PHA-Exchange> World's first treaty on a public health issue

[David Werner]

Aug 22, 2001

Dear friends and fellow activists,

I appreciate that the FCTC has approached the PHA asking the PHA to become
involved in the campaign by non-government organisations to promote a
global treaty on tobacco control.  I think the PHA should definately take
on this challenge, not only because tabacco use is becoming one of the
world's major killer dioseases, but because the abuses of the tobacco
industry are so enormous and indisputable that it should be easy to raise
wide-spread support in opposing it .  In turn, the campaign to rein in the
tobacco industry can be used to help raise awareness among a wider audience
(than us left-wing radicals) about the impact of globalization on health,
and the need for a more pro-people and pro-environment model of economic
and social; development, from the global to the global level.

To add to the anti-tobacco industry argument I include below an article I
have been working on for our next HealthWrights Newsletter, called "The
Smoking Gun."  It looks at the demands placed on China by the WTO in order
to gain membership in that organization.  To join the WTO, China will be
required to open its doors without regulations to the the transnational
tobacco industry, and also to drasticly reduce its tobacco tax (which it
was planning top raise to reduce smoking).  It is predicted that the human
sacrifice for China's entry into the WTO will over the next decade or so be
tens of millions of lives, mostly of women (who will be the industry's
primary target, since now only 4% of Chinese women smoke, compared to 60%
of the men.)

In addition to the article on tobacco in  China, I also include a request
for volunteer assitance in a Politics of Health Reading List, and Politics
of Health Database we are working on, in the hopes that those involved in
the PHA (and FCTC and IPHC) might  contribute to this process.  For these
important tools to be developed, we need your input and assistance.

With best wishes,

David Werner 
  
-----------------------------

Prospects for a "Livable Future" - Dream and Reality  
(by David Werner,. August 2001)

In August, 2001, the Mulago Foundation held a meeting of leaders from
different community-based health and development programs that it assists
in different parts of the world.  The meeting took place at the bucolic
headquarters of Future Generations near Franklin, West Virginia.  The
purpose of the interchange was to help Mulago and the programs it assists
reexamine their overall vision and consider strategies for immediate and
far-reaching change, in view of the problematics of the age we live it.

In our discussions it became clear that many of these programs are doing
outstanding work at the local level. Most are committed to helping
marginalized people in difficult circumstances find ways to cope with their
pressing needs, in ways that also enable communities to conserve the
natural environment. Some of the programs have been "scaling up" their
successful approaches or finding ways to have a more far-reaching impact.
All share a commitment to equitable and sustainable development.

In presenting their vision of a livable future, nearly everyone at the
meeting expressed concern about what they considered to be the socially and
environmentally harmful aspects of  "globalization."  They bemoaned the
huge and often unscrupulous power of transnational corporations, and the
way the current, top-heavy model of economic development is so myopically
pursuing economic growth (for the rich) at enormous human and environmental
costs.  They have witnessed with their own eyes how the widening the gap
between rich and poor, and the cutbacks of social assistance to the poor,
are leading to a pandemic of social unrest, crime, violence, hunger,
resurgence of the diseases of poverty, population growth, and plundering of
natural resources.  They are aware that the sweeping deregulation and
global reach of giant profit-seeking industries is accelerating global
warming and unprecedented ecological degradation.  Many of the program
leaders present have witnessed how different aspects of these global
forces, ranging from trade agreements to adjustment policies, have caused
increased hardships or setbacks to both local people and to ecological
stability in the corners of the earth where they work.

Despite these concerns, as they described their "strategies for change" in
working toward a "livable future," most of the participants at the meeting
conceded that they were doing relatively little to confront the
overwhelming threats posed by the unbridled global economic forces.  For
various reasons, they had preferred to keep their focus on the development
of coping strategies at the local level.  Based on their wealth of
experience in community mobilization for change, they talked about the need
to design activities that give quick, positive and visible results.  The
dangers to a sustainable future that are intrinsic to a global development
paradigm of unlimited growth seemed too huge to get a grip on, or even to
face head-on.  

I began to get the feeling that we visionaries of a "livable future" were a
bit like ostriches with out heads in the sand.  It was as if we were
fervently building an ecologically sustainable village on a bucolic island
whose highest point is a foot above sea level, when we know that in a few
years the polar icecaps will melt and our dream village will become a fish
pond.  Until the fish, too, meet their maker.  

