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DEVELOPED COUNTRIES ARE THE LARGEST IMPORTERS OF HEALTHCARE PROFESSIONALS

healthcare

DEVELOPED COUNTRIES ARE THE LARGEST IMPORTERS OF HEALTHCARE PROFESSIONALS

Living Longer

Personal and home health aides, registered nurses, and medical and nursing assistants are among the fastest growing occupations in the United States. The U.S. Bureau of Labor Statistics projects 1.2 million new personal and home health aide positions – and the need for another 372,000 registered nurses – by 2028. Due to the shortage of qualified healthcare workers, immigrants held 15 percent of all registered nursing positions in the United States in 2016. On April 22, President Trump signed an Executive Order to pause immigration due to COVID-19, but exempted physicians and nurses.

This is not uncommon in developed countries with a growing aging population who are living longer. About eight percent of nurses in Canada are foreign-trained, 15 percent in the UK, 19 percent in Switzerland and 27 percent in New Zealand. The numbers are higher for foreign-trained doctors: 24 percent in Canada, 28 percent in the UK, 27 percent in Switzerland and 42 percent in New Zealand.

Training for Export

India has the world’s highest number of medical schools and is the world’s largest source of immigrant physicians. An estimated 69,000 Indian-trained physicians worked in the United States, UK, Canada and Australia in 2017, according to the OECD. India is second only to the Philippines in training nurses. Nearly 56,000 Indian-trained nurses work in those same four countries, equal to about three percent of total registered nurses in India.

The Philippines has an established international nursing training program and is the largest exporter of nurses globally – accounting for roughly 25 percent of all overseas nurses worldwide. About 85 percent of employed Filipino nurses work in one of more than 50 countries around the world. In the United States, an estimated 20 percent all the registered nurses in California are Filipino. It’s a strong professional cadre. The Philippine Nursing Association of America represents over 145,000 Filipino nurses and has its own theme song.

% foreign trained nurses and docs in OECD

The “Brain Drain” Concern

Health care professionals migrate for many reasons: continuing education, better pay, the opportunity to send remittances to their families and home nation, the prestige of practicing in another country, and others. Filipino nurses in the United States earn 15 times more than those working in the Philippines. Filipino nurses working abroad remit about $1 billion to the Philippines every year, a substantial portion of total remittances which drives 13 percent of the Philippines’ GDP.

International mobility of health workers is accelerating. The number of migrant doctors and nurses working within OECD countries increased by 60 percent over the last decade, along with significant increases in intraregional mobility and migration of healthcare workers among developing countries.

Public health groups including the World Health Organization (WHO) are concerned that health care immigration reduces the number of professional health workers available to serve their home countries. Developing countries are often especially in need of more personnel. Declaring 2020 the Year of the Nurse and Midwife, WHO says 18 million more health care providers are needed worldwide to achieve universal health coverage by 2030. To address the “brain drain” concern, WHO developed a voluntary Global Code that promotes adequate staffing of national health systems and “ethical international recruitment of health personnel”.

Mobility and “Ethical Recruitment”

In a 2019 joint study, the WHO and World Trade Organization (WTO) examined the relationship between free trade agreements that improve health worker mobility and the recruitment goals of the Code. The study primarily reviewed so-called “Mode 4” commitments that deal with the temporary presence of foreign natural persons supplying trade in health-related services.

Commitments have been made by 139 WTO members to liberalize trade in services. Of those, 69 members have taken at least one commitment relating to the provision of health services, from hospital care to midwife services. The commitments vary widely, enabling education and skills exchanges, investment, mobility for charitable purposes, and the protection of health worker welfare.

As an example, the Indonesia–Japan Economic Partnership Agreement includes development assistance by Japan’s International Cooperation Agency to support nursing education in Indonesia. In 2019, Japan updated its Economic Partnership Agreements with Indonesia, the Philippines and Vietnam to extend the period of time a nursing candidate can stay in Japan to obtain national nursing qualifications and healthcare worker certifications.

