UNITED NATIONS AD HOC INTER-AGENCY TASK FORCE ON TOBACCO CONTROL

Transcription

1 UNITED NATIONS AD HOC INTER-AGENCY TASK FORCE ON TOBACCO CONTROL REPORT OF THE SIXTH SESSION GENEVA, SWITZERLAND 30 NOVEMBER - 1 DECEMBER Opening and Welcome Dr Bill Kean, Director, Department of Governance, WHO, opened the 6 th Session of the United Nations Ad Hoc Interagency Task Force on Tobacco Control (hereafter, "the Task Force") by stating that this is a critical and propitious time for the objectives of the Task Force, ahead of implementation of the WHO FCTC. Mr Assane Diop, Executive Director, Social Protection Sector, ILO and host of the Task Force, emphasized in his welcome and introductory remarks that the fight against the tobacco epidemic cannot be led by one agency alone. He mentioned deaths, poverty and workplace implications of tobacco as compelling reasons for interagency cooperation. Dr Catherine Le Galès-Camus, Assistant Director-General, NHM, WHO, cited progress on this front since the last meeting of this group in October 2003, noting that the WHO FCTC now has 114 Contracting Parties. Further ratification and implementation will require the cooperation of sister agencies at the UN, and other institutions. 2. Update of TFI's work since the fifth session of the Task Force Dr. Yumiko Mochizuki provided an overview of TFI's recent work, casting it in the context of a model of how science, knowledge and intelligence interact to inform policy development, within the constraints and opportunities presented by human, institutional and financial resources, and, ultimately, lead to a tobacco-free global network. In this paradigm of core TFI functions, communications and media play an important role in moving the entire process forward. She cites as important next steps in "climbing the Tobacco-Free Mountain": 1) supporting implementation of the WHO FCTC, 2) strengthening research, development and collaboration, 3) developing resources for advisory and training services, 4) enhancing communications around tobacco control and the WHO FCTC and 5) developing databases of key indicators for further monitoring tobacco control efforts. WHO regional representatives then gave a summary of their progress since the last meeting. The representative from PAHO announced that awareness raising workshops had been held in three of the four sub regions, to encourage ratification and buy in of the WHO FCTC. Among countries that had already ratified, a workshop on packaging and labelling was held. She refers to both Chile and Brazil as notable successes in the region on the 1

2 tobacco-free front. In research and surveillance, she touched on the ongoing activities related to the Global Youth Tobacco Survey (GYTS), and the Pan American Tobacco Information Online System (PATIOS), a web-based information system containing country-specific data on a wide variety of tobacco control topics, which should be up and running in the first half of next year. The representative from EURO reported three policy papers relating to taxation, cessation and smoke-free workplaces. The first two have already been published, the one on smoke-free workplaces is to come out this year. There have been workshops in the Balkans, the Baltic countries and CIS, but further work is required and expected for 2006 in these sub regions. She announced continued funding from the Norwegian government for EURO's activities in tobacco control for the coming year. She also mentioned that since 2003 EURO has a database on tobacco control on its website. Apart from data on prevalence, consumption taxation, deaths from tobacco etc., the database now includes information about the tobacco control regulations in the countries of EURO. 3. Update on agency activities related to tobacco control ILO: External activities in tobacco are largely comprised within the SOLVE program, which tackles a number of related psychosocial issues in the workplace. However, a paper on Workplace smoking specifically was published by ILO in It reviews national and local and practical regulatory measures for smoking in the workplace; it can be found on ILO's website. Internally, the ILO promotes a smoke free policy in all of its building, but for three designated areas. ILO officer will be looking at this policy and how it serves the health needs of ILO workers. UNICEF: The representative from UNICEF stated that the organization has been actively working on the issue of tobacco and child and adolescent health since the World Summit on Children, in many countries including Jordan, Sri Lanka, China and Central Eastern Europe. He reminded the audience that tobacco use is a serious concern for children as 250 million children alive today will die from tobacco use in later life. He highlighted the CIS region as being of particular concern, given its increasing consumption trend. He also raised UNICEF's concern with the increasing trend in tobacco use among the youth in the European region. FAO: The FAO highlighted its "Projections of Tobacco Production, Consumption and Trade to the year 2010" paper, financed by the government of Sweden, as an example of the work it has done in the field of tobacco. The document presents a review of existing literature, and develops a database of basic supply, demand and trade statistics for the period. It also provides projections until the year The FAO has also been involved in no less than 6 case studies (Brazil China, India, Malawi, Turkey and Zimbabwe), all of which are available on the FAO website. There are no ongoing activities for the moment, but the FAO is certainly willing to be involved if there is an expressed need, backed by funding. The representative from the FAO highlighted the need to examine alternatives to diversification. 2

