Tobacco Free Initiative (TFI)

Governance of tobacco in the 21st century: strengthening national and international policy for global health and development

Dr Douglas Bettcher
Director of the WHO Prevention of Noncommunicable Diseases

Speech on the Harvard University Conference on Governance of tobacco in the 21st century: strengthening national and international policy for global health and development
Cambridge, Massachusetts
26 February 2013

Dean Frenk, Your Excellency Dr Zuma, Honorable Nicola Roxon, Dr Chan, Ladies and Gentleman, good morning.

Welcome to the Harvard Conference on the Governance of Tobacco in the 21st Century. The World Health Organization (WHO) is grateful for the opportunity to co-sponsor this important conference, a conference which represents a crucial step in the fight against global tobacco use. I would also like to thank all of you for your attendance. The sheer number of international experts and authorities who sit before us today is testament to the global and multi-sectoral commitment to tobacco control. Your presence sends a strong signal to tobacco companies that we will no longer tolerate the status-quo of an epidemic caused by their deadly products.

Today, good health means good markets as virtually every aspect of a nation’s prosperity is dependent on the well-being of its citizens. We can no longer live in the past and we must embrace the reality learned during the last 100 years that tobacco has no benefit to any person or any marketplace if a nation wishes to prosper and to assure the health of its citizens. It is time for us to discuss what we as an international community can do to prevent the premature deaths caused by tobacco and how we can strengthen the governance of tobacco control.

Governance is defined as the way in which power is exercised through economic, political, and social institutions. It is a process that involves balancing competing influences and demands. It means collaborating with other sectors. It is participatory, transparent and accountable. Most of all it is based on accountability of the participants in the governance process, whether they be a nation or a corporation, to be a good global citizen who assures that even poorest of the world have the right to health and that their market promotes healthy goods rather than lethal ones.

A notable step in the process of global governance of tobacco was the High-Level Meeting of the United Nations General Assembly on the Prevention and Control of Noncommunicable Diseases met in 2011 to discuss NCDs, of which tobacco is one of the major risk factors. This historic meeting represented a paradigm shift in public health. It was only the second time in the history that the United Nations General Assembly convened a heads of state meeting focusing on a public health topic; the first time was in 2001 when leaders discussed scaling up of global strategies to address HIV/AIDS. The challenges created by non-communicable diseases are unprecedented in their scope and complexity. They threaten not only health infrastructure, but also economies, and call into question the very viability of our health care systems and the schemes in place to provide financial protection. Part of the meeting highlighted the intolerable role of the tobacco industry in causing NCDs and the devastating consequences that these NCDs have for the health and development of nations.

The United Nations High-Level Political Declaration generated from the UN General Assembly meeting mirrored the commitment that our conference demonstrates towards establishing international and multi-sectorial governance of tobacco. It urges that we must “recognize the fundamental conflict of interest between the tobacco industry and public health” and “accelerate implementation by States parties of the World Health Organization Framework Convention on Tobacco Control”. Following this statement, the World Health Organization has set a tobacco reduction target to reduce tobacco use by 30% by 2025 among individuals aged 15 and older. These meetings and documents highlight the international mobilization against tobacco companies, a global undertaking which we must champion and promote in order to realize the health and development of all countries. Through our collaboration at this conference, we are furthering the UN Political Declaration`s call for a "whole-of-society approach to respond to the global epidemic of NCD and its socio-economic and developmental impacts”, which is essential to protect millions of individuals from the harmful tactics of tobacco companies that generate premature death and disease. And we all need to take to heart the Declaration’s unequivocal statement that “there is a fundamental conflict of interest between the tobacco industry and public health.” Tobacco companies cannot be a part of the solution to the tobacco epidemic because they are the vectors, the source of this globalized epidemic.

We live in the most complex, interdependent and interconnected era in human history – a so-called “hyper-connected” world. In this world, the governance of tobacco is by no means the exclusive domain of health authorities. Tobacco control intersects within the spheres of trade, finance and agricultural policy. Over the next two days we will work together to enhance knowledge, information-sharing, network-building and learning, to identify strategies to strengthen the governance of tobacco, for example, via trade regulations at both national and international levels. We will explore how international laws and institutions regarding tobacco, trade, investment, agriculture and economic development intersect and how public health concerns can be taken into account in international economic policymaking. Ultimately we will work towards fostering greater policy coherence among those involved in the health, trade, and investment sectors in order to better protect the health of individuals worldwide.

This conference is only the beginning of our work in the promotion of a synergy between tobacco and trade policy in order to strengthen the governance of tobacco regulations and improve global health and international development. However, it is the vision outlined during this meeting which will shape and catalyze all future interventions in this field, and which will generate increased collaboration across international borders, industry lines, and policy-making arenas. By improving the governance of tobacco and encouraging the creation of health- and trade- friendly policies, we can protect the lives of those worldwide from the dangers of tobacco use and NCDs and continue the collaboration set forth by the WHO FCTC. By increasing knowledge, networks, and the global governance of tobacco, as an international community we can demonstrate a lasting commitment across the health and trade sectors to ultimately reduce tobacco use to the lowest extent possible. This century will not be the cigarette century that left millions of individuals suffering and dying early from tobacco-related illnesses. From this meeting, we hope to launch a tiny ripple of hope that will join with the hopes of the citizens of the globe, and empowers us as a global community to leave behind, in the words of Stanford University Professor Robert Proctor, “the Golden Holocaust”, which is the swathe of death and destruction brought on by cigarettes as the deadliest artifact in the history of human civilization. From this meeting we hope the science, passion and desire for healthy markets and healthy people spreads worldwide so that a tobacco free world is achieved. In this light, thank you again for your participation. I look forward to listening and learning from your deliberations in the next two days and to contributing to the conversation on how we can align our global and country efforts to reduce tobacco use and increase global health and development.

Finally, I would like to thank Dean Frenk and his team at Harvard for their tireless work in organizing this ground-breaking conference. It has been a joy working with the entire team.

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