The joint WHO-WTO study makes no real conclusion about the compatibility of the Code with greater mobility through trade agreements. It suggests that further analysis such as economic needs tests or labor market tests could help sending and receiving countries understand the impact of healthcare worker service exports on sustainable development.

call out on HC worker impact (1)

COVID-19 is Shifting the Global Healthcare Trade Landscape

COVID-19 may be accelerating two key trends in healthcare work, while at the same time reversing (perhaps temporarily) the trend of job growth by inducing layoffs in the industry.

Telemedicine:

Encompassing remote patient assessment and monitoring as well as health education, the global telemedicine market was projected to grow from $70 billion in 2020 to $266.8 billion by 2026. COVID-19 is accelerating the trend. In March, the U.S. government announced it would temporarily pay clinicians to provide telehealth services for Medicare beneficiaries and would expand the communications platforms that could be used.

Telemedicine has long been encouraged in developing countries, supported by international development agencies and non-government organizations. It can help overcome short-staffing limitations and provide support for local clinicians through overseas physicians who can confirm a diagnosis and collaborate on treatment plans as part of global trade in services.

Robotics:

Robotics are being deployed to decrease COVID-19 risks to frontline healthcare workers. A field hospital in Wuhan, China serving 20,000 patients was staffed by robots that monitored patients’ vital signs through smart bracelets and rings that synced with an AI platform. Other robots served food, drinks and medicine to patients, while other autonomous droids sprayed disinfectant and cleaned the floors. Other countries like South Korea and Lebanon are using robots to measure temperatures, distribute hand sanitizer and perform disinfecting services.

Layoffs and Mobility Restrictions:

COVID-19 is causing governments to retrench in some countries that export healthcare workers,. In March, the Philippine Overseas Employment Administration (POEA) temporarily suspended the deployment of all health care workers “until the national state of emergency is lifted,” freezing the fulfillment of existing contracts with hospitals around the globe. Meanwhile, routine healthcare has been stymied due to ongoing stay-at-home directives, causing massive financial distress to the healthcare industry and significant layoffs.

In all of these ways, COVID-19 may be changing the outlook for cross-border global healthcare services for years to come.

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Sarah Smiley is a strategic communications and policy expert with over 20 years in international trade and government affairs, working in the U.S. Government, private sector and international organizations.

This article originally appeared on TradeVistas.org. Republished with permission.

timber

WOODEN SKYSCRAPERS PUSH TRADE IN CROSS-LAMINATED TIMBER TO NEW HEIGHTS

Closer to Nature

American biologist Edward Wilson is known for popularizing the term “biophilia” to explain the inherent pleasure people derive from being in nature. By extension, “biophilic design” incorporates natural materials, natural light, vegetation, nature views and other experiences of the natural world into the modern built environment. A relatively new building material, cross-laminated timber (CLT), is quickly becoming the darling of the biophilic design movement.

CLT is made from layers of dried lumber boards stacked in alternating direction at 90-degree angles, which are then glued and pressed to form solid panels. The resulting panels have exceptional strength, stability and fire resistance. According to a recent USDA study, a seven-inch floor made of CLT is fire-resistant for two hours. CLT structures have proven more resilient to earthquakes than many other types of building materials, fostering great interest among builders in Japan where biophilic design has been part of the culture for centuries. CLT featured prominently in the rebuild of Christchurch, New Zealand, which was severely damaged by earthquakes in 2010 and 2011.

Global Cross-Laminated Timber “Plyscrapers” Reach New Heights

The cross-laminated timber wood panel system was developed in Europe in the 1990s as an alternative to stone and masonry concrete — and to boost employment in the forests products industry. Europe still leads supply and demand in the CLT market, but use of CLT is rapidly gaining popularity in the United States, Canada and across the world.

CLT is the basis of the “tall wood” movement, as the material’s high strength, dimensional stability and rigidity allow it to be used in mid- and high-rise construction of apartment and office buildings and even power line towers. Growing investment in large-scale wood construction is evident with the completion of several prominent structures over the last several years.