3 UNESCO: Internally, UNESCO's work on the smoking front changed considerably about 2 years ago with a change in senior management. Externally, however, activities have slowed considerably, given the request of Member States that the UNESCO streamline its activities. Resources are being focused on the issue of HIV/AIDS. World Bank: The WB policy remains fully supportive of activities in tobacco control. Practically speaking, the question remains how to best deploy its comparative advantage. In the past, this has meant some stand-alone initiatives, in Indonesia and Uzbekistan to list just two examples. Moving forward, the WB welcomes the opportunities for joint efforts with other UN agencies and external bodies to have maximum effect. The participant suggested that while the classic MDGs emphasized communicable diseases and maternal health, in some settings there were more health gains to be made from tackling non-communicable diseases. He cited a World Bank study on Eastern Europe and Central Asia which concludes that policies in the region must supplement the classical MDGs with indicators of adult health, in particular cardiovascular diseases and external causes of death in order to achieve a greater impact,. The advantages of tobacco control must be clearly communicated in economic terms to the WB to ensure their involvement. To a certain extent, this buy-in is already occurring, as in the example of Russia. UNOG: The UNOG representative remarked that the agency was moving toward a smoke free workplace, but was not there entirely. European Commission: The representative acknowledged that the EC had been widely criticized during the negotiation phase of the WHO FCTC due to its existing tobacco subsidies. He reported, however, that these subsidies would be abolished, effective On the advertising front, he noted that a court case had recently been won on oral tobacco, reinforcing the position that Member States had to implement the directives of the WHO FCTC on this issue. He notes the existence of a concerted effort by some within the industry to promote alternative tobacco products such as chewing tobacco as a harm reduction strategy -- on this, he encourages the WHO to provide Parties to the Convention with some guidance. He would also like to see more guidance and a clear scientific position from WHO on tobacco product regulation. 4. WHO update on progress since the fifth session Main conclusions of the third Secretary General's report to ECOSOC at its Substantive Session of July 2004 and the ECOSOC Resolution on Tobacco Control (Dr Douglas Bettcher) Dr Bettcher gave an overview of the main conclusions and recommendations contained in the third Secretary General's report to ECOSOC: 1) tobacco control has to be recognized as a key component of efforts to reduce poverty, improve development and progress towards the Millennium Development Goals ; 2) with the implementation of the WHO FCTC, tobacco control should be taken into consideration at the Resident Coordinator system level to ensure technical cooperation at the country level; 3) tobacco use needs to 3

4 be addressed in a multisectoral way; 4) the issue of tobacco control could be included in forthcoming activities of the UN Development Group; 5) tobacco control could also be included in the agendas of the regional economic commissions (eg. ESCAP) The resolution adopted by the Member States of ECOSOC, following the presentation of the Secretary-General's report at the Substantive Session of ECOSOC on 16 July 2004, recognizes the adverse impact of tobacco use on poverty. In light of the WHO Framework Convention on Tobacco Control, it: calls upon Member States that have not yet done so, to consider becoming Parties to the Convention; urges Member States to strengthen tobacco control measures; calls upon UN agencies, funds, programmes and other international organizations to provide support for strengthening national and international tobacco control programmes. 5. Smoke free workplaces - Evidence and practical approaches. Overview of the recommendations on Environmental Tobacco Smoke and Overview of the Smoke-free Americas Initiative (Ms Heather Selin) Ms Selin, PAHO, spoke of a domino effect amongst countries in the adoption of smoke free environment policies. The WHO FCTC has further fuelled the momentum on this front. The Smoke Free Americas program, launched on World No Tobacco Day in 2001, seeks to build awareness about Second Hand Smoke (SHS) through work shops, media campaigns, seed grants, research and its website. The representative from PAHO stated that official statements and recommendations from the WHO can prove immensely valuable in some countries. The speaker also talked about the Meeting of Experts, Montevideo, Uruguay, 1-3 November Meeting conclusions and recommendations will form part of published WHO policy recommendations; input from others will also be solicited. These comment on: the negative health effects of SHS, non-existence of alternatives to smoke free environments, the mitigating impact of smoke-free environments on tobacco use, and the positive economic effect of smoke-free environments. Policy development should follow the principles of maximum, universal and legislated protection. Summary of the EURO report on ETS (Ms Kristina Mauer) Ms Mauer, EURO, presented elements of the joint WHO/EURO Policy Paper "Legislating for Smoke-Free Workplaces", arguing in favor of such legislation, and highlighting experience from some of the 52 countries examined in the region. The paper finds that public opinion is favorable to workplace bans: the health consequences of exposure to tobacco smoke are widely known in the region, and thus bans on smoking in public places are widely legislated and accepted. Though the main aim is to protect nonsmokers, workplace bans also raise the motivation of smokers to quit, therefore the issue is relevant for both, smokers and non-smokers. Existing evidence indicates that: 1) a voluntary agreement is not an effective measure; 2) ventilation technology is not sufficiently effective to remove the risk of tobacco smoke to health and therefore can not 4