--O--

A key participant at the meeting a Future Generations was Dr. Carl Taylor,
one of the pioneers of Primary Health Care and architects of the Alma Ata
Declaration.  Among scores of groundbreaking activities around the world,
Carl worked for several years as a UNICEF advisor in China.  Now 85 years
old but with a formidably ageless mind, he has a wisdom and wealth of
experience that lead many of us to seek his council.  

After the meeting in West Virginia, I had the good fortune to ride back
with Carl Taylor to Washington, DC.  On the way we got to talking about the
impact of globalization on health.  We agreed how important it is to find
ways to get main-stream decision makers reexamine their assumptions.  We
need an approach to help them realize that unless the current free-market
paradigm of unbridled economic growth is somehow reigned in and made more
accountable, the future of humanity - rich and poor alike - is bleak.  I
suggested that to begin to get main-stream decision makers to reexamine
their world view, we need some powerful yet indisputable examples of how
specific free market policies and trade agreements are jeopardizing the
health of millions.  In answer, Carl told me of his personal experience in
China, and the failed attempt of the Chinese Health Ministry to prevent the
deadly invasion of transnational tobacco corporations.  To follow is an
account of what Carl told me, based on his experience in China.


The SMOKING Gun:

Evidence of Globalization's Negative Impact on Health: 

As related to David Werner by Dr. Carl Taylor (August 2001)


The impact of economic globalization on the wellbeing of humanity has been
much debated.  Those who extol the benefits of globalization -- and even
those who are trying to objectively understand its pros and the cons --
often complain that the much of the vehement protest against globalization,
though full of sound and fury, is rhetorical and lacks unequivocal
evidence.  Unfortunately, this has often been the case.  (I have been
guilty of it myself.)

There are, however, a number of clear examples where the harmful impact of
global economic policies on health are irrefutable.  One of the most
blatant examples -- where a "smoking gun" is painfully evident -- is the
deadly global reach of the tobacco industry.  

According to the World Health Organization (WHO), tobacco smoking is fast
becoming one of the biggest health problems of our times.  While
consumption of cigarettes has diminished somewhat in the United States and
(to a lesser extent) in Europe due to public education about its harm, in
much of the world tobacco use is increasing.  This is especially true in
underdeveloped countries and Eastern Europe, where the multinational
tobacco companies have intensified their marketing.

The WHO states that smoking has become one of the biggest causes of death
in the world.  It predicts that if current global trade policies remain
unaltered, by the year 2020 tobacco will contribute to over 10 million
deaths annually.  

The biggest increase in deaths from smoking is predicted to take place in
China.  Smoking is not a new problem in China.  It increased drastically
following the Chinese Revolution, partly due to the widespread image of
Chairman Mao, who was a chain smoker. 

In the mid-1990s, Dr. Carl Taylor, then working with UNICEF, helped to
organize a nation-wide survey which showed that 60 percent of men in China
smoked.  By contrast, only 4 percent of women were smokers.  This survey
was conducted by the Chinese health ministry in preparation for a worldwide
conference on Smoking and Health, held in China in 1998. Since that
occasion, with increased awareness of the huge health and medical costs of
smoking, the Chinese Health Ministry has tried hard to try to reduce
tobacco use among its citizens.  But it has been an uphill battle.  

The biggest problem has been the powerful leverage of the tobacco industry,
coupled with a conflict of interest within the Chinese government.  The
tobacco transnationals, especially those based in United States, are now
targeting China - with more than one billion people - as potentially their
biggest and fastest-growing market.  Their main target for new smokers
will, of course, be young women, along with adolescents of both sexes.  To
hook their prey, the industry will promote brands such as "Virginia Slims"
as status symbols of the modern, sexy, liberated, forever youthful woman.
With such seductive marketing, the industry is confident it can snare
literally millions of China's women.  The CEOs are fully aware that for
millions of women this will be a death sentence.  But business is business
and stockholders are hungry for profits.  Since money talks (and buys
votes), international law is on the side financial giants.  
 
China's Health Ministry has made efforts to slow down this lethal trend.
Recently it mandated legislation to prohibit smoking in public places.
(These no-smoking rules have yet to be well enforced).  The Ministry also
wants to outlaw both the import and advertising of foreign tobacco
products.  But because of the big stick of globalized market, such
regulations cannot be approved. 