They include luxury apartment buildings in Melbourne, Australia and Bergen, Norway as well as the Brock Commons on the campus of the University of British Columbia. Last year, construction began on a 24-story hotel and office tower composed of 76 percent wood in Vienna, Austria. In 2018, Sumitomo Forestry announced its plan to build the world’s tallest wooden skyscraper – at 70 stories tall, the building will be made 90 percent of wood, capable of sequestering 100,000 tons of CO2. Japan also used CLT extensively in its 2020 Olympic National Stadium to achieve a natural aesthetic.

Global Plyscrapers

Building Global Customers

The global CLT market was valued at $773 million in 2019 and was expected to grow to $1.6 billion by 2025. Production of CLT worldwide is estimated based on surveys and reported by the publication Timber-Online at 1.44 million cubic meters in 2019, although data is not available for all production sites. An estimated 65 percent is produced in Italy, Czech Republic, Germany, Austria and Switzerland. With additional production coming online, global annual output is expected to grow to between 2 and 2.5 million cubic meters this year.

How much of this production is traded internationally? It’s not entirely clear. There is no international agreement yet on how to classify CLT on the Harmonized Tariff Schedule. The product currently falls within a broader category with glulam (another laminated timber product), obscuring our understanding of specific trade flows. (With support from USDA’s McIntire-Stennis program, The Center for International Trade in Forest Products at the University of Washington is building a database to better understand international trade in wood products while governments sort this out.)

Japan’s Ministry of Finance recorded 918,000 cubic meters of laminated lumber (glulam and CLT) were imported in 2018, mainly from Europe. U.S. imports of CLT in 2018 were much smaller – less than 20,000 cubic meters, also primarily from Europe. Whether this number will grow remains to be seen – it could be that greater use of CLT drives more trade in architectural design, timber engineering and construction services.

Global ICT market

Image: courtesy of Acton Ostry Architects

Supporting the Structure of Rural Economies

CLT was pioneered and promoted in Europe in part to bolster rural employment in the timber industry. Though it is also traded, being close to construction is a big advantage in the timber industry. European companies, which dominate their own market and supply American developers, are starting to build mills in the United States to meet growing demand. Austrian firm KLH partnered with International Beams in Dothan, Alabama, to open the first CLT plant east of the Rocky Mountains utilizing the Southern Yellow Pine native to the region.

To support more CLT production in rural economies, the United States is in the process of updating U.S. building codes to expand the use of CLT, as the International Building Code has already done. The 2018 Farm Bill contains provisions from the Timber Innovation Act intended to advance domestic research and development of further applications for structural wood in the building sector.

The United States isn’t alone in its efforts to build CLT capacity. Japan’s Forest Agency instituted a road map in 2014 for greater utilization of CLT as a follow up to Japan’s Promotion for the Use of Wood in Public Buildings Act. The agency provides subsidies to drive the establishment of CLT facilities with a target of increasing the country’s CLT production capacity to supply both the domestic and international markets. Through the effort, the government also seeks to support employment of women in rural areas, including through encouraging female lumberjacks.

A Breath of Fresh Air

In responding to industry feedback surveys, customers say wood construction, exposed structural wood and biophilic design have a positive impact on their shopping experience because such structures are ecological, healthful and warm. Some studies even suggest wood is a multi-sensory experience for occupants, evoking a sense of calm that can lower blood pressure.

As for environmental benefits, CLT emits less carbon dioxide during the manufacturing phase and finished buildings made with CLT even help sequester existing carbon for a longer period. Murray Grove in London was the first tall urban housing project to be constructed entirely from CLT. Due to its wooden construction, it was calculated to be carbon negative from the start and will take twenty-one years before the building will even reach carbon neutrality, far less than if the building had used concrete. Even tearing down a CLT building at the end of its life is more environmentally friendly than taking down one made of traditional materials.

oregon-conservation-center-lever-architecture-usa_dezeen_2364_hero2
Photo credit: Lever Architecture, cross-laminated timber community center added to the The Nature Conservancy in Oregon.

