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.
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.
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.
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.
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.
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.
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.
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.
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.
· Join the Framework Convention Alliance;
· Educate yourself and your constituencies about global tobacco issues and the FCTC - the Alliance Website (www.fctc.org) has links to many good resources;
· Inform and get the support of the media in your country;
· Get resolutions passed in support of the FCTC;
· 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.
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.
Belinda Hughes, Coordinator, Framework Convention Alliance (FCA). Tel: (66-2) 278 1828 or (66-2) 278 1829. Fax: (66-2) 278 1830
1. Editorial
2. Equity in Health
In the special United Nations session on AIDS next week, there will be much discussion about international aid, about drugs and vaccines. But there is likely to be too little said about what is the primary means by which AIDS is spread in sub-Saharan Africa: risky heterosexual sex.
Following a meeting today with UN Secretary-General Kofi Annan during the U.N. Special Session on AIDS, leaders of some of the world’s biggest companies, including The Coca-Cola Company and MTV Networks International, announced their commitments to fight the global AIDS epidemic, and called upon other business leaders to join the cause.
Following Monday's long day of debate over draft language that included references to specific HIV "vulnerable groups," such as sex workers, homosexuals and intravenous drug users, a finalized version of the United Nations' Declaration of Commitment for fighting HIV/AIDS on a global scale was submitted last night to delegates of the U.N. General Assembly special session on HIV/AIDS, who are expected to vote to adopt the document this afternoon at the conference's closing session, the Washington Post reports. Islamic groups and the Vatican had objected to the inclusion of such groups in the 20-page document, saying it would be "difficult" for them to endorse a plan that referred to behavior that is "illegal and against religious norms" in their countries. The language was removed after a lengthy debate that threatened to "overshadow" the conference's achievements and replaced with references to "risk behaviors, including sexual activity and drug use," the Post reports.
The global health fund conceived by the UN secretary general to combat HIV/Aids has been vastly over-hyped, will not get near its $7bn-$10bn target, and should not be seen as the answer to the pandemic in the developing world, Clare Short, Britain's international development secretary, told the Guardian yesterday.
We, Heads of State and Government and Representatives of States and Governments, assembled at the United Nations, from 25 to 27 June 2001, for the twenty-sixth special session of the General Assembly convened in accordance with resolution 55/13, as a matter of urgency, to review and address the problem of HIV/AIDS in all its aspects as well as to secure a global commitment to enhancing coordination and intensification of national, regional and international efforts to combat it in a comprehensive manner.
A concerted campaign anchored to popular teenage
culture is slowing down the rate of HIV-infection among one of Zambia's most vulnerable demographic groups: older teenagers in urban areas.
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3. Human Resources
It has been discovered that the former apartheid regime colluded with the mining giant, British Cape Asbestos Property Limited to run South African mines for another decade even though it impacted negatively on the workers' health. The company, which is now known as Cape Plc, has been sued by 6 500 South Africans who have contracted asbestosis.
Citing new data showing some 23 million workers
worldwide now infected with HIV/AIDS, the Director-General of the International Labour Organization (ILO) Juan Somavia plans to formally launch a pioneering Code of Practice on HIV/AIDS and the World of Work at the U.N General Assembly Special Session on HIV/AIDS in New York on 25-27 June. The ILO Code of Practice will provide workers, employers and governments with new global guidelines - based on international labour standards - for addressing HIV/AIDS and its impact at the enterprise, community and national levels where most infections occur. It will also help boost efforts to prevent the spread of HIV, manage its impact, provide care and support for those suffering from its effects and staunch stigma and discrimination which arise from it.
Doctors and nurses in Nigeria Friday called off their 18-day strike action, called to protest against the government's failure to offer better conditions of service, according to report by the state-owned Federal Radio Corporation Network news.
Striking public workers in Zambia have scaled down their demands from a 100 percent pay hike to a "reasonable" salary increment, a union leader said Monday. "We have come down from our initial demand. We have asked the government to give us a reasonable offer," Darison Chaala, secretary general of the Civil Servants Union of Zambia, told AFP.
A three-week long strike by Zambian public sector workers has crippled hundreds of schools and hospitals and slowed the delivery of other key government services in this impoverished southern African country. However, a preoccupation with an unfolding political crisis that could see a parliamentary motion to impeach embattled President Frederick Chiluba being passed appears to have diverted official attention from the resultant social crisis.
4. Public-Private Mix
The cost of private health care is rising so rapidly that it is in danger of becoming unaffordable to all but the wealthy. The punch-drunk public health sector is, however, failing to provide an alternative for the average salaried person. Everyone, from blue-collar workers to senior executives, is clamouring for more affordable, quality health care. A radical new deal is needed for the private and public sectors. New ways of delivering and funding health care must be created. Both sectors are on the ropes and are being forced to act.