5 be recommended as a Europe-wide measure; 3) a total ban without exemptions is the best option and easier to enforce. A key factor for successful legislation and its enforcement is the attitude of the population; therefore a proper preparation and prior public consultation process is encouraged. The evidence-based success of the implementation of smoke-free legislation in Ireland, Norway and Italy provides a convincing argument in the political debate. Recent studies indicate that smoking bans do not have an adverse economic effect on trade in the hospitality sector. Such studies should be promoted further to make the economic arguments as convincing as those in public health. Environmental tobacco smoke (ETS) should be classified as a carcinogen for humans following the example of Finland, which has listed ETS as a workplace carcinogen in its national legislation. The strength of this study derives from the fact that was launched at the request of Member States, and from its wide consultative process. The country cases and lessons learned provided a practical tool that was much appreciated. ILO - SOLVE: Addressing Psychosocial Problems at Work (Dr David Gold and Dr Joannah Caborn) Dr Gold and Dr Caborn, ILO, made a comprehensive presentation of the SOLVE program. SOLVE stands for Stress, tobacco, alcohol & drugs, hiv/aids and violence. SOLVE can be used to address tobacco as a stressor or as a consequence of other psychosocial problems. SOLVE is a comprehensive program to tackle psychosocial problems in the workplace In fact, SOLVE addresses 7 of the top ten health hazards cited by the WHO World Health Report of 2002, namely: underweight, unsafe sex, high blood pressure, tobacco, alcohol, iron deficiency and high cholesterol and obesity. Psychosocial problems can lead, at the individual level, to higher risk of accident, increased family or social problems, stigmatization and discrimination, deteriorating health, physical or psychological illness, pain, distress, disability and death. At the organizational level, the consequences of untreated psychosocial problems are: poor morale, increased absenteeism, presenteeism, turnover, reduced productivity, reduced profits or services, higher costs and reduced competitiveness. A study by the Health Management Resource Center of the University of Michigan concludes that the cost associated with an increase in health risk factors is more than twice the amount saved by the reduction of risk factors. The focus of our efforts needs to be on preventing healthy workers from becoming ill. The goal of SOLVE is integration of the psychosocial issues of stress, alcohol and drugs, violence, HIV-AIDS and tobacco into a comprehensive organizational policy and development of action based on the policy. Part of the process of getting management to buy into the program is expressing the costs of psychosocial problems in terms they can understand. As an example on an exercise used in the SOLVE course for managing directors, Drs. Gold and Caborn presented a sample enterprise of 100 workers, in which 10 drink regularly, 30 smoke and 10 have been victims of psychological or physical violence. According to the scientific literature: people addicted to alcohol take 7 times the sick leave as others; smokers take an average of 3 additional sick leave days per year; victims of physical or psychological violence take an average of 7 additional sick days per year. The sample enterprise of 100 workers would need full time replacement workers to make up for the absenteeism caused by these three psychosocial issues. 5

6 In a one-hour course for workers, workers representatives and supervisors, SOLVE demonstrates how multiple psychosocial problems can impact the worker at work, during leisure activities and at home. It can familiarise workers with corporate policy. It uses exercises, group discussion and individual action planning to achieve its objective. MicroSOLVE presents an action-based follow-up to SOLVE, targeted at workers and supervisors, and each addresses one psychosocial issue, broken down into modules on: recognising, dealing with and preventing the problem. Discussions: The participant from FAO pointed out that the source of tobacco and other psychosocial problems may not be confined to the workplace. The ILO responded that this is correct and that SOLVE aims to look at the individual trough an ecological model, taking into account home, work, the social environment, the family and the community. The aim of the program is not to eliminate all problems for workers, but to help them to develop the skills needed to cope with them. If one can change behaviors in the workplace, one might be able to change behaviors at home. The participant representing the EC questioned whether there was a regulatory mechanism within the ILO. David Gold responded that there is no regulation specific to tobacco, but that the issue falls under Convention 155, to the extent that occupational safety and health are affected. The EC would like to see the ILO take a firmer stance, and suggested that the Task Force put in a recommendation for a non-binding code of practice on smoke in the workplace, possibly referring to the WHO FCTC, which is binding, as the principal guiding mechanism. The WHO conceded that it too found it odd that the ILO had never passed a resolution on the issue, and suspects that it has something to do with the ILO's tripartite governance structure. Representatives from the ILO emphasized the ILO has a tripartite structure and a democratic process of social dialogue reflecting the views of governments, employers and workers organizations. They reminded the group that progress on ETS in Ireland was made taking the occupational safety and health perspective. Nonetheless, given increasing awareness about the costs of SHS, and given that some unions are beginning to spearhead developments in ETS, the time might be right to develop such a code of practice. Tobacco smoking, health and work (Ms Evelyn Kortum) A presentation by Ms Kortum, Occupational and environmental Health Programme (PHE/SDE), cast the ETS problem, an occupational hazard in and of itself, in the light of its interactions with other workplace exposures. ETS can result in increased risk of coronary heart disease, lung cancer, asthma and low birth weight. The combination of smoking and airborne particulates can double the rate of COPD & pulmonary fibrosis, the combination of smoking and asbestos exposure can increase the rate of lung cancer over 20 times. Certain workplace factors, such as occupational status, sector or industry, and occupational strains and hazards, may influence smoking prevalence and the success of cessation programmes. On the one hand, Occupational Health and Safety strategies aim at minimizing workers exposure to job-related risks (chemical, biological, physical and/or psychosocial). Measures taken are usually situated at managerial level rather than 6

