“In the U.S., the TPP is a danger to public health and fiscal responsibility because it would lock in policies that keep prices of too many medicines unaffordably high,” says the letter, which is also signed by AIDS and HIV prevention and advocacy groups, Oxfam America, National Nurses United and National Physicians Alliance.

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The move comes a day after 225 agriculture, farm and food groups sent their own letter to Congressional leaders, urging them to approve TPP. In the letter, dated Monday, they applaud TPP’s removal of many tariffs that allows them to better compete in the Asia market.

“TPP will help level the playing field for U.S. exports and create new opportunities for us in the highly competitive Asia-Pacific region,” says the letter, which was signed by the National Cattlemen’s Beef Association, National Association of Wheat Growers, National Corn Growers Association and others.

TPP was signed in New Zealand in February, but Congress must ratify it with an up-or-down vote. It is unlikely the vote will happen before the November presidential election. It is the largest regional trade deal in history, between nations that collectively make up nearly 40 percent of the world’s gross domestic product. The other TPP countries are Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore and Vietnam.

It is not the first time outside interest groups are opposing TPP — environmental and labor organizations have vocally fought the deal for months, saying it would lead to an increase in harmful environmental emissions and erode labor conditions and wages for workers. But it does mark the first time such a large contingent of health organizations is signing onto the cause, said Nick Florko of Public Citizen, a consumer rights advocacy group that signed onto the letter.

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The letters come about a month before the U.S. International Trade Commission, an independent federal agency, is expected to issue an influential report on the economic impacts of TPP. The report, which is slated to come out by May 18, is considered the most authoritative and official economic analysis of the pact, and will be sent to Congress and the president.