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Background: Free trade agreements (FTAs) increasingly extend beyond tariffs to include intellectual property (IP), investment protections, regulatory cooperation, and standards for labour and the environment. These provisions can reshape social determinants of health and the distribution of health outcomes. This review synthesizes how FTAs influence health equity through identifiable mechanisms and appraises the strength and direction of the evidence.

Methods: We conducted a scoping review (PRISMA-ScR aligned) of peer-reviewed and credible grey literature in English from database inception to 31 December 2024 across PubMed/MEDLINE, PubMed Central, BioMed Central, and Google Scholar; we also screened key agency sites (WHO, UNITAID, APHA). We included studies assessing bilateral, regional, or “mega-regional” FTAs that reported health outcomes, equity-relevant determinants (e.g., access to medicines, nutrition environments, employment, environmental exposure), or distributional effects. Screening and extraction followed a predefined framework, with methodological appraisal appropriate to design. Synthesis was thematic, mapped to a priori pathways: (1) policy-space constraints (TRIPS-plus IP; investor–state dispute settlement, ISDS); (2) market and risk-environment shifts (food systems, alcohol/tobacco, product flows); and (3) income, employment, and environmental channels.

Results: Evidence linking FTAs to restricted medicine access via TRIPS-plus provisions and to deterrent effect on public health regulation under ISDS is consistent but context-dependent. Quasi-experimental studies associate specific agreements with higher calorie availability and diet shifts and with heterogeneous changes in NCD risk, while multi-country analyses suggest some health gains via employment and environmental improvements under deeper RTAs. Post-COVID scholarship foregrounds vaccine equity and trade/IP flexibilities as critical equity levers. Overall certainty varies by mechanism and design; distributional impacts are greatest where regulatory capacity is limited.

Conclusions: FTAs can both create opportunities and pose risks for health equity. Equity-concordant trade governance requires transparent negotiation, ex-ante health impact assessment, preservation of TRIPS flexibilities and public-health exceptions, narrowing or excluding ISDS, and targeted measures to mitigate distributional harms—especially in low-capacity settings. We highlight actionable options for negotiators, regulators, and public-health actors and specify priority evidence gaps.

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References How to Cite

1.

Bera OP, U V, Satapathy D, Singh A, Chandge M. Health Equity in the Era of Free Trade Agreements: A Scoping Review of Mechanisms, Evidence, and Policy Options. Indian Journal of Community Health [Internet]. 2025 Sep. 24 [cited 2025 Nov. 4];37(4). Available from: http://www.iapsmupuk.org/journal/index.php/IJCH/article/view/3390

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