Presentation on theme: "Douglas Webb HIV, Health and Development Group"— Presentation transcript:
1UNDP and General Obligations of the Framework Convention on Tobacco Control Douglas WebbHIV, Health and Development GroupBureau for Development PolicyUNDP, New York
2Social determinants on which UNDP’s HIV and health work focuses UNDP works in seven core areas, many of which are social determinants of healthPoverty and inclusive growthSocial determinants on which UNDP’s HIV and health work focuses12Democratic governanceCrisis prevention and recovery34GenderHIV, Health and Development56Environment and energy7Capacity development
3Starting pointsTobacco work is new to most of the UN system, so we are in the early stages of a coherent responseUNDP’s work on social determinants of health is now addressing non-communicable diseases, building on a platform of HIV and AIDS workUNDP’s mandates are only very recently agreed
4Many structural determinants impact multiple health conditions at the same time contributing toDisease/ condition1Urbanization, migrationMalaria, TB, leishmaniasis, plague, intestinal helminthiasisAnopheles mosquito, malaria vectorTB bacillusConflict, displacementMalaria, measles, diarrheaClimate changeCholera, schistosomiasis, vector-borne diseases (e.g., river blindness, sleeping sickness)It will almost never be cost-effective or strategic to address a distal or high-level structural influence for the sake of a single disease outcome. If you are trying to prevent the spread of HIV and have to choose between male circumcision and promotion of girls education, the former may give you more of a result in the short term, per dollar invested, as measured in terms of impact on HIV incidence alone. However the latter may have multiple and longer term health and development benefits, which in addition to reduced HIV risk, might include reductions in adolescent pregnancies, smaller and healthier families, and greater opportunities to contribute to and benefit from economic and social development.So we should not be addressing key structural determinants just because of single disease outcomes. As with promoting girls education, many are important issues in and of themselves, regardless of their contribution to ill health. And many structural determinants impact multiple health conditions at the same time – so structural interventions may lead to multiple positive health outcomes.As I will discuss later, we shouldn’t fall into false dichotomies or choices. Countries can and should select an appropriate mixture of strategies that respond to their own health and development needs and resource constraints.Woman with river blindnessIncome inequalityAvg life expectancy, infant mortality, accidents, smoking1Not exhaustive list; examples onlySources: Pronyk P. at Columbia University,WHO, McMichael T.,Sharma VP; Farmer P., Raviglione MC, Howarth JP, Dick B., Wilkinson RG, and others
5Structural interventions at a policy level were critical in reducing smoking in the United States Policy intervention(s)Advertising restrictionsPublic awareness campaignsCigarette taxesAnti-smoking legislationSmoking levels dropped from 52% to 25% over past 30 years8 cent cigarette tax alone caused 2 million adults to stop smoking and prevented 60,000 teens from startingOne example of the power of this approach comes from tobacco control. Decades of health promotion investment to discourage smoking made relatively little impact on tobacco use in the United States.Once the State started using ‘upstream’ or structural approaches, however, we began to see dramatic results.Source: McKeown T. et al. 1975, US Centers for Disease Control 2000
6UNDP MandateUNDP works in areas related to social determinants of health, including non-communicable diseases(a) decision of the Conference of the Parties FCTC/COP/4(17) in relation to cooperation for implementation of the Convention.(b) the Report of the Secretary-General on Ad Hoc Inter-Agency Task Force on Tobacco Control (July 2012)(c) ECOSOC resolution E/2012/L.18 on the United Nations system-wide coherence on tobacco control (July 2012)
7ECOSOC Resolution: United Nations system-wide coherence on tobacco control Encourages the Ad Hoc Inter-Agency Task Force to promote effective tobacco control policies and assistance mechanisms at the national level, including through the integration of the World Health Organization Framework Convention on Tobacco Control implementation efforts within the United Nations Development Assistance Frameworks, where appropriate, in order to promote coordinated and complementary work among funds, programmes and specialized agencies;
8Article 5.1 Discussion paper for the COP being developed by UNDP and the FCS Integrating tobacco control into national health and development planning strategies and frameworks and UNDAFs: experience and best practice recommendationsArticulate the case for the integration of tobacco control plans into national development plans and UNDAFsProvide an overview of current extent of integration of tobacco control plans into national development plans and UNDAFsProvide collated information about best practice and recommendations for national action from current experienceProvide recommendations for action at national and global levelProvide list of information resources
9Increased support provided by UN country teams for the same. Desired outcomesIncreased action at national level to integrate tobacco control plans in national development plans and UNDAFs through strengthened multi sectoral commitment.Increased support provided by UN country teams for the same.