Trade in Sustainability

A thriving wood industry must embrace sustainability by replanting and harvesting efficiently. The CLT process allows smaller diameter softwood trees to be utilized, more so than in most commercial timber. It also makes use of millions of acres of pine that have been killed by the pine beetle epidemic. Pine beetles have penetrated forests in all nineteen western states, some eastern states and Canada, effectively decimating some 88 million acres of timber. Processing the downed trees mitigates some of the carbon emitted by the decaying wood, which remains strong enough to be useful in CLT processing for up to two years.

Cross-laminated timber provides many possible benefits, including reduced costs, rural employment, strength, fire-resistance, beauty and a sense of being closer to nature. We can also credit trade in CLT with stimulating a global movement that could help all of us live and work more harmoniously on this planet.

The author began her U.S. Government career in the U.S. Department of Commerce, International Trade Administration’s Forest Products division and is still convinced this industry has the best site visits and field trips.

Feature image: The Kajstaden Tall Timber Building by CF Møller Architects in the Swedish city of Västerås.

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Sarah Smiley is a strategic communications and policy expert with over 20 years in international trade and government affairs, working in the U.S. Government, private sector and international organizations.

This article originally appeared on TradeVistas.org. Republished with permission.

humanitarian

ECONOMIC SANCTIONS EXEMPT HUMANITARIAN TRADE

Ailing Relations

Iran has been among the worst affected countries from COVID-19, having emerged as an early hotspot outside China. As of April 7, there were an estimated 62,589 confirmed cases with over 3,800 deaths. Iran’s cases appear to have peaked in late March, but exact numbers are unknown due to the secretive nature of its totalitarian regime. Other countries throughout the Middle East began reporting cases in late February and continue to battle spread of COVID-19 due to travel linked to Iran.

U.S. offers of assistance were rejected by Iran’s Supreme Leader Ayatollah Ali Khamenei, who said publicly on March 22, “You might give us a medicine that would spread the disease even more or make it last longer.”

According to the U.S. State Department, the United States has offered more than $100 million in medical assistance to foreign countries, including to the Iranian people, and reports that Iranian health companies have been able to import testing kits without obstacle from U.S. sanctions since January. The U.S. government has urged Iranian leaders to be more truthful about its efforts to contain the virus.

Iran assistance

Humanitarian Trade Exemptions

U.S. economic sanctions against Iran include a general exemption for U.S. exports of agricultural commodities, food, medicines and medical devices to Iran and an authorization process to obtain licenses for a specific list of medical supplies and equipment not covered under the general exemption. Such licenses are usually given for one year.

The U.S. government recently reinforced its messaging that sanctions are directed at the Iranian regime, stating: “[Sanctions] are not directed at the people of Iran, who themselves are victims of the regime’s oppression, corruption, and economic mismanagement.”

A 2019 Congressional Research Service report suggests U.S. sanctions have limited access by the Iranian population to “expensive Western-made medicines such as chemotherapy drugs,” due to a lack of bank financing for such transactions and that the limited supplies that exist have gone to elites.

Role of Financing

Between 2018 and 2019, overall U.S. trade with Iran went from small to very small under tightened sanctions. In 2018, U.S. exports to Iran were valued at $425.7 million. In 2019, U.S. exports had decreased 82 percent to $73.1 million.

Underlying that decrease in trade, even of humanitarian-related goods and services, reflects a tendency toward over-compliance by banks and multinational firms that avoid transactions with Iran to minimize possible violations of U.S. sanctions. Doing so, even inadvertently, could cut off their access to vital U.S. financial markets. The U.S. government has also explicitly cited concerns about the Iranian regime’s abuse of humanitarian trade to evade sanctions and launder money.

To close these loopholes, in October 2019 the Treasury Department announced a new payment mechanism “to facilitate legitimate humanitarian exports to Iran.” The measure restricts the role of the Central Bank of Iran in facilitating humanitarian trade, which the U.S. government views as financing terrorism. It also imposes rigorous reporting requirements to thwart diversion of funds intended for humanitarian use.

By late February 2020, as the COVID-19 medical crisis unfolded in Iran, the U.S. Treasury Department issued a general license authorizing certain humanitarian trade transactions involving the Central Bank of Iran while also approving the use of a Swiss financial channel to finance such transactions.