7 individual worker actions. Health Promotion, on the other hand, aims at reducing riskrelated behaviours such as the use of tobacco. In this approach the individual behaviours are targeted. The worksite provides an important setting for educational efforts to reach large numbers of workers not accessible through other channels. Despite the differences of these two approaches, they clearly share the common goal of promoting worker health. Their complementary functions in protecting and enhancing the health of workers provide an important opportunity for coordinated efforts. A comprehensive approach addresses several organizational levels, as well as multiple factors that influence worker health including efforts to reduce exposures to workplace hazards, modify job factors to support healthy outcomes, and promote health-enhancing behaviours, including nonsmoking.. Discussions: The representative from PAHO pointed out that the evidence is now conclusive: asthma and low birthweight are indeed a consequence of tobacco use. She also highlighted the fact that blue collar workers may have higher smoking rates than others, but that cessation activities are equally successful, and that therefore it is more a consequence of the fact that blue collar workplaces may be the last to go smoke-free. She takes this to mean that cessation and smoke free initiatives must run in parallel. The representative from FAO asserted that a complete intervention in the markets to ban smoking would be difficult, and questioned whether smokeless tobacco might not present an alternative. One participant cited a study by the IARC which shows that smokeless tobacco is still carcinogenic, and from experience in California, that it is inappropriate as a harm reduction strategy. She reminded the Task Force that California instituted farreaching smoking bans without offering such alternatives. The EC representative revealed that while some smokeless products have heretofore been banned in Europe, this partial ban will have to be lifted. Further, on other alternatives to smoking bans, the EC representative pointed out that the engineering required to provide sufficient ventilation to a smoked filled room in order to meet safety standards would imply such costs as to make it prohibitive. A WHO representative argued from a practical standpoint, that we simply do not have the standards by which to compare these products in a regulatory environment. He asserted that while the WHO is prepared to consider harm reduction strategies, it is wary of the path down which the tobacco industry is trying to lead it. Productivity implications of smoking in the workplaces (Dr Ayda Yurekli) Dr Ayda Yurekli, TFI, presented data on the cost of smoke in the workplace, both in terms of the cost of ETS for workers, as well as the cost for employers of having smokers on their payrolls. Her economic justification of smoke-free workplaces included the reduction of external costs to employers and non-smokers, as well the increase in health benefits through decreased prevalence and consumption as well as in non-monetary costs for smokers. External costs include absenteeism and smoking breaks, decreased productivity on the job, earlier retirement, higher health, life and fire insurance premiums, as well as increased maintenance and cleaning costs. 7

8 One study cited finds that quitting may increase absenteeism in the short run, but with time, will decrease to a rate somewhere between never smokers and continuing smokers. She made particular note of the fact that smoking bans can have a strong impact on smoking prevalence and cigarette consumption. There is no evidence to suggest that bans on smoking in the workplace lead to increased consumption in the home. In fact, a study in the UK finds that a total public ban on smoking has resulted in a 22-37% increase in smoke-free homes between 1996 and There is also no evidence that sales or employment in restaurants, bars and hotels have suffered due to public smoking bans. Discussions: The representative from the World Bank cautioned against assuming that smoking bans cause job growth, in the absence of contextual data on general trends in employment and a discussion of confounding factors. UNICEF suggested there was a need for a good study comparing pre- and post-intervention periods, including for example, the interventions undertaken under SOLVE. What is the knowledge gain, and what is the increase in productivity? 6. Smoke free workplace in the UN - Case studies and impact WHO Smoke free policy and Kofi Annan's smoking ban in UN premises (Dr Yumiko Mochizuki) Dr Mochizuki provided an overview of the development of the smoke free policy at WHO. While smoking had been restricted to specific areas of the HQs since 1987, smoke free policies at WHO were intensified in 2000: smoking was only permitted in two designated outdoor areas. Opinion of the workers was very favorable. In a WHO survey, 95% of respondents from the WHO either completely or somewhat agreed with the WHO policy, whereas 47% and 70% of respondents at the ITU and ILO felt the same about their respective smoke-free policies. The percentage of smokers at WHO (21%) was somewhat lower than that of at the ITU or ILO (27% and 30% respectively). In all organizations, however, a plurality of respondents favored a total ban on smoking in working areas. In a more recent survey of WHO employees, from 2005: 8.8% of respondents were smokers 58.8% of smokers said they would like to quit within the next year, 58.5% of smokers said they would like to receive help in-house, 81.7% of respondents "strongly agreed" that WHO should ensure a smoke-free environment, 67.7% of respondents felt that there should be more no-smoking signs around the WHO premises. Since 1 December 2005, WHO applies a new rule for hiring smokers and tobacco users. A candidate applying for a job at WHO is asked the following two questions "Do you smoke or use tobacco products?" and "If you currently smoke or use tobacco products, would you continue to do so if employed by WHO?". If the answer to both questions is 8

