UNDP and General Obligations of the Framework Convention on Tobacco

Control

Douglas WebbHIV, Health and Development Group

Bureau for Development PolicyUNDP, New York

UNDP works in seven core areas, many of which are social determinants of health

Poverty and inclusive growth

Democratic governance

Crisis prevention and recovery

Gender

HIV, Health and Development

Environment and energy

Capacity development

Social determinants

on which UNDP’s HIV and health

work focuses

1

2

3

4

5

6

7

Starting points

• Tobacco work is new to most of the UN system, so we are in the early stages of a coherent response

• UNDP’s work on social determinants of health is now addressing non-communicable diseases, building on a platform of HIV and AIDS work

• UNDP’s mandates are only very recently agreed

Many structural determinants impact multiple health conditions at the same time

Structural determinant1

contributing to Disease/ condition1

Urbanization, migration

Malaria, TB, leishmaniasis, plague, intestinal helminthiasis

Conflict, displacement

Malaria, measles, diarrhea

Climate change

Cholera, schistosomiasis, vector-borne diseases (e.g., river blindness, sleeping sickness)Income

inequalityAvg life expectancy, infant mortality, accidents, smoking

1Not exhaustive list; examples onlySources: Pronyk P. at Columbia University,WHO, McMichael T.,Sharma VP; Farmer P., Raviglione MC, Howarth JP, Dick B., Wilkinson RG, and others

Anopheles mosquito, malaria vector

Woman with river blindness

TB bacillus

Structural interventions at a policy level were critical in reducing smoking in the United States

Policy intervention(s)

•Advertising restrictions•Public awareness campaigns•Cigarette taxes•Anti-smoking legislation

•Smoking levels dropped from 52% to 25% over past 30 years

•8 cent cigarette tax alone caused 2 million adults to stop smoking and prevented 60,000 teens from starting

Source: McKeown T. et al. 1975, US Centers for Disease Control 2000

UNDP Mandate

UNDP works in areas related to social determinants of health, including non-communicable diseases

(a) decision of the Conference of the Parties FCTC/COP/4(17) in relation to cooperation for implementation of the Convention.(b) the Report of the Secretary-General on Ad Hoc Inter-Agency Task Force on Tobacco Control (July 2012)(c) ECOSOC resolution E/2012/L.18 on the United Nations system-wide coherence on tobacco control (July 2012)

ECOSOC Resolution: United Nations system-wide coherence on tobacco control

Encourages the Ad Hoc Inter-Agency Task Force to promote effective tobacco control policies and assistance mechanisms at the national level, including through the integration of the World Health Organization Framework Convention on Tobacco Control implementation efforts within the United Nations Development Assistance Frameworks, where appropriate, in order to promote coordinated and complementary work among funds, programmes and specialized agencies;

Article 5.1 Discussion paper for the COP being developed by UNDP and the FCS

Integrating tobacco control into national health and development planning strategies and frameworks and UNDAFs: experience and best practice recommendations• Articulate the case for the integration of tobacco control plans

into national development plans and UNDAFs

• Provide an overview of current extent of integration of tobacco control plans into national development plans and UNDAFs

•Provide collated information about best practice and recommendations for national action from current experience

• Provide recommendations for action at national and global level

• Provide list of information resources

Desired outcomes

• Increased action at national level to integrate tobacco control plans in national development plans and UNDAFs through strengthened multi sectoral commitment.

• Increased support provided by UN country teams for the same.

Article 5.1 in Africa

• 34/41 Parties have some aspect of tobacco control incorporated into national plans/strategies

– 15 (37%) Parties have an operational comprehensive multisectoral national tobacco control strategy

– 17 (41%) Parties have included tobacco control into national health plans (out of which 2 also have multisectoral plans)

– 13 (32%) Parties have referred to any aspect of tobacco in other national strategies (out of which 9 parties also included tobacco in either multisectoral or national health plans)

Article 5.1 Globally

Of the 120 of the 174 FCTC parties for whom data is available from the 2012 reporting cycle: •74/120 (62%) indicated a comprehensive multisectoral national tobacco control strategy. •43 (36%) of parties reported tobacco control being incorporated in national health plans and •21 (18%) parties reported including tobacco control in other national plans.