5. Resource allocation and health financing
A sustained campaign on a vast scale, building on pockets of success, is needed to reverse the destructive tide of HIV/AIDS in Africa. Such a campaign would include a broad range of actions to prevent new infections, care for the infected, and mitigate the negative impacts of the pandemic – all underpinned by expressions of the highest political will and by the commitment of substantial sums of money. This short paper outlines the case for billions of dollars for AIDS in Africa, puts forward a bold but achievable financing plan for mobilizing resources on such a scale, and points to a number of the actions that need to be taken today to implement large-scale resource mobilization for the fight against AIDS.
Gershenson, Dmitriy, International Monetary Fund, IMF Institute Working Paper WP/01/66, May 2001
Using a general equilibrium framework, this paper analyses how sanctions imposed on the contestants in civil conflict affect the welfare of these contestants and the allocation of resources to conflict. It is shown that weak sanctions can hurt the contestants they are supposed to help, while strong sanctions augment the expected welfare of their intended beneficiaries. Moreover, sanctions are more likely to be sucessful if the contestant who is subject to sanctions can expect to derive a positive income in case of compliance. The likehood of success rises as this income increases.
6. Governance and participation in health
His skin itches madly from shingles, the thrush in his mouth makes it difficult to talk or eat and he has had chronic diarrhea for weeks, but South Africa's most prominent AIDS activist fights on. "There is no holiday from HIV," said Zackie Achmat, chairman of the Treatment Action Campaign, a group lobbying for affordable treatment for the 4.7 million South Africans infected by the epidemic. While 3,000 health experts, politicians and scientists gathered at the United Nations in New York this week to discuss ways to fight AIDS, Achmat and other activists remained on the ground in Africa, prodding their governments and their people into tackling the pandemic.
7. Monitoring equity and research policy
2001, 169p., ISBN 92 75 12288 1
The concept of equity has emerged as a primary guiding for the work of the Pan American Sanitary Bureau. The Bureau has been gathering information on and examining issues related to disparities in health in the Americas, especially as they relate to socioeconomic factors. The articles gathered in this publication represent an important step toward a more equitable distribution of health conditions and health related services, insofar as they represent the status of the issues and dilemmas faced by that Bureau in making equity an operational concept for its work in the Region. The authors have attempted to show how equity and the insights it yields into the distribution of health-dependent as this is on differences in education, income, class, ethnicity and race, geographic location, gender, and other distinctions-can underpin the Bureau's work at the operational level and be incorporated into technical cooperation activities.
A new global fund to combat HIV/AIDS, tuberculosis and malaria will be administered by the World Bank in collaboration with WHO and UNAIDS. Officially announced by UN secretary general Kofi Annan in May, discussions have so far focused on raising the US$10 billion experts say is needed. Less clear are details on how it will fit into national processes and poverty reduction strategies. Some NGOs, academics and officials are worried the fund reflects donors' priorities and the desire to apply "quick fixes" to complex problems. Welcoming the fund in principle, Save the Children, UK, and MEDACT warn in a joint report that lessons of the past 30 years must be taken into account or "billions of dollars could be wasted". "Donor led programmes that focus on specific diseases rather than taking a holistic approach to building services and resources have contributed to the collapse of developing countries' health systems," comments Regina Keith, health adviser to Save the Children, UK. The report The Bitterest Pill of All: The Collapse of Africa's Health System, argues that a significant amount of any new global health fund should be dedicated to the long term strengthening of health systems. European Commissioner for Development Poul Nielson also warns that, without efficient delivery systems, "there is a big risk of this whole discussion being hijacked by PR-politics in rich countries".
8. Useful Resources
The Centre for AIDS Development, Research and Evaluation (Cadre) is a South African non-profit organisation working in the area of HIV/AIDS social research, project development and communications. Cadre has offices in Johannesburg, Grahamstown and Cape Town. Cadre's main objective is to ensure that relevant social research is applied to developing a coherent and systematic response to the HIV/AIDS epidemic in Southern Africa. The Cadre website offers a wide range of downloadable publications and a searchable bibliographic database.
The following countries are entitled to free access to our sites. This list is compiled of countries defined by the World Bank as "Low
Income Economies". Potential subscribers should follow the standard subscription procedure as our subscription system will automatically recognise the origin of access; countries in the list below will automatically qualify for free access. For further details on this policy, please refer to the relevant editorial in each journal. The following electronic editions of journals are freely available on the net: (see: http://www.bmjjournals.com/)
Now rebuilt and redesigned to feature easier navigation and searching, richer internal and external linking and more images, animations, audio and video, Nature Science Update is a free, authoritative and accessible online round-up of what's new in scientific research.