9 "yes", the applicant will not be considered for selection. WHO sees its role as supporting cessation among its staff and prospective ones. In addition, WHO's Health and Medical Services provide support for cessation of tobacco use in the form of individual counseling, prescriptions for pharmaceutical therapy (including nicotine replacement products) and follow-up. WHO is at the forefront of the global campaign to curb the tobacco epidemic. The Organization has a responsibility to ensure that this is reflected in all its work, including in its recruitment practices and in the image projected by the Organization and its staff members. In the case of tobacco, the importance for WHO not to be seen as "normalizing" tobacco use also warrants consideration in the Organization's recruitment policy. In September 2003, Secretary-General Kofi Annan issued a bulletin asking diplomats and staffers to refrain from smoking inside New York City United Nations buildings for the purpose of eliminating the risks associated with second-hand smoke for all those working on U.N. premises at headquarters. Some diplomats reacted very strongly, pointing out that although the Secretary-General is the chief administrator at the U.N., the power to issue mandates comes from the members of the General Assembly. As a consequence, the policy can be applied only to staff and not the delegates. A letter jointly signed by WHO's DG Dr Lee and UNICEF's Executive Director Ms Ann Veneman was sent in November 2005 to SG Kofi Annan asking him to consider strengthening the enforcement of the tobacco free policy in the UN by implementing a ban of sales of tobacco products on UN premises and a complete smoking ban in all UN offices throughout the world. Yomiko Mochizuki closed her presentation with a call for the creation of a common UN smoke free policy to be implemented in all UN premises at Headquarters but also at Regional Offices and Country Offices. Smoke free policies of the other agencies Participants each reported on the workplace smoking policy at their respective agencies and organizations. UNICEF, one of the early pioneers, initiated smoke free workplaces in UNICEF offices worldwide in the 1980s. The WCO has designated areas for smoking. The WB, including its regional offices, is entirely smoke-free indoors. UNOG, where the final decision on such policies resides with the delegates, has been unable to institute a comprehensive smoking ban. The EC is smoke-free worldwide, and a mechanism exists for workers to report non-compliant seniors. The European Parliament, an exception, has designated areas for smoking. UNESCO also retains some designated smoking areas. The WHO, including EURO and PAHO regional offices, is entirely smoke-free indoors. HQ is moving towards extending the ban to the entire campus, including outdoors. Since 1997, the ILO has had designated areas for smokers, including in the cafeteria -- restaurant workers are therefore still exposed to smoke. An ILO participant reminded the Task Force that budgetary constraints also influence the scope and implementation of smoking bans. In any case, insists the ILO, whatever measures are taken should be in consultation with staff groups. The FAO bans smoking in the workplace, but appears to have an implementation problem. Additionally, the representative pointed out that the duty-free tobacco was on sale in the building. 9

10 Discussions: WHO emphasized that the decision on the new recruitment policy was made based on three factors 1) there is no safe way of using tobacco 2) WHO is at the forefront of tobacco control as a health organization and 3) WHO had to set an example in the nonnormalization of tobacco use. WHO suggested making clear and concrete recommendations to the SG and to ECOSOC in support of 1) smoke free policy at the UN and of 2) a ban on tobacco sales on UN premises. The SG should consider implementing a smoke-free policy in order to protect his staff. Consequently, no staff service would be provided where the delegates smoke. Participants agreed on the basic outline of such a recommendation, using as a template the joint letter written by UNICEF and WHO, citing the two above points, and adding two additional qualifications: 1) that smoking bans be negotiated in consultation with staff, and 2) that any measures approach the issue from an occupational safety and health perspective. The report to ECOSOC should also recall the Secretary General's bulletin in 2003 promulgating that the UN premises are smoke-free. Furthermore, it should also mention the large number of countries adhering to he WHO FCTC and accepting the measures outlined there, including the one on banning smoking in public places. Responding to a question by the WB, a representative from the WHO agreed that while such a letter could not overcome objections by delegates at UN headquarters who resist smoking bans, the letter could raise the possibility of a resolution in the General Assembly on the issue. Alternatively, the idea of a resolution could be raised in the ECOSOC meeting itself. The representative from the WHO, citing experience from the resolution on the WHO FCTC, emphasized that any such resolution would have to be very focused or it will risk failure in what is an already difficult process of adoption. 7. Poverty, the Millennium Development Goals and tobacco Tobacco and development - Overview of TFI's work since the last meeting of the Task Force (Ms Anne-Marie Perucic) Ms Perucic, TFI, presented an overview of TFI's work in tobacco and development since the last meeting of the Task Force. She cited World No Tobacco Day in 2004, a campaign which highlighted, based mainly on evidence from developing countries, how tobacco use and growing increase the poverty of individuals, families and countries. WHO/TFI organized during the UNCTAD XI conference a parallel event entitled "Globalization of the Tobacco Epidemic: Tobacco Control and Development" on 17 June At the end of the panel a statement was made by the participants, which stressed the link between tobacco, poverty and the MDGs, as well as the importance of incorporating tobacco control in the development programmes of countries and intergovernmental agencies. The SG report to ECOSOC on Activities of the Task Force, 2004 highlighted the link between tobacco and development, and called for stronger collaboration with UN agencies to strengthen tobacco control at country level. The report focused on three main issues: 1) the fact that consumption and production are both 10

