Privatising the World Health Organisation

As expected, the Tobacco Control Blog ended last week's World Conference on Tobacco and Health in Singapore with a glowing appraisal of Director General's leadership of the conference, and spiritual leadership of the whole tobacco control movement.

Before the conference the Framework Convention Alliance was less optimistic that headway could be made against the tobacco industry's many empires. They are now excited about a huge donation promised by Michael Bloomberg ($220 million), which will enable them to focus efforts to implement the Framework Convention on Tobacco Control in less developed countries.

The Framework Convention on Tobacco Control is the only international treaty under the auspices of the World Health Organisation. Quite why tobacco control came to be the only health topic worthy of a global treaty is no doubt a matter of historical record.

A report in last month's Third World Resurgence by Tom Fawthrop discusses whether the WHO is 'under siege from the private sector', in part because of the high costs of its activities. It opens by pointing out that Bill Gates addressed the last meeting of member states, describing this as 'symbolic of the crisis facing the United Nations' World Health Organization'. I would add that Bloomberg's donation to the tobacco control cause last week was also symbolic. Gates represents the ultra-wealthy 'globalists', who seek to influence global health policy.

Fawthrop discusses whether Margaret Chan is sufficiently aware of potential conflicts of interest arising from big shots in the corporate world seeking involvement in this field. He lists the wide range of private interests attending the NCD summit last September, noting the concern from professional groups and NGOs at the level of private interest present. He also goes into the recent history, claiming that the World Health Organisation was sidelined in the 1980s by the World Bank, which imposed drastic health cuts as part of its Structural Adjustment Programmes (conditions for financial help), and privatised what was left.

WHO is still sidelined today, as the architects of global governance, the World Economic Forum, seeks 'a new governance paradigm': a complete rethink, in their words:

The model of development characterised by donors and recipients is dead ... In place we need to think about collective responsibility. A world where an increasing number of stakeholders should have a role in shaping and making policy is a given. Governance does not equal governments alone.

Doesn't it sound lovely? We're all in it together! But Fawthrop points out that the WEF does not include medical personnel, patients or the general public among its stakeholders.

It recommends the use of public–private partnerships to meet the provision of health needs. In my book that means that the public will have to pay for projects that will maximise benefit to the shareholders of private companies, and if that means public borrowing, then the general public pays interest, as well as paying for any services that are not free at the point of use. The private corporations win, the banks win and the public benefits only if it can afford to. Countries are quite capable of running a system like that without being supervised by a global 'health authority'.

I used to be starry eyed about the World Health Organisation, before I became aware of its role in tobacco control. But any global authority will become prey to corporations, because they represent business opportunities, and this is what health issues offer them. Without adequate checks to ensure that global health rather than shareholder profits will be the bottom line we might as well not have a global health authority at all.

Australians won't pay tobacco levy

The World Health Organisation has proposed a tobacco levy known as the Solidarity Tobacco Campaign to be added by wealthier countries to support tobacco control efforts in developing countries.

This is the latest of a number of ideas, which have included levies raised on currency transactions and airline seats, in order to raise funds for tobacco control.

Article 26 of the Framework Convention for Tobacco Control provides for these fund-raising efforts.

Article 26 of the WHO FCTC expressly relates to the generation of funds "for the development and strengthening of multisectoral comprehensive tobacco control programmes" of developing countries. Furthermore, a study developed by the WHO Secretariat in accordance with Article 26.5(c) of the treaty and submitted to the Conference of the Parties (COP) to the WHO FCTC in 2006 indicated that tobacco taxation is a sustainable, stable means to generate funds for tobacco control and other public health initiatives. The COP gave “full support to the prioritization of resource mobilization for tobacco control at the national and international levels”.

It is interesting that they call this fund a 'solidarity' fund. Solidarity implies voluntarism. It's also interesting that they regard tobacco taxation in developed countries as 'sustainable', but perhaps paradoxical to want health programmes to rely for their funding on tobacco sales. They get off with it because it supports their goal to make tobacco as expensive as they possibly can.

The World Health Organisation seems to focus quite a bit of attention to getting money out of countries – a variable voluntary contribution is levied on all countries, poor as well as rich, and some of them seem to be having trouble keeping up with payments. In fact its financial difficulties are long-standing, and it cites financial difficulties as an impediment to tobacco control in poorer countries.

The World Health Organisation tries to persuade governments to tax tobacco heavily to fight tobacco-related harm in their own countries. In addition it wishes to encourage a solidarity fund, for helping other countries:  

Concerning international assistance for health, for decades, a key principle underlying provision of such assistance has been solidarity, whereby richer countries assist developing countries ...

It is heartening to see that Australia has rejected this suggestion. In spite of a heavily anti-smoking policy stance, it has stated that it will not be implementing an additional levy: it announced a $700,000 donation following the conference last month on non-communicable diseases. Perhaps it has begun to notice the insatiable nature of global tobacco control efforts:  

... The spread of some diseases across countries also requires collective action based on solidarity to address global public health needs. To further support global solidarity and strengthen health‐development investments, Member States could decide to contribute a part of their tobacco taxe revenues for international purposes.

Oh aye! 

In acknowledging the precarious state of Framework Convention finances the Framework Convention Alliance says this: 

FCTC Parties must now face the reality that existing international funding systems have failed tobacco control. And the world is paying the price – NCDs have been ranked as one of the most serious threats to global stability.

Ranked by whom? The World Economic Foundation, based in Geneva. (Aren't fuel and resource shortages more likely to cause instability?) The referenced work is called Global Risk Factors 2011 and no url is provided. This report, on the other hand, is entitled Global Risks 2011. It's hair-raising (discussing cyber security, resource security and WMDs among other issues), but gives no more than a passing nod at non-communicable diseases. 

Good for Australia – now drop the plain packaging proposal and put life back into perspective.