PETRA commissioned a systematic review to update a previous one published in 2017 to take account of a recent increase in publications looking at the health impacts of trade and investment agreements. This review found that individuals in higher income groups with higher levels of education experienced reduced food insecurity and less child mortality. Trade deals were also found to be associated with increased supply of tobacco and alcohol as well as growing supply and sales of ultra-processed foods. The authors concluded that effects vary across socioeconomic groups according to individual trade deals and that there was limited evidence of a cross-disciplinary approach to research in the field. The review calls for better design of trade policy to mitigate adverse effects with greater attention being paid to health policy and using a rights-based approach to evaluating trade and investment agreements to identify where these undermine the right to health.