The Swiss Humanitarian Trade Arrangement (SHTA) enables Swiss-based exporters and trading companies in the food, pharmaceutical and medical sectors to access a secure payment channel with a Swiss bank to guarantee payments for their exports to Iran. Novartis was the first Swiss company to send medicine for use in cancer treatments. Germany, France and Britain have also used this new channel to offer a $5.5 million package to Iran to help fight the coronavirus.

exemptions in sanctions

Trade in Food and Medicine

Much has been written recently about governments restricting exports and otherwise increasing the cost of traded medical supplies during the pandemic.

For two decades now, the Trade Sanctions Reform and Export Enhancement Act of 2000 (TSRA) has ensured that each U.S. country-based sanctions program provides for trade of agriculture, medicine and medical devices under a broad humanitarian exemption. This is intended to limit potential adverse effects on civilian populations who are not the target of sanctions.

The United Nations Security Council maintains 14 active sanctions programs that also include humanitarian exemptions driven by the belief that a supportive and healthy citizen population is necessary to achieve improvements in a sanctioned regime.

Recently, the United Nations Security Council approved a humanitarian exemption to sanctions against North Korea (DPRK) requested by the World Health Organization for diagnostic and medical equipment to address COVID-19. The United States supported this decision.

Exemptions Thwarted by Totalitarian Regimes

The health impacts of embargoes are difficult to isolate and quantify. They may not become apparent until years after resource shortages occur. Domestic production challenges can also play a role. For example, Iran produces 97 percent of its medicines locally, but a third of these drugs rely on active ingredients that are imported, according to the head of Iran’s Food and Drug Organization.

Although humanitarian trade exemptions are intended to mitigate shortages of essential supplies, totalitarian regimes are known for putting their goals before the needs of their citizens. The negative impacts of sanctions are often compounded by inequitable distribution or outright theft of essential goods and ongoing civil conflicts.

In any case, it’s difficult to know the net effect of sanctions and humanitarian trade exemptions because data on key indicators of health effects are often missing or unavailable from embargoed regimes. However, it is clear that enabling trade in essential goods like food and medical supplies has served a role in health diplomacy for decades.

During her career in international trade and government affairs, the author worked with pharmaceutical and medical device manufacturers to navigate U.S. sanctions policies and requirements.

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Sarah Smiley is a strategic communications and policy expert with over 20 years in international trade and government affairs, working in the U.S. Government, private sector and international organizations.

This article originally appeared on TradeVistas.org. Republished with permission.

live animals

THE GLOBAL TRAVELS OF LIVE ANIMALS

Horses, Asses, Mules and Hinnies Atop the Tariff Schedule

Unless you’re a farmer or animal breeder, the first item in Chapter 1 of the Harmonized Tariff Schedule is one we may think about the least – Live Animals. For most Americans, live animals are a long supply chain away from the supermarket.

At over $21 billion in 2017, global trade in live animals has increased 140 percent over the last two decades. Some 45 million hogs, 16 million sheep, 11 million head of cattle, 5 million goats and 1.9 million poultry (mainly chickens) were transported around the globe, some for breeding and about 80 percent intended for consumption.

A specialized segment within the transportation sector is dedicated to transporting live animals by air, land and sea – from air cargo, tractor trailers and trains, to ocean container shipping.

HTS snippet 0101

Shifting Resource Burdens

The world will be home to 9.7 billion people by 2050. With more mouths to feed, agriculture production must become more efficient against the challenges of limited arable land, energy and water resources, especially in developing countries. International development agencies promote raising livestock as a way to increase income for smallholder farmers (owners can sell products and/or offspring) and to achieve greater food security in rural areas through access to high quality proteins. Importing livestock in the last few months of their life can reduce expenses associated with animal feed and veterinary care while conserving limited water resources.

The water-stressed Middle East region has become a major importer of live animals. Demand for meat and dairy products has grown steeply in Egypt, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar and Saudi Arabia. Importing mature live animals avoids the need to rear animals from birth, shifting the water burden while meeting demand for animals freshly slaughtered in adherence to religious requirements.

