bases e.g. land, natural resources, capital)  Market access for goods produced by Australian and NZ companies  Market access for services supplied by Australian & NZ firms/companies (including in the health and education sectors)  Investment access (and access to other resource bases e.g. land, natural resources, capital)

4 Current problems in PIC health systems  Shortage of medical personnel  Globalization of health care  Emigration of experienced medical personnel (Fiji, Samoa and Tonga) –> Australian & NZ (Feb 2008 – 160 doctors reported by MoH to have left Fiji; 5 doctors in Nadi Hospital;  Labour migration of nurses (privately contracted, short-term, informal care work – open recruitment of nurses by agencies from Australia)  As many Fiji doctors and nurses working abroad as in Fiji  Several studies/papers (Kelsey, Narsey, McClellan, Connell, Naidu)  Triple burden of disease –communicable diseases, NCDs (diabetes, cardiovascular diseases and cancer) and injuries.  Budgetary allocations to public health systems  Reduced per capita allocations to health  Largest allocation to emoluments (58%)  High expenditure on curative cf preventive services  Shortage of drugs, equipment and other medical supplies  High reliance on curative services abroad  Shortage of medical personnel  Globalization of health care  Emigration of experienced medical personnel (Fiji, Samoa and Tonga) –> Australian & NZ (Feb 2008 – 160 doctors reported by MoH to have left Fiji; 5 doctors in Nadi Hospital;  Labour migration of nurses (privately contracted, short-term, informal care work – open recruitment of nurses by agencies from Australia)  As many Fiji doctors and nurses working abroad as in Fiji  Several studies/papers (Kelsey, Narsey, McClellan, Connell, Naidu)  Triple burden of disease –communicable diseases, NCDs (diabetes, cardiovascular diseases and cancer) and injuries.  Budgetary allocations to public health systems  Reduced per capita allocations to health  Largest allocation to emoluments (58%)  High expenditure on curative cf preventive services  Shortage of drugs, equipment and other medical supplies  High reliance on curative services abroad

5 Health Sector reforms  Part of donor-driven public sector reforms  Decentralized outpatient services  Separation of administrative and medical functions and personnel  Privatization of outpatient services  Private health providers  Health financing reforms  National Health Accounts  Health Master Plans  User pays (exemptions 60; chronically ill; communicable diseases)  Social health insurance (earnings-based contributions from formal sector employees; an alternative to more universal tax- financed health system financed through taxes and non tax government revenue)  Part of donor-driven public sector reforms  Decentralized outpatient services  Separation of administrative and medical functions and personnel  Privatization of outpatient services  Private health providers  Health financing reforms  National Health Accounts  Health Master Plans  User pays (exemptions 60; chronically ill; communicable diseases)  Social health insurance (earnings-based contributions from formal sector employees; an alternative to more universal tax- financed health system financed through taxes and non tax government revenue)

6 Some trade-related health issues  Reduced tariffs -> government revenue -> reduced capacity for social provisioning (e.g. in health services)  Increased VAT or GST to compensate for lost revenue -> increase health costs (services, supplies, drugs – Sarah Meade study)  Increased privatization of health -> declining quality of health care in public health system (health personnel tend to move from (or between) public to private  Unhealthy food imports from Australia and NZ  Fatty waste-products from the meat industry (namely lamb/mutton flaps, lard) - a lucrative export earner for the NZ and Australian meat industries  Other unhealthy processed food imports (e.g. SPAM)  Access to health services in Australia and NZ?  Reduced tariffs -> government revenue -> reduced capacity for social provisioning (e.g. in health services)  Increased VAT or GST to compensate for lost revenue -> increase health costs (services, supplies, drugs – Sarah Meade study)  Increased privatization of health -> declining quality of health care in public health system (health personnel tend to move from (or between) public to private  Unhealthy food imports from Australia and NZ  Fatty waste-products from the meat industry (namely lamb/mutton flaps, lard) - a lucrative export earner for the NZ and Australian meat industries  Other unhealthy processed food imports (e.g. SPAM)  Access to health services in Australia and NZ?

7 Gender implications  Major health problems affecting women  Cancers (cervical and breast)  NCDs – lifestyle diseases  Diabetes, hyper-tension, obesity  STIs  Reproductive health problems  Health services important to women  Early detection screening services for female cancers  Community health  Maternal health care  Reproductive health services  Weakened public health systems, cost-barriers to accessing health services, including treatment not available locally, affect women most  Poor preventive health services – including public health education and awareness also leave women particularly disadvantaged  Major health problems affecting women  Cancers (cervical and breast)  NCDs – lifestyle diseases  Diabetes, hyper-tension, obesity  STIs  Reproductive health problems  Health services important to women  Early detection screening services for female cancers  Community health  Maternal health care  Reproductive health services  Weakened public health systems, cost-barriers to accessing health services, including treatment not available locally, affect women most  Poor preventive health services – including public health education and awareness also leave women particularly disadvantaged

 Health does not just mean the absence of disease  For women, the health implications of poverty include:  living with stress (their own and their partners – VAW is known to increase in families in economic crisis)  being unable to access treatment  Self treating with traditional medicine  Relying on prayer for a cure  The PACER Plus gender implications in health? Apart from implications of restrictive IP (which could reduce PIC’s access to generic drugs), would be speculating.  Health does not just mean the absence of disease  For women, the health implications of poverty include:  living with stress (their own and their partners – VAW is known to increase in families in economic crisis)  being unable to access treatment  Self treating with traditional medicine  Relying on prayer for a cure  The PACER Plus gender implications in health? Apart from implications of restrictive IP (which could reduce PIC’s access to generic drugs), would be speculating. 8