10Article 5.1 in Africa34/41 Parties have some aspect of tobacco control incorporated into national plans/strategies15 (37%) Parties have an operational comprehensive multisectoral national tobacco control strategy17 (41%) Parties have included tobacco control into national health plans (out of which 2 also have multisectoral plans)13 (32%) Parties have referred to any aspect of tobacco in other national strategies (out of which 9 parties also included tobacco in either multisectoral or national health plans)
11Article 5.1 GloballyOf the 120 of the 174 FCTC parties for whom data is available from the 2012 reporting cycle:74/120 (62%) indicated a comprehensive multisectoral national tobacco control strategy.43 (36%) of parties reported tobacco control being incorporated in national health plans and21 (18%) parties reported including tobacco control in other national plans.
12Non Communicable Diseases and tobacco control 11 countries have integrated NCDs into their latest UNDAFs3 countries have integrated any mention of tobacco into their latest UNDAFs (Burkina Faso, Djibouti, Mauritania)Only 1 specifically mentions FCTC (Mauritania)
14Case Study – Ghana;Planning ChallengesLack of knowledge and representation of FCTC issues in the planning processFCTC seeks to prevent a tobacco epidemic from occurring in Ghana – not to deal with an existing epidemic – therefore it is not seen as a priorityDevelopment partners and their priorities still have a strong influence on the process. FCTC is not yet a development partner priority in comparison to HIV/AIDS, malaria and TB.Adapting health plans to development planning formats and M&E created unintended structural problems
15Implementation Challenges Case Study – Ghana;Implementation ChallengesLack of funds to produce legislative instrument to progress the recently passed tobacco control billLack of funds to promote tobacco control messages down to the district levelNo further external nor internal funding allocated to tobacco control as an outcome of the process
16Case Study – Ghana; Critical Enablers Planning Key enablersThe thorough GHS health planning process that builds from district level up to a multisectoral national Health Summit to identify Health priorities and objectivesIncluding NCDs in the Health Plan, facilitated including NCDs in the National Development Plan.Although FCTC and tobacco control not mentioned specifically in NDP, inclusion of NCDs facilitates including FCTC implementation in operationalizing the NDP
17Implementation Enablers Case Study – Ghana;Implementation EnablersA National steering committee for tobacco control including, Ghana Health Service, Ghana Education Service, media and the NGO coalitionMedia has been educated and sensitized to report on tobacco control.Health care staff has been given public education through media outlets; including preparing an educational video clip.Capacity building in public health schools and medical schools has been initiated in order to make the future health workforce advocates of tobacco control (facilitated by FCS and WHO)
18Case Study – Ghana;RecommendationsThe Government side needs to come to a consensus on national priorities; and donors and other development partners should be more flexible and responsive to the country needs and priorities. (whether FCTC or other health issues)NCDs should get their own section in the plans, not come under a sub-headingDonors and partners should look beyond specific disease priorities to more broad health service issues; it’s not enough to have the vaccines must also have the means to deliver them to people
21Areas of collaboration within the Convention Article of the WHO FCTCAgencySpecific actionArticle 5(General obligations)UNDPTake into account requirements of Article 5 in UNDP's country level role as convener and coordinator, where appropriate and under its governance programmes.Article 6(Price and tax measures)World BankSupport countries with the design, implementation and evaluation of tobacco tax issues, upon countries demand. This effort would complement ongoing efforts by WHO/TFI in this area.Collaborate with the WHO FCTC secretariat to assess the possibility of having joint Needs Assessment missions with regards to Article 6 issues.Research to assess the potential regressivity of tobacco taxes as well as the impact of tobacco use in poverty.Research on the effects of tax incases on tobacco economic agents, particularly farmers as well as illicit tobacco trade.
22Areas of collaboration within the Convention Article 8(Protection from exposure to tobacco smoke)ILOImplement the ILO SOLVE programme (an interactive educational program designed to assist in the development of policy and action to address health promotion issues at the workplace) to promote smoke-free workplaces.Article 12(Education, communication, training, and public awareness)UNESCO (International Bureau of Education)Include tobacco awareness in school curriculums and teacher trainings.Promote smoke-free schools.World BankIntegrate tobacco in education programmes within Trust Funds.Article 15(Illicit trade in tobacco products)WCOProvide support to the negotiations of the Protocol on Illicit trade.