11 increasing in developing countries; 2) the use of tobacco by the very poor, the pitfalls for small farmers engaged in tobacco production, the negative environmental impact of tobacco, and the dangers of the increasing use of tobacco by women in developing countries, and 3) the strong link between tobacco and the MDGs. On the later point, she calls attention to the WHO/TFI Publication of "The Millennium Development Goals and Tobacco Control: An opportunity for global partnership" (2005) as an important document, mapping out how tobacco relates to all eight of the MDGs: from poverty and hunger, to education, gender equality, child mortality, maternal health, HIV/AIDS and malaria, as well as environmental sustainability. On the development of a global partnership for development, she insists that MDG implementation should incorporate tobacco control. In its future work, TFI will be encouraging publication of studies on tobacco and poverty in other developing countries, including ongoing work in Bolivia, Nigeria and the Philippines. It will also organize national workshops to assist governments in developing poverty reduction strategies for the achievement of the MDGs which include tobacco control. Discussions: Responding to questions from participants, WHO insisted that Finance and Trade departments are being involved in national awareness workshops, which bring together representatives from all domains, not exclusively health. Developing countries are being encouraged to put tobacco control on their development agenda and request funding. UN agencies and the UNDP in particular need to be involved at country level for facilitating the implementation of the WHO FCTC. UNESCO suggested that, given that so many issues were already being imposed on the Resident Representatives (Res Rep) of the UNDP in countries in their Poverty Strategies, the Task Force should focus on providing data and evidence to inform and encourage their participation. It was suggested as a starting point to encourage Res Reps participation in national workshops organized by WHO aimed at facilitating the implementation of the WHO FCTC. Participants agreed upon next steps, which stated that the role of UN agencies in tobacco control must be clearly mapped out and discussed, at the organizational and country levels, in order to best use their comparative advantages. Agencies must also be more active in involving other non-un, non-health bodies and social partners must be involved, such as Finance, Trade, Customs and Labour bodies. Focus, however, should be on gathering and analyzing information, knowledge and evidence. Agencies and countries are already heavily burdened by MDG work; it is important to first provide evidence to these agencies and countries. We need to find ways of collaborating between agencies without creating added burden of tobacco as an MDG issue, and find ways of reaching the informal sector. Also important is the development of agency capacity, including but not restricted to the naming of contact people (focal points at regional and country level). 11

12 8. Update on the WHO FCTC and preparation for its implementation Presentation on the WHO FCTC and the results of the study on identifying existing and potential sources of funding for the implementation of the WHO FCTC (Dr Douglas Bettcher) Dr Bettcher informed the participants on the status of the WHO FCTC. As of 31 December 2005, there were 114 Parties, located across the globe and across income groups. The first Conference of Parties (COP) will meet from 6 to 17 February 2006 in Geneva. The COP is expected to adopt the Rules of Procedure; designate the Permanent Secretariat and adopt the modalities of its functioning; adopt the budget for the period ; consider the study on existing sources and mechanisms of assistance prepared by the Interim Secretariat; recommend a template for reporting; and suggest possible protocols to be negotiated. As the WHO FCTC moves from ratification to implementation, WHO is increasingly dependent on partnerships with other UN agencies, international organizations and NGOs for its success. Multisectorality is indeed a cornerstone of the treaty. He outlined the ways in which the other agencies and bodies present could assist the WHO in this effort. He highlighted FAO's technical potential input in the implementation of Article 17 on the provision of support for "economically viable alternative activities for tobacco workers, growers and, as the case may be, individual sellers, and article 22, on cooperation in the scientific, technical, and legal fields and provision of related expertise. He also noted cooperation with the ILO on article 8, relating to protection from exposure to tobacco smoke. Citing the Preamble to the WHO FCTC, which states that Parties are "deeply concerned about the escalation in smoking and other forms of tobacco consumption by children and adolescents worldwide", he singled out Article 16 on sales to and by minors as an area of cooperation with UNICEF. Article 12 on education, communication, training and public awareness was highlighted as being of particular relevance to UNESCO, and Article 18 on the protection of the environment and the health of persons states to UNEP. Article 6 on price and tax measures to reduce the demand for tobacco invites considerable input from the World Bank and the IMF, and Article 15 on illicit trade implies an important role for WCO, OLAF and Europol. UNFPA, WTO and UNDP would also be invaluable partners, and their absence at the meeting was regretfully noted. As per Article 26.5 (c) of the WHO FCTC, a study was commissioned to examine existing and potential sources of funding and technical assistance for tobacco control and implementation activities. In addition to such assistance from the WHO, the study found that 5 other International Organizations stated that funding was or is available: FAO, UNICEF, UNFIP, UNODC, and the WB. The European Commission was also cited as a possible source. Nonetheless, a comprehensive system of tobacco funding for target countries is at a developing stage. Recognition is needed on the part of the international donor community that tobacco is a fundamental part of the MDGs. It will be up to developing and transition countries to prioritise tobacco control within their country strategies to begin the necessary dialogue with donors. 12

