Yet another fight against corruption -- Return to main page
THE ANTI-TOBACCO POWER FRANCHISE By Anne MacDiarmid
' The World Health Organization hopes to present an International Framework Convention for Tobacco Control to its general assembly later this month — just in time for World No-Tobacco Day on May 31.
If the convention is adopted, WHO will ask its 191 member states, including Canada, to sign it by 2003. The move would force signatories to place drastic curbs on the way tobacco is advertised, marketed, taxed and grown. In effect, it would be the first worldwide public health treaty.
This move is a marked departure for WHO. The international organization used to believe that individual countries and health organizations should deal with the issues surrounding tobacco. Now it is convinced that smoking is a global issue that has to be addressed on an international scale.
"WHO cannot remain indifferent," says Dr. Gro Harlem Brundtland, the director general. "We need to free our population — in particular the young — from the tobacco pandemic." '
These words, from a medical association press communiqué, christen the largest plan of political interference and economic appropriation in modern history.
Faced with an increasing world population, and with disease running amok in the Third World, why would the WHO divert immense funding to the tobacco issue?
Certainly, the anti-tobacco lobby in the United States has given impetus to this departure; indeed, some of the players are the same people. The shocking extent of the WHO's dependence on private industry for its funding may also play a role, and changes the culture of the WHO and the nature of its decision-making process.
Beyond these considerations there is an answer that perhaps goes to the heart of the matter: the political spirit of the times. It's hard to exactly define that spirit, but there are some key words that most of us would acknowledge: efficiency, zero tolerance, globalization, partnerships, and of course -- health.
Today's political trend is to place a premium on efficiency even at the expense of due process and well-established norms. For example, Great Britain has just dropped the choice of trial by jury for some offenses in order to save money. U.S. citizens frightened by crime support "zero tolerance" laws and crackdowns even when these run roughshod over civil liberties and a tradition of individual freedom and privacy. The health care sector makes the efficiency argument in lobbying Congress for broad access to individuals' health records, and waves aside important privacy objections.
"Globalization" emphasizes the idea of a world collective self-interest and thus downplays the importance of national self-interest and autonomy. In doing so, it degrades the value of diversity, and undermines the well-established and hard-won systems of governance that nations -- particularly in the West -- have relied on for decades, if not centuries.
The internationalization of the Tobacco Wars through the WHO offers a prime case study of all of these trends. If health objectives clash with other values (like free speech), then these values must bow down, as the New Zealand government has recently made clear. If health objectives clash with economic self-interest (like the interests of Third World tobacco growers), economic self-interest must bow down.
"Health values" must prevail, both domestically and internationally. And who is declaring this constitutional-sounding principle as a world value? Certainly not "the people" or even their representatives in a representative democratic structure. The WHO, at many removes from any kind of public accountability whatsoever, presumes to speak for the world.
It's clear that the WHO does speak for the health establishment of the rich countries, a health establishment that includes huge corporate interests as well as public entities. This group is powerful, and has recently been made even more powerful by its successes in the U.S. tobacco wars. It is advancing a very paternalistic agenda which substitutes its vision of a healthy and productive society for messier models in which the flawed decision-making capacities and conflicting preferences of all sorts of people who didn't go to medical or business school must be taken into account. Democracy, as some members of the Intervening Classes will cheerfully remark over a cigar and a superlative Scotch, doesn't work.
Neither, apparently, does national sovereignty. The WHO wants to play a role of "global leadership" in tobacco control, and it may have the power to do that whether individual nations like it or not. With the World Bank showing an interest in the anti-tobacco agenda, the prospect of banker's blackmail may push nations into adopting a crusade that is unwanted, unwelcome, and economically counter-productive.
It is quite reasonable to imagine a scenario where a Third World nation is wrestled into adopting WHO's public policy -- including the replacement of tobacco as a crop -- through threats from the World Bank to deny loan renewals.
A poor country's economic condition could be expected to worsen as a result of replacing highly profitable tobacco crops with less profitable substitutes. In this scenario, individual farmers would lose their lands to banks, and many millions of acres would be available at firesale prices. If the lands once available for a whole tobacco economy were suddenly up for grabs, multinational investors would have an unprecedented opportunity for a Third World land grab -- sorry, "partnership"-- to initiate modern corporate farms. The country would be forced to appeal to the World Bank, and submit to conditions that might well include particularly favorable inducements for those multinationals.
That's speculative, of course, but it may be one reason why the multinationals are suddenly so interested in "health partnerships" with the WHO at an international level.
The other reason, which applies to the First World, is simple -- the WHO is a marketing tool and so much more. If international "health intervention" actually succeeds in choking off world tobacco production, then the market for certain products -- patented nicotine delivery devices, for example -- will be more or less captive in places like New York and London. What company wants to rely solely on persuading people to be "helped" through tedious, expensive and uncertain promotional campaigns, when it's so much easier to just cut out the competition?
The WHO, for its part, now has a clear interest in promoting what helps the shareholders in its new "partner" companies. Yes, that translates into a conflict of interest that may be actual or may (if you're a cock-eyed optimist) remain potential. But quibbling over these details smacks of Victorian, or even merely pre-Clintonian, notions about morality in the exercise of power. Since nobody really seems to mind -- or dares to speak -- it doesn't really matter one way or the other.
If the WHO makes good on its intention to use its anti-tobacco campaign as a model for other "interventions", the potential for interference in the lives of nations and citizens is virtually limitless. Who will set the priorities? The government of the United States? Corporations accountable only to their shareholders? Who knows? All that's certain is that health will be used as the justification for whatever "strategy" is deemed necessary. Almost any controversial or problematic aspect of humanity -- smoking, drinking, sex, pornography, unpopular religious and political convictions, gun ownership, ritual circumcision, the availability of junk food, violent movies, unpopular beliefs about the roles of the sexes, arranged marriages, a miscellany of annoying personal traits -- these and countless others can be attacked by arguing the prospect of damage to someone's health, somehow. And if health is enshrined as our sovereign value, political power is consolidated with those who define health and enforce it.
If WHO were a multinational corporation seeking to manipulate governments into creating better conditions for its business, there would be no real problem. We'd recognize the nature of this familiar beast, and maybe buy a few shares if we were so inclined. If the WHO were a politically neutral international aid agency set up to fund health care programs in a transparent manner and accountable only to member countries, that would be appropriate to what we expect from it. But it's neither. The WHO, straddling both identities, is a strange experiment in mechanisms for creating non-democratic government across national borders at a time when everyone's shrieking "globalization!"
And that is why it is so dangerous, not just to smokers, but to everyone.