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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.

Corinthian steamers

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.

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CGAP is the World Bank’s (not-quite-so-)arm’s-length sub-organisation whose role is to promote microfinance. CGAP (“see-gap“) once stood for “Consultative Group to Assist the Poorest“, now it officially stands for “Consultative Group to Assist the Poor”. Actually, if nomen were to be omen, it should probably stand for “Consultative Group to assist (those who lend to) the Poor (and not-so poor)”.

Giant_Knife_1[1]

So many functions … but can it cut? Image: Slartibartfass (CC BY-SA 3.0)

I don’t expect CGAP to function as an independent evaluator of microfinance. What I do expect is that CGAP publications have minimum standards of research quality and logic.

The most recent CGAP report, entitled “Latest Findings from Randomized Evaluations of Microfinance” (Bauchet et. al.), however, is appalling on both counts. Nearly everything about this report is problematic. It is racked by wishful thinking – to paraphrase: “we may not have evidence that microfinance does what it was supposed to, but we still believe it works” – and it has a disturbing feel about it, which derives from: (1) what the authors have left out, and (2) the heavy tension between concern for the poor and patronising them.

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The Book

Governance across borders: transnational fields and transversal themes. Leonhard Dobusch, Philip Mader and Sigrid Quack (eds.), 2013, epubli publishers.
January 2019
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