13 He concluded by enumerating some of the areas of desired participation of UN agencies and other bodies in the implementation phase: 1) assist in providing coordinated responses to country concerns/questions; 2) participate in policy dialogue with developing country governments on a range of sectoral issues; 3) participate as experts in some awareness building workshops; 4) help identify research needs and provide technical inputs at country level Discussions: In ensuing discussions, the FAO added that in addition to work on diversification, the FAO could contribute to tobacco control in matters relating to subsidies and trade, provided resources are available. The ILO could also provide input on activities related to Article education and communication -- which complements the objectives of the SOLVE program, as well as work towards a code of practice for workplace tobacco issues. The ILO pointed out that its safety and health professionals around the world could be a valuable resource. The World Bank highlighted that though it could try to build tobacco into macro programmes, it is difficult to push the tobacco agenda without a request from the country, from the Ministry of Finance for example. With its contacts in education and media, UNESCO could also participate in the education and communication aspects of the WHO FCTC. Europol offered its help in combating illicit trade in cigarettes, but said that it was up to TFI to augment awareness of the issue amongst EU States, for whom tobacco smuggling is not currently a priority. Furthermore, the ILO inquired whether there was any possibility that funds might flow two ways -- that is, if a pool of funds was to be made available, could it also flow to the other agencies. The representative from WHO asserted that as the WHO FCTC is a multisectoral treaty there would definitely be demand for this sort of flow of resources, and that requests for funding would be considered as the needs of Contracting Parties dictated. He expressed the hope that this Task Force meeting would serve as a catalyst for creating opportunities for joint projects with other agencies, building on the successes of 9 previous such ventures. He resolved to specify in more precise terms the sort of projects that might be undertaken over the next two years or so. He also pointed out that an invitation letter was being sent to all the agencies asking for their participation in the Conference of Parties. 9. Illicit trade in tobacco products Report of the workshop on "Tobacco-Health Inequalities and Illicit Trade" organized by the Department of Health in the United Kingdom, London, October 2005 (Ms Anne Grosskurth) Ms Grosskurth, UK Department of Health, spoke of the Workshop on illicit tobacco trade at the Health Inequalities Summit of the UK Presidency of the EU. She cited growing supply of cheap smuggled tobacco in workplaces, public housing estates and colleges and increasing prevalence among working class communities as reasons for the choice of illicit tobacco trade for the Summit. The workshop aims were to highlight the impact of 13

14 tobacco smuggling on health inequalities, bring together all agencies involved in control of illicit trade, generate EU understanding of value of a protocol, share experience and good practice, and identify measures for a possible illicit trade protocol. The international trend in illicit tobacco trade is characterized by the bigger role of organised crime and by the growth in intra-eu smuggling. Many states ignore the problem while others lack the capacity to deal with it. In countries that do choose to do something, the results are encouraging. In the UK, through close work with manufacturers and a tough seizure policy, there has been a reverse in the rise in smuggled cigarettes which now stands at 17%. Over 9 billion sticks have been seized in 4 years. The workshop concluded that illicit trade makes cheap tobacco easily available to poor people and young people. It boosts smoking rates in those groups with devastating health consequences, and undermines tobacco control measures like smoke-free policies, high taxes, media campaigns and cessation programmes. It is a global problem needing global solutions. The WHO FCTC protocol should be a priority. The EU group could press for it with support from the Euro region. There is a need to build on and link together valuable work done by OLAF, Europol, WCO, TFI and others. WHO claims that the economics of tobacco control has put smuggling on the radar screen. The intervention of the UK government and the EC contribute to a call for a protocol relating to illicit trade. The WHO will be in contact with OLAF in order to draft a document on the illicit tobacco trade for COP purposes. Activities of EUROPOL in combating illicit trade in tobacco products (Mr Andreas Mausolf) Mr Mausolf, Europol, clarified that Europol's mission is to make a significant contribution to the EU s Law Enforcement actions in preventing & combating serious international crime, with a particular emphasis on the criminal organisations involved. The Analysis Work File (AWF) Smoke program began in April, 2005, and joins customs and police from some 26 countries in Europe and the USA. Eurojust, SECI-Center, World Customs Organisation, OLAF and the UN-WHO have expressed their full support for the project. The AWF's objectives include: to create a centralised service to which investigation teams contribute high-quality operational data from live investigations; to process and analyse this data quickly and effectively to allow the dissemination of analytical reports which describe the criminal networks involved in smuggling, counterfeiting and illegal manufacturing of cigarettes and other tobacco products in the European Union; to identify the key individuals within the criminal networks, and to reveal the modus operandi in each case, in such a way as to detect and subsequently deprive the criminals from their illicit proceeds of crime. Organized crime is particularly involved in tobacco fraud and expands into other areas from its tobacco revenues. It has been found for example that tobacco fraud has funded terrorist activities. Activities of the European Anti-Fraud Office (OLAF) in combating illicit trade in tobacco products (Mr Ian Walton) Mr Walton, OLAF, explained that the role of OLAF is the protection of the financial interests of the Community against all frauds and irregularities affecting the revenue and 14