A complicating factor is China's plan to become a member of the World Trade
Organization.  In order to sustain its current double-figure rate of
economic growth (GDP), the government considers it imperative to join the
World Trade Organization.  But to do so, China will be compelled to comply
with WTO's trade liberalization rulings.  These include deregulation of
import and advertising of tobacco.  In short, Marlboro, Winston, Benson and
Hedges, and other transnational giants will be given a free hand to bombard
China with their addictive carcinogens and to promote them through a
deceptive multimillion-dollar advertising blitz.   

Another complication is that many Chinese economists oppose a decline in
tobacco consumption. This is because in China -- as in many countries --
the biggest source of government revenue is the tobacco tax.  To offset
this, the health ministry has proposed a steep increase in the tobacco tax.
 Studies in several countries have shown that when the tobacco tax rises,
cigarette consumption drops.  If China's tobacco tax is doubled, cigarette
smoking will predictably drop by half.  Yet revenue from tobacco taxation
would stay much the same.  
Clearly, an increase in the tobacco tax makes sense from both an economical
and a health point of view.  But not from the viewpoint of the tobacco
lords.  Along with other giant industries, the tobacco industry has a
strong influence on global trade agreements.  For entry into the WTO, China
must cut its current tobacco tax by half.  This tax cut, combined with the
high-power marketing of Western brand-name cigarettes, will drastically
increase tobacco consumption -- and its deadly consequences  -- with no
corresponding increase in government revenue.  

The cards are stacked for a major health disaster, which potentially is
completely preventable!  China's compliance with the WTO rules is destined
to increase by tens of millions the number of tobacco-related deaths,
especially of women.  The price of China's integration into the global
economy will be a massive human sacrifice, comparable to the Holocaust in
both numbers and distorted values.  Under the current rules of the
globalized market, such a sacrifice seems unavoidable.  The world's most
populous nation is well on the way to becoming yet another pawn in the
inequitable global system.

And yet the human sacrifice to sustain the growth of the tobacco industry -
though numerically in the millions - is but the tip of the iceberg toward
which the ship of humanity is headed.  It is bit of "friendly fire"
compared to the suffering wrought on humanity by the world's biggest
business, the weapons industry.  And it is a mere blip of the seismograph
of civilization compared to the world's second biggest business, the oil
industry.  For as we all know (or should know), the oil industry's
opposition to energy saving regulations leads boot-kissing politicians
(those who finance their campaigns with corporate money) to pretend that
global warming is not an imminent threat to a livable future.

Unless the whole of humanity is to go the way of the Roman Empire ("Eat,
sleep and be merry for tomorrow we may die 
") it is time to collectively
open our eyes and work together for a livable future, for all of us.


What is needed to change the global system?

Can such massive human sacrifice to the juggernaut of free-market
development be avoided?  We must hope so.  But we must do more than hope.
To create a livable future will require at first reforms, and in the long
run a sweeping transformation, of the dominant globalized economic system:
of the basic rules of the game.  Such far-reaching change will require a
global movement of well-informed people. As can be seen by the murderous
invasion of the transnational tobacco industry into China, we live in an
age (to borrow David Korten's term) "when corporations rule the world."
The world's economic and trade policies are dictated, often behind closed
doors, by an elite minority with enormous wealth and power.  As we have
observed, the corporate development model of lop-sided economic growth is
not only ruthlessly widening the gap between rich and poor and endangering
the health and lives of millions of people.  It is relentlessly unbalancing
vital ecological systems, placing at risk the continuity of life on this
planet.  

To those of us who are committed to building healthy communities for a
sustainable future, it is becoming apparent that action at the local level
is essential but not enough.  Time and again, we see the local advances we
have worked for swept aside by global imbalances.  Therefore many of us who
have believed that Small is Beautiful and have devoted our lives to
enablement at the local level, have had to revise our thinking.  Though we
recognize our efforts are but one more grain of sand, we feel we must
actively take part in global efforts to reform -- and eventually transform
-- the current inequitable and unsustainable model of globalized
"development" (of which the WTO-condoned tobacco invasion of China is but
one example.) 

