Trade Liberalization, Social Policies and Health: A theoretical and empirical exploration

This thesis theoretically and empirically explores how trade liberalization and social protection policies interact to influence health. It is conducted from a political economy of health perspective. A systematic review of the literature finds that trade liberalization is often conceptualized in public health work in problematic ways. Because the health impacts of trade liberalization are especially under-conceptualized in the context of labour markets, this thesis empirically explores the 2005 phase-out of the Multi-Fibre Arrangement (MFA). This phase-out abruptly liberalized the textile and clothing (T&C) sector and triggered substantial shifts in employment across a wide range countries. Data from 32 T&C reliant countries were analysed in reference to the pre- and post-MFA periods of 2000-2004 and 2005-2009. Fuzzy-set qualitative comparative analysis (fsQCA) was used to examine the association between: a) T&C employment changes, b) countries’ level of labour market and welfare state protections, and c) changes in adult female and infant mortality rates. FsQCA is a cross-case method which enables logical statements to be made about the combinations of causal conditions that are sufficient for an outcome. Process tracing was used to further investigate these fsQCA results through in-depth case work. Findings suggest that the worsening of adult female mortality rates is related to T&C workers’ lack of social protection in the context of trade liberalization. Overall, it is found that social protection is often inaccessible to the type of workers who may be the most vulnerable to processes of liberalization, and that many workers are particularly vulnerable due to the structure of social protection policies. Social protection policies can therefore both moderate pathways to health and influence the type of health-related pathways resulting from trade liberalizing policies. This work contributes to our understanding of the complex pathways between trade liberalization and health and sets the stage for further investigations.