Non Communicable Diseases and tobacco control

• 11 countries have integrated NCDs into their latest UNDAFs

• 3 countries have integrated any mention of tobacco into their latest UNDAFs (Burkina Faso, Djibouti, Mauritania)

• Only 1 specifically mentions FCTC (Mauritania)

Case Study: Ghana

Case Study – Ghana;

Planning Challenges•Lack of knowledge and representation of FCTC issues in the planning process •FCTC seeks to prevent a tobacco epidemic from occurring in Ghana – not to deal with an existing epidemic – therefore it is not seen as a priority •Development partners and their priorities still have a strong influence on the process. FCTC is not yet a development partner priority in comparison to HIV/AIDS, malaria and TB.•Adapting health plans to development planning formats and M&E created unintended structural problems

Case Study – Ghana;

• Implementation Challenges • Lack of funds to produce legislative instrument

to progress the recently passed tobacco control bill

• Lack of funds to promote tobacco control messages down to the district level

• No further external nor internal funding allocated to tobacco control as an outcome of the process

Case Study – Ghana; Critical Enablers

• Planning Key enablers• The thorough GHS health planning process that

builds from district level up to a multisectoral national Health Summit to identify Health priorities and objectives

• Including NCDs in the Health Plan, facilitated including NCDs in the National Development Plan.

• Although FCTC and tobacco control not mentioned specifically in NDP, inclusion of NCDs facilitates including FCTC implementation in operationalizing the NDP

Case Study – Ghana;

• Implementation Enablers• A National steering committee for tobacco control

including, Ghana Health Service, Ghana Education Service, media and the NGO coalition

• Media has been educated and sensitized to report on tobacco control.

• Health care staff has been given public education through media outlets; including preparing an educational video clip.

• Capacity building in public health schools and medical schools has been initiated in order to make the future health workforce advocates of tobacco control (facilitated by FCS and WHO)

Case Study – Ghana;

Recommendations•The Government side needs to come to a consensus on national priorities; and donors and other development partners should be more flexible and responsive to the country needs and priorities. (whether FCTC or other health issues)•NCDs should get their own section in the plans, not come under a sub-heading•Donors and partners should look beyond specific disease priorities to more broad health service issues; it’s not enough to have the vaccines must also have the means to deliver them to people

Emerging UN wide support

Health or Tobacco?

Areas of collaboration within the Convention

Article of the WHO FCTC

Agency Specific action

Article 5(General obligations)

UNDP - Take into account requirements of Article 5 in UNDP's country level role as convener and coordinator, where appropriate and under its governance programmes.

Article 6(Price and tax measures) 

World Bank - Support countries with the design, implementation and evaluation of tobacco tax issues, upon countries demand. This effort would complement ongoing efforts by WHO/TFI in this area.

- Collaborate with the WHO FCTC secretariat to assess the possibility of having joint Needs Assessment missions with regards to Article 6 issues.

- Research to assess the potential regressivity of tobacco taxes as well as the impact of tobacco use in poverty.

- Research on the effects of tax incases on tobacco economic agents, particularly farmers as well as illicit tobacco trade.

Areas of collaboration within the Convention

Article 8(Protection from exposure to tobacco smoke)

ILO - Implement the ILO SOLVE programme (an interactive educational program designed to assist in the development of policy and action to address health promotion issues at the workplace) to promote smoke-free workplaces.

Article 12(Education, communication, training, and public awareness)

UNESCO (International Bureau of Education)

- Include tobacco awareness in school curriculums and teacher trainings.

- Promote smoke-free schools.

World Bank - Integrate tobacco in education programmes within Trust Funds.

Article 15(Illicit trade in tobacco products)

WCO - Provide support to the negotiations of the Protocol on Illicit trade.

Areas of collaboration within the Convention Article 17(Support for economically viable alternative activities) 

FAO (Agriculture Department)      FAO (Economic and Social Development Department)

- Provide technical support in tobacco growing areas for sustainable crop production intensification with the goal to diversify production, reduce environmental and health impact and reduce the risks of tobacco growers in depending on one single product (subject to funding).

- Update of the world tobacco production and market situation; (subject to funding: minimum budget required 50,000$).

UNCTAD (Special Unit on Commodities (SUC), Division on Trade in Goods and Services, and Commodities (DITC))

- Collaborate with key partners including international agencies to conduct research and analysis of the tobacco supply chain analysis from the ‘farm to the cigarette’.