23Areas of collaboration within the Convention Article 17(Support for economically viable alternative activities)FAO (Agriculture Department)FAO (Economic and Social Development Department)Provide technical support in tobacco growing areas for sustainable crop production intensification with the goal to diversify production, reduce environmental and health impact and reduce the risks of tobacco growers in depending on one single product (subject to funding).Update of the world tobacco production and market situation; (subject to funding: minimum budget required 50,000$).UNCTAD (Special Unit on Commodities (SUC), Division on Trade in Goods and Services, and Commodities (DITC))Collaborate with key partners including international agencies to conduct research and analysis of the tobacco supply chain analysis from the ‘farm to the cigarette’.Policy review of tobacco producing developing countries (include diversification options).
24Areas of collaboration within the Convention ILOExpert input to the WHO FCTC Working Group on Articles 17&18.Updating a 2003 study on the state of employment in the tobacco sector globally (forthcoming November 2012 report).Develop economic & labour market analysis; toolkit on agricultural cooperatives; training material for establishing small enterprises; local development; value chain development tools (rural): rural skills development tools, etc.Develop research on diagnostic and scope studies on decent work, food security and alternatives for tobacco growers.Promote social dialogue to support economically viable livelihoods for tobacco growers and workersUNEPPromote green economy framework for economically viable alternatives for tobacco growers and workersWIPO (Development Agenda, under the thematic project “Project on intellectual property (IP) and Product Branding for Business Development in developing countries and least developed countries (LDCs)”)Provide through Technical Assistance and Capacity Building support to actions by governments to help farmers move to tobacco alternative livelihoods.
25Areas of collaboration within the Convention Article 18 (Protection of the environment and the health of persons)UNEPTechnical assistance related to :Sound management of chemicals in tobacco growingEnvironment audit, impact assessment of tobacco growingIntegrating tobacco related issues within national environmental protection programmesArticles 20, 21& 22 (Research, Surveillance and exchange of information) and (Reporting and exchange of information)UNCTAD (International Investment Agreements (IIA) Section, Division on Investment and Enterprise (DIAE))Share database and information on:Trade data (all bilateral official trade data at HS-6 digit).Border measures: import tariffs at 6-digit, tariff rate quota (TRQ) and other (e.g. domestic support).Non-tariff measures.
26Areas of collaboration within the Convention UNDPIntegrate WHO FCTC/NCDs reporting into the Human Development Reports (HDR).UN WomenEnsure gender sensitive data collection, in particular for surveillance, survey including data on women's role in tobacco products.Gender specific strategies to ensure women are equally informed about their rights.World BankCooperate with WHO for harmonization of tobacco questions into surveys such as Living Standards Measurement Study (LSMS) and LSMS-like surveys and provide input to existing tobacco questions in the WHO surveys.Cooperate also with the Convention Secretariat for analyzing the data collected from the reporting instrument.
27Potential UNDP rolesSome specific opportunities for UNDP in tobacco are emergingUN system coordination (RC) and UNDAF integrationPost-2015 development agendaSupport to National action plan developmentIntegration of tobacco/FCTC/NCDs into national development planningSupport to national governance structures on tobacco/NCDsAnti-corruption and regulatory independenceIntellectual property/TRIPS, trade, and plain packagingStrengthening law enforcement, justiceStrengthening local government-municipal programmingCSO engagementGender and tobacco, human rights
28Principles of strategies Principles for tobacco strategy development strategies need to become more fit for purpose and integrated –integrate the tobacco strategies into wider health and development strategies;A national strategy that is shorter, higher level with emphasis on planning processes that are smarter and lighter on people’s time and moneyStrategies and implementation plans should aim for results, prioritizing interventions and represent value for money, determined by the effectiveness, efficiency and equity of the programme that is planned. In particular, strategies and implementation plans must prioritise halting tobacco use initiation and not only invest the bulk of resources in treatment.Strategies should give more effort and attention to implementation and review, linking interventions to expected results, and then monitoring progressDeveloping indicative, medium term budgets with realistic costing of major programme areas, together with ensuring the level of investment is closely aligned with evidence of ‘what works’ and development of scenarios for what interventions are to be prioritised in low, medium and high level funding scenarios
29Organisational options TobaccoHIV (TB and Malaria)NCDs
30Conclusions A multisectoral response is essential Experiences of Article 5 implementation are now being gatheredOnly One third of parties in Africa have a comprehensive multisectoral strategy on tobaccoAround one third of parties mention tobacco in other development or sector plansExperience suggests that integration of FCTC into other development instruments leads to greater implementationUN Mandates are recent so work can now accelerateUN partners can assist if the demand is there at country levelCoordination structures are to be assessed to determine efficiency of different modelsThere is political capital in tobacco control, isn’t there?