Trade liberalization, social policies and health: an empirical case study

BACKGROUND: This study investigates the health impacts of a major liberalization episode in the textile and clothing (T&C) sector. This episode triggered substantial shifts in employment across a wide range of countries. It is the first study to empirically link trade liberalization to health via changes in employment and offers some of the first empirical insights on how trade liberalization interacts with social policies to influence health. METHODS: Data from 32 T&C reliant countries were analysed in reference to the pre- and post-liberalization periods of 2000–2004 and 2005–2009. Fuzzy-set qualitative comparative analysis (fsQCA) was used to examine the association between countries’ a) level of development b) labour market and welfare state protections c) T&C employment changes and d) changes in adult female and infant mortality rates. Process tracing was used to further investigate these associations through twelve in-depth country studies. RESULTS: Results from the fsQCA relate changes in employment after the phase-out to both changing adult female and infant mortality rates. Findings from the in-depth country studies suggest that the worsening of adult female mortality rates is related to workers’ lack of social protection, both in the context of T&C employment growth and loss. CONCLUSIONS: 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 policies are therefore found to both moderate pathways to health and influence the type of health-related pathways resulting from trade liberalizing policies. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12992-015-0126-8) contains supplementary material, which is available to authorized users.