Trade in live animals 3x increase

Trade in Genetics, No Goats No Glory

Countries are investing in improving their livestock by either importing live animals or importing frozen semen and embryos for artificial insemination, a process that is achieving higher success rates as costs are coming down. Global trade in purebred animals for breeding in 2017 was a $780 million industry. The animal genetic market is projected to grow from $4.2 billion in 2018 to $5.8 billion by 2023.

In November last year, 1,503 U.S.-origin Holstein heifers valued at $3 million were sold out of Statesville, North Carolina and shipped to Egypt aboard a livestock carrier in an effort by the Government of Egypt to improve the country’s dairy operations supporting output of milk for yogurt and cheese. Qatar is importing American-born dairy cows to surmount trade bans by neighboring countries.

Chickens are by far the largest category of live animals traded globally with hogs coming in second. But it’s dairy goats that could prove key to achieving the United Nations’ 2030 Agenda for Sustainable Development. Goats consume fewer resource inputs than cows, goat milk is nutritious, and women often have strong roles in dairy goat ownership and management.

Caprikorn Farms is the oldest goat dairy in Maryland. Raising some of the best dairy goats in the United States and the world, their genetics are in demand. They have worked with Russian authorities to not only send several live animal shipments to Russia but also improve Russia’s health protocol for international shipment. Ten of their goats even flew to Qatar on a private jet.

Bees also get in on the global trade act. Not only do bees circulate throughout the United States to pollinate our many crops, $48.1 million worth of live bees – including Queen bees and semen — were exported globally in 2018. Europe shipped $26.5 million or 55.2 percent of the global total.

Live animal trade routes 2017

Protecting Livestock on the Journey

While North American cattle and hogs have a short truck ride or may even live on ranches along the borders, many animals face a long ocean journey during which their health can be compromised. They are sometimes relegated to older vessels that may be converted from general cargo and not purpose-built to transport the animals in safe conditions. Often on journeys for weeks at a time, animals are at risk for fatigue, heat stress, overcrowding, injury and the spread of disease in close quarters.

The World Organization for Animal Health (OIE) issued the Terrestrial Animal Health Code in 2019 that provides standards for transporting animals by land, sea and air to protect the health and welfare of the animals and prevent the transfer of pathogens via international trade in animals.

As the global population increases and agricultural producers seek to maximize the resources available to them while improving output, global trade in live animals is likely to continue to grow. Standards and cooperation in international trade practices will need to evolve along with that trend.

Contributor Sarah Smiley lives on her family farm in Appalachia where they have raised fainting (myotonic) goats and Charolais cattle for more than 20 years.

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Sarah Smiley is a strategic communications and policy expert with over 20 years in international trade and government affairs, working in the U.S. Government, private sector and international organizations.

This article originally appeared on TradeVistas.org. Republished with permission.

chinese

From A to QI: The Global Rise of Traditional Chinese Medicine

Find Your Qi

Maintaining balanced Qi (many of us know it as “chi”) – the body’s vital energy level — is a bedrock of Traditional Chinese Medicine (TCM). To help your Qi flow, TCM offers herbal supplements and treatments like acupuncture and cupping.

Strongly promoted by the Chinese government, TCM has become a global industry and an economic driver for China. The sector grossed $130 billion in 2016. According to World Finance, China exported $526 million worth of TCM to the United States alone, making up 15 percent of China’s TCM exports in 2016, while China’s overall TCM exports grew 54 percent between 2016 and 2017.

Recalling the ancient spice routes, TCM is sprouting up as a traded item all along China’s modern Belt and Road routes. The Belt and Road initiative set a goal to register 100 TCM products and establish 30 TCM centers in Belt and Road countries by 2020.

Taking Root but Germinating Concerns

Meeting a goal of Chinese President Xi, TCM got a big boost in legitimacy in 2019 when the World Health Organization (WHO) included TCM for the first time in its global compendium of health conditions and treatments.