15 expenditure of the Community Budget. Tobacco smuggling has a major impact on the revenue of the Member States and the Community. There has been a huge increase in production and smuggling of counterfeit cigarettes and reinforced cooperation is needed to combat the problem. The participant spoke of the Anti-Contraband and Anti- Counterfeit Agreement between the European Community, certain Member States and Philip Morris International: a comprehensive anti-smuggling and anti-money-laundering system for PM products before and after distribution. It requires: 1) supplemental payments of up to 500% of duties and taxes due on smuggled genuine PM Cigarettes seized in the future; 2) compliance Protocols to protect against smuggling and money laundering; and 3) tracking and tracing Protocols to assist law-enforcement authorities to prevent future smuggling. However, it is not enough to have an agreement with only one manufacturer. A more global solution is needed, at European or world level. The WHO s FCTC is a vehicle for progress in this regard. A Protocol on Tracking and Tracing, based on provisions of the Agreement with PMI, would be a major positive step. Activities of the World Customs Organization in combating illicit trade in tobacco products (Mr Giorgio Sincovich) Mr Sincovich, RILO-WCO, described the work of WCO through its central, regional (RILO) and national (NCP) offices. The WCO collects information (number of seizures, quantities seized around the globe) from its different offices which feed in their database. Among its main activities, WCO assists its Member countries in their daily risk assessments, intelligence work and training. The WCO also prepares analytical reports on smuggling in different products, including tobacco. In 2005 WCO published its Customs and Tobacco reports intended for officials only. Some data from the report were summarized. Between 2003 and 2004 seizure in smuggled tobacco products increased mainly in Eastern Europe and Asia Pacific whereas it decreased in Western Europe and South America. In terms of quantity seized, the quantity increased as well in Eastern Europe, Asia Pacific and slightly in Western Europe and it decreased in the other regions of the world. However, globally, the seizures in smoking tobacco increased fourfold between 2003 and 2004 and seizures in counterfeit cigarettes almost doubled between 2002 and Discussions: OLAF observed that contacts and cooperation with the tobacco industry should be handled cautiously; governments should not cooperate with them through backdoor means or via voluntary memoranda which cannot be enforced. It is important to be tough with them and negotiate binding agreements which contain strong financial incentives. Philip Morris, under the terms of the agreement with the European Community, has already made annual payments of about 400 million US$. The Agreement foresees two different types of payments: there is a series of 13 payments over 12 years which in total amount to 1 billion $; and then there are individual payments whenever there is a seizure of genuine PM cigarettes over a certain amount. The 400 million $ received is part of the series of annual payments (not in relation to seizures).regarding tackling counterfeit, the representative suggested that officials could look at the materials used for the 15

16 production of such products and have cooperative agreements with the producers of those products to identify and prevent any sales which might fall into the hands of counterfeiters. WCO noted that counterfeit cigarettes mainly come from the Asian Pacific region but the phenomenon exists also in eastern and central Europe and South America. WCO collects data on seizure from countries such as China but they are not nominal (exact place and date of seizure) because WCO's aim is not operational, it is different from that of EUROPOL and OLAF. Customs are not forced to give data, data is given on a voluntary basis which may lead to insufficient information provided. There is a need for capacity building as well for the national administration collecting such information and providing them to WCO. WHO noted that if Parties of the WHO FCTC wish to move forward on a protocol on illicit trade, WHO will contact the specialized agencies for input for the preparation of a background document. 10. Tobacco control and the tobacco industry Overview of Corporate Social Responsibility (CSR) activities of the tobacco industry (Ms Stella Bialous) Stella Bialous, TFI, spoke of how, with a change in the social environment and in the face of an increased demand for accountability, tobacco companies were pursuing a Corporate Social Responsibility strategy. She quotes the ITC (Indian Tobacco Company) website on so-called Corporate Citizenship: As a responsible corporate citizen, ITC promotes art, culture and education, besides working for the protection and enrichment of the environment and overall social development. Activities of the tobacco companies have ranged from assistance to the elderly in Romania, to restoration of the Historic Garden Railings of St. Petersburg. Other activities such as Youth Smoking Prevention Programs are at best ineffective, and at worst deceitful. The main problem with these programs, it was pointed out is that the unique feature of tobacco products -- which kill their consumers when used as directed by the manufacturer -- renders the ongoing operations of the tobacco companies incompatible with the very notion of Corporate Social Responsibility. She concludes that tobacco industry and health promotion goals are mutually exclusive: no partnership is possible and the unequal balance of power and skills don t make the foundation for true partnerships. Summary of the activities of the International Standardization Organization (ISO) working group on CSR (Ms Marta Seoane) Ms Marta Seoane, TFI, made a presentation on ISO on Social Responsibility (ISO SR), of the International Organization of Standardization, a body which joins stakeholders from: Industry, Government, Consumer groups, Labour, Non Governmental Organizations, Service, support, research and others. The stated goal of the ISO SR is "to develop guiding principles with global relevance that will be useful to organizations 16