- Policy review of tobacco producing developing countries (include diversification options).

Areas of collaboration within the Convention ILO 

- Expert input to the WHO FCTC Working Group on Articles 17&18.

- Updating a 2003 study on the state of employment in the tobacco sector globally (forthcoming November 2012 report).

- Develop economic & labour market analysis; toolkit on agricultural cooperatives; training material for establishing small enterprises; local development; value chain development tools (rural): rural skills development tools, etc.

- Develop research on diagnostic and scope studies on decent work, food security and alternatives for tobacco growers.

- Promote social dialogue to support economically viable livelihoods for tobacco growers and workers

UNEP - Promote green economy framework for economically viable alternatives for tobacco growers and workers

WIPO (Development Agenda, under the thematic project “Project on intellectual property (IP) and Product Branding for Business Development in developing countries and least developed countries (LDCs)”)

- Provide through Technical Assistance and Capacity Building support to actions by governments to help farmers move to tobacco alternative livelihoods.

    

Areas of collaboration within the Convention

Article 18 (Protection of the environment and the health of persons)

UNEP    

Technical assistance related to :-Sound management of chemicals in tobacco growing-Environment audit, impact assessment of tobacco growing -Integrating tobacco related issues within national environmental protection programmes

Articles 20, 21& 22 (Research, Surveillance and exchange of information) and (Reporting and exchange of information)

UNCTAD (International Investment Agreements (IIA) Section, Division on Investment and Enterprise (DIAE))

Share database and information on:-Trade data (all bilateral official trade data at HS-6 digit).-Border measures: import tariffs at 6-digit, tariff rate quota (TRQ) and other (e.g. domestic support).-Non-tariff measures.

Areas of collaboration within the Convention

UNDP - Integrate WHO FCTC/NCDs reporting into the Human Development Reports (HDR).

UN Women - Ensure gender sensitive data collection, in particular for surveillance, survey including data on women's role in tobacco products.

- Gender specific strategies to ensure women are equally informed about their rights.

World Bank      

- Cooperate with WHO for harmonization of tobacco questions into surveys such as Living Standards Measurement Study (LSMS) and LSMS-like surveys and provide input to existing tobacco questions in the WHO surveys.

- Cooperate also with the Convention Secretariat for analyzing the data collected from the reporting instrument.

Potential UNDP roles

Some specific opportunities for UNDP in tobacco are emergingo UN system coordination (RC) and UNDAF integrationo Post-2015 development agendao Support to National action plan developmento Integration of tobacco/FCTC/NCDs into national development

planningo Support to national governance structures on tobacco/NCDso Anti-corruption and regulatory independenceo Intellectual property/TRIPS, trade, and plain packagingo Strengthening law enforcement, justiceo Strengthening local government-municipal programmingo CSO engagemento Gender and tobacco, human rights

Principles of strategies

Principles for tobacco strategy development •strategies need to become more fit for purpose and integrated –integrate the tobacco strategies into wider health and development strategies;•A national strategy that is shorter, higher level with emphasis on planning processes that are smarter and lighter on people’s time and money•Strategies and implementation plans should aim for results, prioritizing interventions and represent value for money, determined by the effectiveness, efficiency and equity of the programme that is planned. In particular, strategies and implementation plans must prioritise halting tobacco use initiation and not only invest the bulk of resources in treatment.•Strategies should give more effort and attention to implementation and review, linking interventions to expected results, and then monitoring progress•Developing indicative, medium term budgets with realistic costing of major programme areas, together with ensuring the level of investment is closely aligned with evidence of ‘what works’ and development of scenarios for what interventions are to be prioritised in low, medium and high level funding scenarios

Organisational options

Tobacco

NCDsHIV (TB and

Malaria)

Conclusions

• A multisectoral response is essential• Experiences of Article 5 implementation are now being gathered• Only One third of parties in Africa have a comprehensive

multisectoral strategy on tobacco• Around one third of parties mention tobacco in other development or

sector plans• Experience suggests that integration of FCTC into other

development instruments leads to greater implementation• UN Mandates are recent so work can now accelerate• UN partners can assist if the demand is there at country level• Coordination structures are to be assessed to determine efficiency

of different models• There is political capital in tobacco control, isn’t there?