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How did tobacco and smoking become a global health policy issue? This article – the third in our series (1, 2) on non-communicable diseases (NCDs) – examines the critical juncture at which new information, new information technology and an emergent transnational activism combined to produce a new agenda for reducing the impact of NCDs.
Health hazards of smoking in 1824: the flaming moustache
(Detail from “Corinthian Steamers”. Source: Wikimedia Commons)
Once upon the time, the multi-billion dollar tobacco industry appeared legally impregnable, and held enough sway to turn United Nations (UN) organisations against the World Health Organisation (WHO) to neutralise global tobacco control efforts.
A 1999 World Bank report estimated that four million people died annually from tobacco-related illnesses and predicted the number to rise to ten million by 2030, with 70% of these deaths occurring in “developing” countries. According to Taylor and Bettcher, 800 million of the 1.25 billion smokers worldwide lived in developing countries in 2000.
However, within the emerging global health community, a transnational anti-tobacco movement was gaining momentum by the late 1990s. One major shift in approach by the WHO was the development of a new anti-smoking initiative within its new commitment to non-communicable diseases (NCDs). NCDs increasingly became a legitimate area of WHO involvement, which was concerned about tobacco as the second leading NCD risk factor, causing 9% of mortality worldwide.
Thirteen years ago the largest-ever gathering of world leaders took place on 8 September 2000 at the United Nations (UN) General Assembly in New York, where the UN Millennium Declaration was made. The Declaration was the most supported, ambitious and specific list of global development goals agreed upon to date, and established a list of commitments to reduce extreme poverty by 2015 which became known as the Millennium Development Goals (MDGs).
The Millennium Development Goals set in 2000
Source: United Nations
The MDGs were significant for global development cooperation due to their ability to stimulate global support, specifically financial resources. Many aid agencies and donors used them to direct their funding projects, and several governments also largely founded their health strategies upon them to receive external funding, which could comprise over 50 per cent of the state’s health budget. The MDGs thereby created a specific global development agenda, which some critics however now argue was not entirely in tune with the real needs of development of low- and middle-income countries. For example, proponents of a greater focus on non-communicable diseases (NCD) criticise that despite NCDs are now the leading cause of death worldwide, they did not receive a single mention in the 2000 MDGs.
Historically, infectious diseases such as HIV/AIDS, Tuberculosis and Malaria have been at the center of global health initiatives, as they easily spread across national borders and threatened the lives of millions of people in low- and middle-income countries with under-developed health care systems. Yet as the world celebrates its progress on the reduction of infectious diseases, the globalisation of unhealthy lifestyles, rapid and unplanned urbanisation, and liberal market forces have propelled a possibly greater threat to the health and development of the Global South, organisations like the World Health Organisation (WHO) fear. This threat is often referred to as “the invisible epidemic” of non-communicable diseases (NCDs), yet strategies on how to overcome them still remain unclear.
Causes and effects of non-communicable diseases
Source: World Health Organization
This blog entry is the first in a series of contributions exploring the rise of NCDs as a major health and development issue in low- and middle-income countries. The aim is to present and discuss evidence of the leading actors who are increasingly seeing NCDs not only as a challenge for developing countries, but also as an issue of transnational health governance that cannot be resolved at the national level alone. Read the rest of this entry »
governancexborders.com 