CHAPTER 5 Global Perspectives on Politics and Public Health Policy: The Case of Tobacco By: Michele Zebich-Knos Richard B. Davis

Multilateral Perspective Health policy can be made within countries at the local, provincial or state, and national levels. Policy can also be made in international organizations by member countries. Framework convention: General agreement to garner worldwide support, details later World Health Organization (WHO) is a major player in determining global health policies

Millennium Development Goals The 2000 Millennium Development Goals (MDGs) seek to –eradicate poverty and hunger, –achieve universal primary education, –promote gender equality, –reduce child mortality, –improve maternal health, –combat disease, –promote environmental sustainability, and –develop a global partnership for development (UN Millennium Project, 2006).

MDGs and Tobacco These 2000 Millennium Development Goals (MDGs) apply to problems related to tobacco –eradicate poverty and hunger, –improve maternal health, –combat disease, –promote environmental sustainability, and –develop a global partnership for development (UN Millennium Project, 2006).

WHO interprets the MDGs WHO interprets the MDGs as a means for developed countries to contribute money and expertise to developing countries so as to improve global health Creation of a global tobacco treaty seeking to curb the economic activity of a major industry would not be unanimously received by all states

Brief History of WHO/WHA Resolutions Re Tobacco WHO 1970 –Resolution 23.32, “Health Consequences of Smoking.” 1992, WHO at 45th WHA (World Health Assembly) –Resolution 45.20, health and economics May 1995: refocused on negative health ramifications –Resolution 48.11, “An International Strategy for Tobacco Control.”

Global Health and Tobacco World Health Organization’s (WHO’s) Framework Convention on Tobacco Control (FCTC) adopted 6/03 in force 2/05. Tobacco fits “global health agenda” Openly accepted by major stakeholders— states, international governmental organizations, nongovernmental organizations (NGOs), and general public—as a health problem that merits action. U.S. signed but has not ratified

U.S. Failure to Ratify FCTC U.S. reluctance may appear detrimental to global anti-tobacco goals Less troublesome than one might think 84% of the world’s smokers live in developing and transitional, or former communist, countries These countries overwhelmingly ratified the treaty and should thus reap its benefits with or without U.S. participation.

Economics: tobacco use = more spent on tobacco related illness than profit from sales Tobacco use increasing in developing countries Current plan = decrease use vs. stop production WHO Tobacco Free Initiative projects Tobacco is a cross-border issue Transcends the “bounds of public health”

Global Environmental Policy: A Model for Health Policy Making? UN Framework Convention on Climate Change “Cause no harm” “Common but differentiated responsibility” “The Precautionary principle” “Polluter pays” “Sustainable development”

Tobacco Prevention Activities 2008, Mauritas started a graphic tobacco- warning on cigarette packs such as –“Smoking causes a long and painful death” 2011, WHO Center for Tobacco Control in Africa opened in Kampala, Uganda –Song about about “smoking up my cash for a tiny piece of trash”