Introduction

For too long, our health care system and economy have marginalized many American communities. Throughout the 116th Congress, the Committee on Ways and Means has explored the root causes of health and economic disparities, inequitable outcomes in national maternal morbidity and mortality, vulnerabilities in our ability to adapt to climate change, and the devastating acts of gun violence tearing apart communities across the country. Most recently, this Committee examined the disproportionate impact of the coronavirus (COVID-19) on communities of color and people with disabilities. The expert testimony and solutions proposed during each of these diverse hearings underscored two key principles: Health does not exist in a vacuum, and achieving health equity will require addressing the economic and social inequities that have long persisted within our country. 

For over a century, health services research has demonstrated the irrefutable link between disparities in health and inequities in employment, income, and wealth opportunities. Pre-pandemic data show that on average, Americans can expect to live shorter and less healthy lives compared to people living in every other wealthy democracy – and, yet, we far outspend the average developed country on health care. Now, the COVID-19 crisis has highlighted how unchecked vulnerabilities within the United States (U.S.) health system cause inequities and impact every other aspect of our lives – how we earn, learn, and live in our communities. In light of these lessons learned, we must prioritize efforts to improve the return from our significant investments in the U.S. health system. 

Our future depends on transcending traditional health and discrimination frameworks to achieve a 21st century vision that creates the conditions for all Americans to thrive. As the committee with jurisdiction over health, tax, and trade policy, as well as social safety net programs, the Ways and Means Committee is well-positioned to address the role that racism, ableism, and other social, structural, and political determinants play in perpetuating health and economic inequity. This report outlines the intersection between health and economic well-being and describes aspects of policies and practices relevant to the Committee’s jurisdiction and efforts to achieve health and economic equity in the United States.

The excerpt on trade below is from page 20 onwards.

Access to the Benefits of Trade for Individuals and Communities

Commonplace discussions about the objectives of international trade policy generally identify and promote the interests of economic sectors – industrial, agricultural, and services, for example. Seldom have trade’s effects on individuals or communities been considered, much less prioritized as such, beyond in any but the most abstract terms. When trade policymakers have taken the time to make the interests of individuals and communities a priority, however, their efforts have generated substantial political support for those policies. Consequential developments in recent years – and in 2020 in particular – are challenging policymakers to investigate further the role that trade policy has played in either perpetuating or exacerbating unequal access to the benefits of trade for certain individuals and communities – both in the U.S. and worldwide. In 2020, the COVID-19 pandemic has highlighted the fact that these disparities in outcomes among different communities result from structural and systemic inequities U.S. laws and policies create – inequities that emerged as far back as some of the first U.S. international economic policies involving the exchange of goods and people.

Globally, the pandemic has also revealed the fragility of our international supply chains and the inequity in the treatment of workers in low-cost labor countries where manufacturing has become concentrated. Predominantly non-White workers from developing countries and former colonies across the world suffer compromised labor conditions while producing goods for U.S. and global consumers. Unequal contracting and employer relationships that have developed from the arbitrage that conventional trade policies enable have encouraged a spectrum of exploitative practices, including the prevalence of forced labor in certain regions. In their attempts to minimize financial losses related to COVID-19, U.S.- and European-based multinational companies have left already low-wage workers in developing countries – also struggling to survive the pandemic – without pay. In this way, COVID-19 revealed how globalization has incentivized supply chain models that depend on finding the lowest cost workforce for production, regardless of living or working conditions, with dire consequences for public health, supply chain resilience, and a disparate impact on those already bearing the heaviest burdens in the existing global economic order. Indeed, some have called on brands and global retailers to remedy inequitable purchasing practices and commit to support millions of garment workers of color around the world who have enabled substantial industry profits, particularly in light of recent corporate public actions to promote racial justice.