The first step in working toward reforming - and eventually transforming -
the unhealthy and unfair aspects of the global free-market system is to
help more people, at every societal level, open their eyes.  Many more
people need to understand how short-sighted macro-economic policies affect
their daily lives and endanger and the future of their children.  They need
the analytic skills to comprehend how corporate dollars purchase public
elections, undermined democratic process, and put profit before people and
the environment.  With this new understanding, people around the world can
join together to demand election financing reforms so as to gain a stronger
voice in the decisions and regulations (or deregulations) that affect their
lives.  They can mobilize to elect officials who put healthy and
sustainable wellbeing as both a local and global priority.

Such an awakening to the realities of our time by a critical number of the
world's people will require a huge coordinated effort.  The challenge is
more daunting because the mass media (mainstream newspapers and TV) are
owned by the same corporate giants - the arms, oil, pharmaceuticals,
alcohol, tobacco, and other industries - that dictate the global
marketplace.  Therefore it is essential that progressive NGOs, and anyone
working toward sustainable change at the local level, also make a concerted
effort to raise widespread awareness about the global obstacles facing
humanity and the planet, and to help to build coalitions for change at the
macro level.  

In sum, it is no longer enough to "think globally and act locally."  To
advance toward change for a livable future we now have to "think and act
both locally globally."  Unless our immediate efforts to enable
marginalized peoples or conserve endangered ecosystems at the local level
go hand-in-hand with a long-term strategy to transform our dangerously
inequitable and unsustainable global market system, all our local endeavors
are likely to come to naught.  

Nevertheless, local empowerment and action is still the heart of equitable
and sustainable development.  Helping  people in immediate danger find ways
to cope with hunger, poverty, and crushing social structures must
necessarily come before more long-term strategies to reform or transform
the overarching unfair system.  But today more than ever we must not lose
sight of the forest for the trees.  When we plan or evaluate coping
strategies at the local level, we must continually ask ourselves, "to what
extent does this local activity or coping strategy sew the seeds or prepare
the ground for building healthier, more sustainable structures and policies
at the national and international level.  For without far-reaching change
at the macro level, the changes we work so hard for at the local level are
increasingly less likely to survive.  As part of today's endangered
biosphere, we cannot seriously talk about sustainable change at the
community level, without at the same time pursuing structural change at the
global level.  

--O--

For those interested in exploring these questions in greater depth, and for
suggestions of action that people can take in working toward a way forward,
we suggests you look at the most recent papers on the HealthWrights
Website: www.healthwrights.org.  Or ask us for printed copies (US$5.00 each
if you can afford it).


TOOLS FOR CHANGING THE WORLD:  HOW YOU CAN HELP 

HealthWrights, in collaboration with the International People's Health
Council and the People's Health Assembly, is making an effort to contribute
to a process of information sharing that can help, in its own small way, to
"change the world."  By "change the world" we mean first reforming and then
transforming the top-heavy global economy.  We refer to the struggle to
build a development model that is healthier, fairer, and more sustainable.
To achieve such change, an exponentially expanding process of popular
education is needed, in order to mobilize a critical number of people. 

Struggle for such change has begun, and is evidenced by mobilization and
organized protests is many parts of the world.  We are concerned, however,
that much of the confrontation of key players in the inequitable global
economy -- such as the World Bank, International Monetary Fund -- has been
based more on shouting of slogans and inflammatory rhetoric than on solid
facts and well-documented evidence.  This makes it in some ways
counterproductive.  It becomes difficult to convince anyone who is looking
for balanced arguments and objective information.

With this in mind, HealthWrights, in cooperation with the IPHC and PHA, has
embarked on two interrelated projects to help promote the sharing of key
information concerning the Politics of Health, especially as it relates to
macroeconomic factors.  These are:

1. Politics of Health Annotated Reading Lists. These lists were started
several years ago and we now hope to update and expand them.  We currently
have 3 versions: a Very Short List of Essential Readings, a Comprehensive
List of Readings, and an Exhaustive List of Readings (including a record of
about everything we come across, without eliminating much of anything).
The lists are arranged in different categories and are coded according to
relative importance and to level of reader sophistication (i.e.
schoolchildren, community health workers, academics, etc.).  Currently the
lists are in dire need of updating.  

We need volunteers (with computer and organizational skills) to help with
the compilation of new materials and updating of the lists.  