But many in the medical field have expressed concern over the move. TCM treatments may lack rigorous scientific study. Testing has revealed the presence of heavy metals, pesticides and toxins in plants grown and harvested in China, and standardization of natural ingredients is not well regulated.

Stats on Traditional Chinese Medicine

Chinese Ginseng in Wisconsin?

In part to remedy quality concerns, China’s TCM producers are partnering to establishing growing sites overseas. They include operations in Wisconsin, which produces over 90 percent of total U.S. cultivated ginseng. Global ginseng production is between 4.5 million and 5.9 million kilos per year. The United States produces roughly half a million kilos. Last year, U.S. ginseng exports were valued at about $30 million, with China the biggest buyer, though ginseng shipments were significantly dampened by 25 percent tariffs applied by China as part of the ongoing trade war.

As ginseng’s health benefits have become popularized in the United States, import demand for Asian ginseng has increased in recent years. The Asian variety is considered “hot,” versus American ginseng which has a “cooling” effect on the body, so trade may flow in accordance with the flow of consumers’ Qi.

Beyond ginseng, more small farms around the United States are producing a variety of Chinese herbs both for export and domestic use in response to concerns with the age and potency of imports, possible contamination, and over-harvesting of wild herbs in China.

The Side Effects of TCM

Africa has become the largest regional TCM export market for China. In 2015, Chinese researcher Tu Youyou won the Nobel Prize for Medicine for discovering the antimalarial properties of the Asian plant Artemisia annua. That validation increased confidence in the use of TCM, particularly in countries that suffer shortages of biomedical healthcare practitioners and in remote, rural areas that lack access to healthcare facilities. But many in the healthcare sector worry that the limitations or risks of TCM are not well understood and that patients turning to TCM may be less likely to seek proven treatments, causing a worsening of their conditions. Quality control and counterfeit medicines prevalent in Africa are also serious concerns.

WHO listing of TCM text

Another side effect is increased demand for African wildlife, already a serious problem. The plight of endangered species such as pangolins are well known, but common farm animals such as donkeys are now in high demand as well. Sought after for gelatin, TCM has driven demand to over four million donkeys per year and growing. Donkeys are being poached from small farmers and landowners and smuggled to such an extent that illegal donkey trade is being compared in severity to rhino poaching.

TCM is also spawning an increase in crocodile farming in Kenya, Zambia, Zimbabwe and South Africa. Eighty-five percent of African crocodile exports go to China, Hong Kong and Taiwan, which gives rise to yet another major concern. TCM can include the practice of eating of exotic wild animals. Wild animals can carry diseases transmitted to humans, as was the case with the SARS outbreak in 2002, traced to consumption of wild civet cat. Exotic species available in a wet market in China may also be the origin of the current strain of Coronavirus affecting thousands. Out of caution, China recently announced a temporary ban on wild animal trade.

Deep Trade Roots

It could be that the U.S.-China trade relationship is founded on traditional Chinese medicine. In February 1784, a cargo ship named Empress of China set sail for China loaded with nearly 30 tons of American ginseng. The profits from that trade prompted a congressional resolution encouraging further trade with China. President George Washington is said to have had Daniel Boone search forests for ginseng in an effort to help fund the fledgling U.S. government through trade with China.

Such is the storied history of TCM. But as TCM is traded globally in the modern age, the industry will need to find its own Qi for a balanced approach to quality, safety, and the sustainability of precious resources.

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Sarah Smiley

Sarah Smiley is a strategic communications and policy expert with over 20 years in international trade and government affairs, working in the U.S. Government, private sector and international organizations.

This article originally appeared on TradeVistas.org. Republished with permission.
rose

WHEN A ROSE ISN’T JUST A ROSE: HOW TRADE POLICY WAS USED TO FIGHT DRUGS FROM COLOMBIA

A Grand Gesture

As evidence that Valentine’s Day is here, roses are everywhere – grocery and drug stores, gas stations, and sidewalk vendors offering a bunch for the last-minute Romeo. Until the late 1980s, most roses sold in the United States came from California. A dozen roses would have set you back around $150, which is why the tradition was a grand gesture and a symbol of the seriousness of your relationship. Not really so much today – a dozen roses can be purchased for less than $20.

