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A wind of change has begun to blow through the corridors of the World Health Organisation (WHO). Earlier this year, the new Director General, public health physician and former prime minister of Norway Dr Gro Harlem Brundtland, identified tobacco, along with malaria, as the two priority areas where she wanted to implement new projects when she took up office in July. The identification of effective operational programmes to combat tobacco was among nine areas of work taken on by a transitional team sponsored by the Norwegian government, to help the change-over process from the WHO’s previous leadership, under Director General Dr Hiroshi Nakajima of Japan, to the new regime.
The team’s work was split into “satellites”, a term coined to describe clusters of work based on the initial priorities which Dr Brundtland outlined to the WHO executive board in January. In addition to organisational concerns such as finance, staffing, and communications, these included health and development, health sector development, health and environment, health and emergencies, and mental health, as well as malaria and tobacco. External experts were appointed to guide the satellites’ work, with tobacco benefitting from the appointment of Dr Judith Mackay, director of the Asian Consultancy on Tobacco Control (and vice-chair of the editorial advisory board ofTobacco Control).
Tobacco is the programme with probably the greatest potential for improvement in any reassessment of WHO’s work. Despite maintaining its tough statements about tobacco’s massive contribution to worldwide disease and premature death, the WHO had let its practical commitment to tobacco wither away, from a staff of 10.5 in the early 1990s, to just 3.5 by early 1998, and from four regular budget posts to one.
This had come about through a lack of senior-level advocacy on tobacco within WHO, the apparent demotion of the Tobacco or Health Unit (TOH) by its absorption into the Programme on Substance Abuse, and cutting, freezing, or sharing of TOH positions, ending up with only one full-time staff member (and that a one-year post ending in December), and the other two posts being spread over five people, all part-time or temporary. This sorry decline has occurred despite a steady rise in the number of smokers and deaths from tobacco.
Tobacco’s budget, too, has suffered a comparable fate, dropping over 70% since 1994–1995, to less than US$600 000 per annum. This extraordinary decay is in marked contrast to other important programmes, where budgets have grown substantially in real terms. The staffing levels are almost unbelievable when compared with programmes such as tropical diseases, malaria, tuberculosis, AIDS, and immunisation, which each have between 55 and 100 staff. In 1979, a memo from a tobacco industry employee who attended the Fourth World Conference on Tobacco and Health, contained this recommendation to his colleagues: “We must try to mitigate the impact of WHO by pushing them into a more objective and neutral position.”
It would not be hard for a conspiracy theorist to conclude that the industry had managed to get its way in the various processes of decision, and indecision, that led to the sorry state of affairs of recent years. Now, at last, there is an opportunity for real change.