We also ask persons and groups concerned with health and development issues
who have access to relevant publications and information, to send us their
recommendations of books, papers and articles for possible inclusion in the
reading lists.   Please include full references (title, author, publisher,
date, address and website if available).  If possible, also include a brief
annotation or summary of the content, specifically as it relates to the
politics of health and sustainable development.  (An extract of key facts
and statistics from these writings for the Database would also be a help.
See the following:)

2.  Politics of Health Database.  This database is in its early stages.
Our objective is to compile and present, in an easily accessible form, a
wide range of accurate facts, statistics, and information relevant to the
politics of health  and sustainable development.  This database will
function as a reliable information resource for anyone who is trying to
obtained statistics or well-documented facts to provide substance to
lectures, classes, workshops, or articles concerning the politics of health
and sustainable development, and designed to create awareness for action.
This Database will be accessible through Internet (and possibly on paper is
well).  

At present this Database is very much in its infancy. For it to become a
useful tool, the compilation of facts and data must be a collective effort.
 You can help! 

We are looking for volunteers with computer and data-processing skills to
help put the Database together and enter new information.  

We also need "information gatherers," as many as possible.  This can be
anyone who is willing to send in pertinent data they come across in their
readings or research.  

If you are interested in contributing to the Reading Lists or the Database,
either by providing information or by volunteering to help with logistics
and/or compilation, please contact us at HealthWrights:  E-mail,
healthwrights at igc.org.  Also see our Website:  www.healthwrights,org

