Perjanjian Perdagangan Mega-Regional dan Kesehatan Publik: Tinjauan Kritis terhadap Dampak Ekonomi, Konsumsi Gula, dan Akses Obat

Abstract

Mega-regional trade agreements reshape not only flows of goods, services, and investment but also health determinants through food prices, sugar production, intellectual property protection, access to medicines, and governments’ policy space. This article critically assesses the findings of Narayanan and Khorana on the consequences of mega-regional agreements for developing economies and connects them with recent scientific and policy evidence. A critical literature review was conducted. The focal article was assessed in terms of problem formulation, the Global Trade Analysis Project model, simulation results, argument quality, and policy relevance. Its findings were compared with systematic reviews, health-economics research, and official documents issued by WHO, WIPO, WTO, and UNCTAD. The review indicates that liberalisation can generate aggregate economic benefits, but these gains are unevenly distributed. Stronger intellectual property protection tends to favour economies with greater innovative capacity, while developing countries may face higher costs of technology and medicines. Food-market liberalisation can also increase the availability of high-sugar products and contribute to the burden of non-communicable diseases unless accompanied by effective health regulation. Simulation models are useful for estimating the direction and scale of effects, although their conclusions depend on assumptions, database structures, and the translation of economic changes into health outcomes. Trade-agreement assessment should therefore incorporate health, equity, access to medicines, and policy-space indicators from the negotiation stage. Developing countries require TRIPS flexibilities, health-impact assessment, food regulation, and stronger trade–health coordination so that economic integration does not weaken public protection.