NGO Networks for Health (Networks) is pleased to present the second edition of its Resources series. The Resources series describes useful training manuals, reference materials, and documentation of best practices and emerging lessons through many years of international, national, and community-based health programs. It is hoped that the series will help non governmental and private voluntary organizations (NGOs/PVOs) plan and strengthen health programs for women, children, and families in developing countries. The series also includes references that will help community-based organizations,
health workers, and policy-makers advocate for improved delivery of health information and services. The first edition of the Resources series documented resources for family planning, maternal and child health, and HIV/AIDS programs. This second edition is broken into two sections. Section I describes resources available on the topic of primary health care. Section II describes newsletters and periodicals on a range of health issues, including family planning, reproductive health, HIV/AIDS, child health, primary health care, pharmaceuticals, disabilities, and eye health. We hope you will find this edition of Resources full of valuable information to assist you in your work.
The malaria educational site from Royal Perth Hospital, is now available in French, English and Spanish. The site contains sections on Diagnosis, Prophylaxis, Treatment and History as well as an innovative interactive "Test & Teach" self assessment module. It is an ideal site for Clinicians, Scientists, Healthcare Professionals and Students. The MK IV version of a trilingual (English/Spanish/French) CD-ROM (sponsored by Abbott Diagnostics) with the same content as the website is now ready for distribution (FREE) to institutions without, or with only limited internet access. (The CD-ROM is now being used by medical/educational institutions in 112 countries). For further details please contact Graham Icke.
9. Jobs and Announcements
From July 15 to 20, 2001, the French Committee for Health Education (CFES) is organising the XVIIth World Conference on Health Promotion and Health Education on behalf of the International Union for Health Promotion and Education (IUHPE) to be held at the Palais des Congrès in Paris.
The XVIIth World Conference intends to take up the challenge of health for all by adopting the overall theme: Health, an investment for a just society. Investing for health is a way of expressing an approach to addressing the private and public policies that influence the social, economic and environmental determinants of health. The conference will examine questions concerning traditional foci on practice, policy, research and training, those that are pertinent for the improvement of global health, while remaining sensitive to their local and regional implications. These foci will be explored through plenary sessions, forums and workshops in the context of each of the four major themes of the conference: - Ethics: Health, a focus of civil debate and democracy. - Evidence: Models, frames of reference, evaluation: upon what should good policies be based? - Advocacy: How to use the media for health advocacy? How to promote healthy public policies? - Partnership: Partnership as an essential element in health promotion.
As the epidemic is increasingly recognized as a major development problem, more and more countries have begun to integrate HIV/AIDS programmes into their main development instruments. UNAIDS supports these efforts through its work programme "Mainstreaming the response to HIV/AIDS". The programme aims to enable client countries, with support from partner agencies, to develop and include effective materials for combating HIV/AIDS in their development instruments. These instruments include the poverty reduction strategies, debt relief agreements and public sector expenditure frameworks.
Global Health Action, a non-profit organization located in Atlanta, Georgia with a strong 29-year history of conducting health and leadership training, offers three courses this year:
INTERNATIONAL HEALTH MANAGEMENT COURSE (IHMC), August 6 - September 14, 2001 The goal of this six-week course is to enhance and develop the leadership, management and project planning skills that will allow each participant to work with their community and effectively plan, direct, implement, and evaluate programs and activities.
COMMUNITY HEALTH SERVICES IN RURAL AREAS COURSE (CHS), September 17-28, 2001 This is a two-week add-on course immediately following the IHMC. ONE MUST COMPLETE THE IHMC IN ORDER TO ATTEND THIS COURSE. This special companion course offers participants diverse experiences in the field of community health.
HEALTH LEADERSHIP AND MANAGEMENT COURSE (HLMC), October 22 - November 2, 2001 The goal of this intensive two-week course is to provide each participant with the basic leadership and management skills necessary to plan and implement health and development programs in their countries. This course is open to senior-level health management personnel.
It is clear that over the last several years, a lot of new frontiers of knowledge have been crossed in the medical, pharmaceutical, social, economic and related fields in response to the HIV/AIDS epidemic. These developments provide new hope against a backdrop of a continuing and devastating HIV/AIDS pandemic. The epidemic continues to threaten the existence and development of humankind, especially in sub-Saharan Africa. Insights and experiences gained in HIV/AIDS/STD control and management strategies need to be shared within the African context in order to facilitate greater regional and inter-regional collaboration. The diversity of concepts, practices and solutions to the HIV/AIDS epidemic compels us to seek ways in which we can learn from each other for better responses to the epidemic. In particular, the conference will aim to: 1. Review, discuss and provide updates on the major advances in understanding the HIV/AIDS/STD epidemic from a community, socio-economic, cultural, political, epidemiological, clinical and basic science standpoint.2. Provide a forum for a critical analysis of various responses to the HIV/AIDS epidemic and to discuss the extent to which these responses have impacted on the course and status of the epidemic. 3. In the light of the above, suggest and set new (or strengthen old) strategies and priorities for dealing with the epidemic from an African perspective and resource context.