Why are roses so affordable? The explanation is years of U.S. Government trade, development, and drug eradication policies designed to move South American growers away from cultivating the coca plant used to make cocaine, by substituting commercially profitable production of cut flowers.

Flower Power

Americans will give each other 200 million roses over the Valentine season. The majority were grown in Colombia. Over the course of a year, Colombia exports around 4 billion roses to the United States and supplies 60 percent of U.S. imports of fresh cut flowers overall. Production and shipping are so efficient and cost-effective that roses from Colombia can reach the U.S. East Coast ahead of a similar shipment from California.

The competition from South American suppliers, particularly Colombia, has caused California production to plummet by 95 percent since 1991. The year 1991 is significant. It was the year Congress passed the Andean Trade Preference Act (ATPA, later expanded and renamed the Andean Trade Promotion and Drug Eradication Act).

ATPA represented a tool in the U.S. policy toolkit to disrupt the drug trade and cartels in Bolivia, Colombia, Ecuador and Peru, and slow the flow of drugs into the United States. Reducing or eliminating tariffs on imports from the region was intended to incentivize farmers to replace illicit coca production with legitimate (and safer) alternatives.

Thorny Issues

The reduction in tariffs gave Colombian growers a boost, but the seeds to grow the Latin American rose industry were really planted back in the 1960s under President Kennedy through economic development programs implemented by the U.S. Agency for International Development (USAID) to combat the spread of Communism in Latin America. Over decades, U.S. funding supported the infrastructure critical to developing an industry that could offer employment, education and empowerment to hundreds of thousands – predominantly female – workers.

The program’s successes came at the expense of U.S. growers. The U.S. florist industry petitioned for a series of anti-dumping investigations that resulted in negligible penalties on importers, and little tangible relief for U.S. industry. As imports grew, the number of U.S. rose farms dwindled from several hundred to fewer than 20 large-scale rose producers today.

Not Everything is Coming Up Roses

The savanna near Bogotá, Colombia’s capital city, is ideal for flower cultivation. It sits 8,700 feet above sea level about 320 miles north of the equator and possess clay-rich soil. Since the 2016 peace accords between the Colombian government and the Revolutionary Armed Forces of Colombia (FARC) rebels, many of the coca farms in this area have been replaced with flower production.

But Colombia’s blessings are also a curse. FARC offshoots and other guerrilla groups have been able to move coca production from central highlands to the country’s coastal deltas and frontier areas where it is thriving.

Aerial fumigation to wipe out coca plots was discontinued due to concerns about the effects on human health and damage to local soil and water systems. As well, crop substitution programs have lapsed, leaving a lack of economic alternatives for poor communities where cocaine traffickers have moved in ( though the government has announced plans to replace around 50,000 hectares of illegal crops with the growing of cacao and fruit trees).

As a result, coca production is on the rise. With somewhere between 150,000 and 180,000 hectares of coca under cultivation, according to United Nations and U.S. estimates, Colombia produced its largest crop of coca in 2016 in nearly two decades.

A Rose by Any Other Name

Trade preference programs played some role in helping to provide a safer livelihood for hundreds of thousands of South Americans while making roses accessible to most everyone and for all occasions. Walmart buys so many roses that its purchases are actively monitored by the industry as an economic indicator.

Back in California, the remaining growers still produce around 30 million roses each year. Rather than cultivate mass-produced roses (the red, long stemmed, no scent, durable variety), these growers are working with universities and research centers to create new and specialty cut rose varieties to serve niche segments of the markets such as weddings and other high-end celebrations.

More reading: Archived reports by the Office of the U.S. Trade Representative on the operation and impact of the Andean Trade Preferences Act can be accessed here.

Sarah Smiley

Sarah Smiley is a strategic communications and policy expert with over 20 years in international trade and government affairs, working in the U.S. Government, private sector and international organizations.

This article originally appeared on TradeVistas.org. Republished with permission.