How UK trade policies could help heal global healthcare inequalities | Ruth Bergan and Natalie Sharples

Theresa May’s recent visit to India, during which discussions about cooperation over trade in health services were a priority, is a reminder that trade and investment cannot be isolated from other areas of policy.

Key among these is universal health coverage – the provision of quality medical services to all people when they need them, without causing financial hardship. This is a concept that is having its moment: it is championed by everyone from health activists to the World Bank, and is one of the targets in the sustainable development goals.

What is obvious, but perhaps less palatable to some of its advocates, is that achieving universal health coverage requires addressing polices far beyond the health sector. Policies that need to work for universal health coverage include those on water and sanitation, nutrition and education, but also global policies and practices that impede the right to health.

In the context of Brexit, UK trade is one such policy we urgently need to examine. Trade has huge implications for health. This was seen very clearly in the EU’s failed attempt to agree a trade deal with India. When the EU proposed to include stricter patenting rights for companies in the deal, Indian negotiators, the UN and activists all raised serious objections, fearing it would drive a huge increase in the cost of medicines relied on by poor communities across the globe.

Fears about trade rules are well-founded. One third of the world’s population lacks access to essential medicines. New treatments for people living with HIV in middle-income countries can cost between $ 3,000 (£2,400) and $ 28,000 per person each year. No surprise that for many people this is out of reach. Inequalities in power between companies and citizens is at the heart of this. Patent protection given to pharmaceutical companies through provisions in trade agreements restricts access to cheaper, generic medicines and pushes up drug prices. In the US, the Food and Drug Administration reports that the cost of a generic drug is 80% to 85% lower than the brand name product.

Similar power distortions are unmistakable in bilateral investment treaties. Like the controversial TTIP and Ceta agreements, these trade deals include a parallel judicial system allowing companies to sue governments at private international tribunals, curbing the ability of states to provide for the right to health for their people, and undermining democracy.

Companies are already using such provisions to challenge government health policy. In 2012, pharmaceutical giant Eli Lilly began legal proceedings against the Canadian government for $ 500m for invalidating two of its patents. The invalidations were the result of a new national law that required the “utility” of an invention to be demonstrated when the patent was filed – in other words the drug did not do what the inventor said, or implied, it would do when the patent application was made, as was the case with the two contested drugs from Eli Lilly. The company then sued Canada under the Nafta treaty for lost profit and unfair treatment – a lawsuit that is not only intended to challenge the withdrawal of the patents but also Canada’s national law.

While there are no public cases of health companies suing India, UK companies have certainly been using the provisions of UK bilateral investment treaties to challenge other aspects of Indian government policy. Vedanta Mining and Vodafone have both challenged changes to Indian tax law. The companies had used offshore vehicles to buy out Indian companies, neatly avoiding having to pay significant amounts of tax. When India attempted to close the loophole (pdf) that allowed this to happen, the companies used the UK-India treaty to sue the government for “compensation”.

Every day 16,000 children under-five (5.9 million a year) die. The causes of their deaths are largely preventable, meaning these children are not killed by illness, but bad policies. As the Alma Ata – the first international declaration underlining the importance of primary health care – made clear almost 40 years ago, health inequalities within and between countries are “politically, socially and economically unacceptable”. Achieving universal health coverage requires training more health workers, improving health information systems and mobilising more domestic financing. It also requires addressing the global causes of poverty and inequality. Trade and investment policies should be first on the list. India has already revised its bilateral investment treaties to limit the range of policies that can be challenged. The UK now has an opportunity to make sure its own trade policy supports the health of people across the world. We must demand that MPs act now to ensure it.

• Natalie Sharples is senior policy advisor at Health Poverty Action

How UK trade policies could help heal global healthcare inequalities | Ruth Bergan and Natalie Sharples

Northampton hospital staff in protest over lockout techniques | Natalie Bloomer

Biomedical scientist Carol Whittaker on the picket line at Northampton Standard hospital with Unite common secretary Len McCluskey Photograph: David Levene for the Guardian

Carol Whittaker is terrified she will be forced out of the work she loves. In what is believed to be the very first time in the historical past of the NHS, hospital workers including Whittaker, have been “locked-out” of function, following a bitter dispute over spend and hours.

“We have had our swipe cards cancelled and accessibility to the laboratory denied. I cannot feel they are treating us like this. I am not crying nevertheless today, but most days I am in tears. After all these years, I truly feel absolutely allow down by the management,” says Whittaker, who has worked for 23 years as a senior biomedical scientist at Northampton Standard hospital.

Unite, the union that represents the 54 scientists, pathologists and laboratory help personnel at the centre of the dispute, has been in negotiations with hospital bosses because final July. The hospital believe in place forward proposals, which the union says would imply the pathology team, who analyse check benefits and also aid diagnose and deal with ailments, having to operate more evening shifts and see their out-of-hrs payments slashed by up to 80%. The believe in says pathology support employees obtain increased on-contact and out-of-hours payments than their counterparts in other departments. It adds that the proposals are component of wider plans to “harmonise” NHS terms and problems.

Whittaker, who typically performs twenty hours per week, above 5 mornings, says that the planned modifications would make it not possible for her to continue her employment at the hospital. Operating nights would clash with her husband’s task. “It really is not about the income for me, my son is just 13 and a lack of childcare indicates I can’t work nights,” she says.

In June, 84% of the staff voted not to strike, but to consider other industrial action. They were due to commence a perform to rule on 26 June with a ban on overtime, out of hrs operating and the education of other workers. But they say on arriving at perform, they had been told unless they signed documents agreeing not to consider industrial action, their companies would no longer be necessary at the hospital.

“Lockouts”, in which employers stop personnel taking industrial action from accessing their workplace, are rare in the Uk, but in latest weeks striking firefighters in Buckinghamshire have also been threatened with it and the RMT rail union says some London Underground cleaners have been locked out in a dispute above a biometric fingerprinting method.

The move by employers comes at a time when the Conservatives have announced strategies for new laws to curb the rights of public sector unions to take industrial action . This is in spite of recent figures from the Office for National Statistics exhibiting the quantity of strikes in 2013 was down on the preceding two years, with just 114 stoppages.

Len McCluskey, the Unite general secretary, is assured the union will not shed the dispute in Northampton, but says the implications if they did could be far-reaching across the public sector. “I am totally shocked by [their] therapy. The perform they do behind the scenes is absolutely vital. I am confident there will be senior managers across the nation, hunting at this scenario proper now and rubbing their hands with glee at the believed they have a green light to behave in this appalling way.”

The TUC common secretary, Frances O’Grady, agrees. “Rather than looking for to intimidate employees, employers should be speaking to union members and striving to resolve disputes. If the sturdy-arm tactics used in Northampton be successful, it may possibly encourage other employers to believe that they too are over the law. If this happens we should all be deeply concerned.”

Northampton Standard hospital NHS believe in says that the pathology services must be offered in the most expense-effective way. A trust spokeswoman says: “600 personnel across the hospital have been affected by revised terms and problems and 94% of people have accepted the alterations. The proposals are in line with nationwide suggestions from the NHS workers council.”

Whittaker says she can not bear to feel about what will come about if the dispute cannot be resolved. “If I could say one particular thing to the management, I would simply request them to listen to us and deal with us like the educated men and women we are. We will not want to be out right here, we want to be back inside performing the occupation we love.”

Northampton hospital staff in protest over lockout techniques | Natalie Bloomer