To make these Reading Lists and Database into useful tools for change,

WE NEED YOUR HELP






At 11:10 AM 8/20/2001 +0700, you wrote:
>Dear Colleagues
>
>I am writing to you to investigate the possibility of the your organisation
>becoming involved in the campaign by non-government organisations to promote
>the global treaty on tobacco control, the Framework Convention on Tobacco
>Control (FCTC). The FCTC will be the world's first treaty on a public health
>issue and will set an important precedent in controlling rogue
>multinationals which are promoting harmful (and in this case deadly)
>products unrestricted in developing countries.
>
>Tobacco use is often thought of as a 'first world' issue when in reality
>smoking is a large and growing problem in developing countries and has
>multiple effects which compound poverty and increase the gap between the
>rich and poor. Smoking is almost universally more common among men of low
>socio-economic status and since poorer groups smoke more, it can be expected
>that they will suffer from tobacco-related illnesses more often as well. A
>World Bank commissioned study has found that, where mortality can
>be reliably measured, in high income and former socialist countries of
>Europe, it appears that much of the excess mortality of poor and
>less-educated men can be attributed to smoking.
>
>Currently approximately 80% of the world's smokers live in developing
>countries where smoking rates have risen dramatically in the past few
>decades. Cigarette smoking is an important risk factor in the development of
>cancer, lung disease, coronary heart disease, stroke and birth defects and
>by 2020 is expected to kill more people than any single disease. As smoking
>declines in the West, per capita cigarette consumption rates are growing in
>the developing world. Unless steps are taken to reduce smoking rates, it is
>anticipated that in the year 2025 the worldwide death toll due to smoking
>will climb t! o 10 million per year, with 7 million of those deaths
>occurring in the developing world.
>
>I have attached below some information on the FCTC and tobacco control and
>poverty which I hope you will find interesting. Please let me know if I can
>be of any help at all.
>
>Looking forward to hearing from you in the near future.
>
>Sincerely,
>Belinda Hughes
>Coordinator
>Framework Convention Alliance
>Web: www.fctc.
>Email: FCTCalliance at inet.co.th
>
>_____________________________________________________________________
>Tobacco Control and the FCTC in Developing Countries: Millions Dying but
>Where is the Outrage?
>____________________________________________________________________________
>___
>
>According to the World Health Organisation, tobacco use is set to cause an
>epidemic of heart disease and cancer in developing countries. Currently, 4
>million people die each year from tobacco use, but that number is set to
>rise to 10 million a year by 2030. In addition to premature death, smokers
>suffer from an ongoing health problems due to smoking and inflict health
>problems on others due to secondhand smoke. Yet few countries are taking
>concrete actions to stem this epidemic. This is in part because of the
>political and economic power of multinational tobacco companies which have
>tried to define tobacco control as solely an issue for rich countries in
>order to protect their enormous profits from the developing world.
>
>Tobacco Transnationals Target Developing Countries
>
>The aggressive marketing tactics of the multinational tobacco companies have
>greatly contributed to the tremendous increases in smoking in developing
>countries, particularly amongst women. These companies use their enormous
>political and financial power to influence governments and promote their
>products in every corner of the globe. The expansion of these companies into
>the developing world has meant that in the near future it is developing
>countries which will carry the majority of the burden of disease due to
>tobacco use.
>
>The Rich get Richer and the Poor get Poorer
>
>Currently, approximately 80% of the world’s smokers live in developing
>countries where smoking rates have risen dramatically in the past few
>decades. Yet it is the poor who can least afford to waste money on the
>purchase of tobacco products. Much of the tobacco industry is dominated by
>multinationals, so profits flow from poor to rich countries. Since most poor
>countries are net importers of tobacco, precious foreign exchange is being
>wasted. In addition poor countries are less able to afford the medical and
>other costs attributable to tobacco use.
>
>A Pariah Industry
>
>The tobacco industry has become a pariah industry. For decades it has denied
>the truth about the harmful effects of tobacco addiction in order to protect
>its profits. However whilst it has come under attack in the courts and the
>parliaments of some countries, the majority of countries have felt powerless
>to restrain the industry with effective legislation and litigation. In fact,
>many continue to offer the industry tax breaks and other incentives.
>
>Jobs--But at What Price?
>
>Whilst some jobs are created by the tobacco industry those which are offered
>to people in developing countries are usually dangerous and badly paid.
>Tobacco farm workers are often exposed to dangerous pesticides and other
>chemicals and small farmers are often chained to a cycle of debt by a
>tobacco industry system whereby loan schemes are run to help farmers start
>farming tobacco, but then low prices are offered for the tobacco. In a
>number of countries the tobacco industry exploits the poor and powerless,
>employing children and paying starvation wages.
>
>Framework Convention for Tobacco Control
>
>What is the FCTC?
>
>The Framework Convention on Tobacco Control (FCTC) is a global treaty
>currently being negotiated by governments which will address trans-national
>and trans-border issues, such as global advertising, smuggling and trade.
>Yet the FCTC will also serve as an important catalyst in strengthening
>national tobacco legislation and control programmes. The process of
>negotiating and implementing the FCTC will also help to mobilise technical
>and financial support for tobacco control and raise awareness among many
>government ministries about tobacco issues.
>
>What could the FCTC achieve?
>
>If properly negotiated, the FCTC could help turn the tide against the
>tobacco industry by weakening its political power and helping to end its
>reckless behaviour through regulation and legislation. But this will only
>occur if the voices of the people are heard.
>
>What will happen next?
>
>The next FCTC negotiation is scheduled for November 2001 in Geneva,
>Switzerland. At this meeting, WHO member states will debate the draft
>treaty. It is paramount that NGOs from around the world lobby their
>governments and mobilise public support for a strong FCTC.
>
>How can NGOs get involved?
>
>To ensure the success of the WHO FCTC in combating the global tobacco
>epidemic, non-governmental organizations must play a key role in the
>development and negotiation of the treaty.
>
>o	Join the Framework Convention Alliance;
>o	Educate yourself and your constituencies about global tobacco issues and
>the FCTC – the Alliance Website (www.fctc.org) has links to many good
>resources;
>o	Inform and get the support of the media in your country;
>o	Get resolutions passed in support of the FCTC;
>o	Find out what your country’s delegates to the FCTC have said so far and
>meet with them in order to influence their future positions.
>
>What is the Framework Convention Alliance?
>
>The Framework Convention Alliance (FCA), a coalition of over 150
>organizations and networks from over 50 countries, serves as an umbrella for
>networks and individual organizations working on the FCTC. The Alliance
>facilitates communication between NGOs already engaged in the FCTC process
>and reaches out to NGOs not yet engaged in the process (especially those in
>developing countries) who could both benefit from and contribute to the
>creation of a strong FCTC.
>
>- end -
>
>---
>PHA-Exchange is hosted on Kabissa - Space for change in Africa
>To post, write to: PHA-Exchange at kabissa.org
>Website: http://www.kabissa.org/mailman/listinfo/pha-exchange
>

HealthWrights
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