Advocacy for Health and Social Justice Works: the Case of the Transatlantic Trade and Investment Partnership (TTIP)

The recognition that the TTIP prioritized the “right to profit” of transnational corporations over the “right to health” of citizens deeply affected people’s sense of justice. It is exactly for this reason that it triggered such widespread civic protest that has been decisive in stopping the fast-track approval of the TTIP 


 by Roberto De Vogli*, PhD, MPH1 2 3

1 Department of Public Health Sciences, School of Medicine, University of California, Davis, US

2 Department of Epidemiology and Public Health, Division of Population Health, University College London, London, UK

3 Department of Psychology, University of Padova, Padova, Italy

Advocacy for Health and Social Justice Works: the Case of the Transatlantic Trade and Investment Partnership (TTIP)


The Transatlantic Trade and Investment Partnership (TTIP) is a moribund treaty. The largest ever free trade agreement, designed to influence countries that account for 50% of global Gross Domestic Product (GDP) (1), has received a series of lethal blows from a critical mass of organised civic society organisations and advocates. The agreement may not be dead yet, but it is severely wounded. It was supposed to be signed this year, but France, through its Minister for Foreign Trade, Matthias Fekl, has already demanded an end to TTIP talks (2). Without the French support, the deal is not going very far, actually nowhere; and the chances that it will be approved in the future are rather slim.

But make no mistake: major lobbyists of the TTIP, such as those large transnational corporations (TNCs) that have proposed the treaty to the EU and USA, will not concede an easy defeat. In fact, they are already working hard to find new ways to move the trade agenda forward. For example, another treaty, similarly dangerous for our health, has been recently approved: the Comprehensive Economic and Trade Agreement, or CETA (3) Yet, there is little doubt that the political efforts of protest movements have been decisive in stopping the fast-track approval of the TTIP. Civic society made a difference and, to some extent, the protest against the treaty has already partially succeeded.

What caused this preliminary success? What accounts for incapability of the EU and US to approve the TTIP on time? Not many years ago, the first acts of protests against the TTIP were largely ignored. The early pioneers of the campaign were easily dismissed as lunatics, or radicals. Now, only a few have audacity to openly support the treaty. The belief that the TTIP will produce significant economic benefits and that the income generated by the TTIP will trickle down to the general population (4) is not taken very seriously. The public is instead convinced more than ever that the TTIP is a dangerous policy for people’s health. In a recent review of the literature, we showed that the trade deal is likely to have a series of negative health consequences including the underutilization of needed healthcare services and medications especially among vulnerable populations such as low-income communities and people with multiple chronic diseases. In the same review, we also indicated that the TTIP is likely to generate a negative impact on regulations aimed at reducing cigarette smoking, alcohol consumption, diet- and agriculture-related diseases. The treaty is also very dangerous because it can impair international environmental agreements on climate change that has been recognised as the major threat to global health of the century. (5)

The publication of evidence on the potential health effects of the TTIP in academic journals, and the wide dissemination of the same results through social media, newspapers, and other outlets, was certainly important, but not crucial. Very often, scientific evidence is ignored and political decisions are taken on the basis of collective emotions about a topic. What persuaded governments to withdraw support from the TTIP was not the science on its negative impact on health probably. Rather, it was the active involvement of civic society and the massive protests of non-governmental organizations and activists that reduced the political desirability of the trade deal. The relentless advocacy work performed by the alliance of organizations such as those under the ban STOP TTIP European Initiative Against TTIP and CETA (6), the massive demonstrations against the treaty throughout Europe involving up to 250,000 people (7) and the collection of over 3.4 million signatures demanding the abandonment of the treaty were impressive demonstration of people’s power by any standards. (8)

What mobilized the most these protest movements? It is difficult to establish a single cause for there is no quantitative data to rely on. Yet, a plausible culprit seems the widespread recognition of the potential injustices promoted by the TTIP. People are particularly outraged, and for very good reasons, about the TTIP’s Investor to State Dispute Settlement (ISDS) arbitration system, a mechanism that allows TNCs to sue governments when a policy or law reduces the value of their investment. It is especially through the ISDS that the TTIP has finally been recognized for what it is: not a free trade agreement, but an investor protection treaty.

It is no coincidence that the treaty was made in secret and supposed to be approved relatively quickly among closed doors. About 92% of consultation meetings for the TTIP have been carried out with private companies or their representatives with no involvement of civic society. (9) It was only thanks to organizations such as Wikileaks (10) and Greenpeace (11) that we are all aware of the details of the treaty. Clearly, the recognition that the TTIP prioritized the “right to profit” of TNCs over the “right to health” of citizens deeply affected people’s sense of justice. It is exactly for this reason that it triggered such widespread civic protest.

The story of the temporary defeat of the TTIP contributes to our understanding of what needs to be done in order to build effective, successful public health movements. It shows that, in order to mobilize people around health issues, it is key to address their sense of justice and injustice. In a time where there is widespread hopelessness about so many intractable problems, from climate change to rising income inequality, this story provides a ray of hope for the future of public health. Those who do not bother engaging in advocacy work because they feel hopeless and believe that large TNCs are just too powerful to be defeated have been, at least in this case, proven wrong. Indeed, they have been proven wrong multiple times as lessons about success stories in reducing cigarette smoking and car accidents have shown us. This story adds to the literature and shows one more time that public health advocacy works, especially when it addresses problems of social injustice at the same time. (12)



  1. Transatlantic Trade and Investment Partnership. The Economic Analysis Explained. Brussels: European Commission, Centre for Economic Policy Research, 2013.
  4. Raza W, Grumiller J, Taylor L, Tröster B, von Arnim R. ASSESS TTIP: Assessing the Claimed Benefits of the Transatlantic Trade and Investment Partnership. Final Report. Vienna: Austrian Foundation for Development Research, 2014.
  5. De Vogli R and Renzetti N. The Potential Impact of the Transatlantic Trade and Investment Parternship (TTIP) on Public Health? Epidemiol & Prev 2016;40(2).
  9. Corporate Europe Observatory. Who lobbies most on TTIP? Available: Accessed: February 19, 2014.
  10. Public Citizen. The Trans-Atlantic “Free Trade” Agreement (TAFTA). U.S. and European Corporations’ Latest Venue to Attack Consumer and Environmental Safeguards? 2015.
  12. Gielen A, Green L. The Impact of Policy, Environmental and Educational Interventions: A Synthesis of the Evidence from Two Public Health Success Stories. Health Education & Behavior 2015;42(1S)20S-34S.



*Correspondence to: Roberto De Vogli, Department of Public Health Sciences, School of Medicine, Department of Public Health Sciences, University of California, Davis. One Shields Ave. Med Sci 1-C Build. Davis, CA 95616 email: