Published on Thursday, May 1, 2003 by Inter Press Serviceby Leonardo Sacchetti,
While the most dramatic global health issue of the moment is the outbreak of severe acute respiratory syndrome (SARS ), which had claimed a total of 353 lives by Wednesday, a heated political battle continues to rage quietly between the United States and the World Health Organization (WHO).
The battlefields are the fight against tobacco use, the movement to make affordable anti-HIV (the AIDS virus) drugs available to poor countries, and the clear links between chronic diseases and diets that are rich in fats and sugar.
In all three cases, powerful U.S. business interests are opposed to the specific scientific and health recommendations put forth by the WHO, the world's leading global health body.
The diplomatic battle will come to a head May 19-28, when the 191 WHO member nations hold the World Health Assembly, where they will name a new director general to replace Gro Harlem Brundtland, and adopt the Framework Convention on Tobacco Control.
Not only diplomatic factors but political and economic aspects are key to understanding what is happening in the corridors of WHO headquarters in Geneva.
SARS, which had infected 5,462 people around the world and killed 353 as of Wednesday, according to WHO statistics, has diverted international attention from the conflict over tobacco, which involves economic interests that far outstrip the WHO's total annual budget of U.S. $2.2 billion.
At the late May World Health Assembly, South Korean physician Jong Wook Lee will be presented as the new director general, and the member nations will approve the United Nations agency's program and major policy decisions for the next few years.
During the negotiations of the anti-tobacco convention, the text of which was finalized on March 1, the United States and Germany fought against an overall ban on cigarette advertising, a key aspect of the international treaty that will be presented for adoption in May.
Arguing in favor of freedom of expression, the United States successfully pushed for the ban to be subordinate to constitutional provisions of member nations that, for example, protect free speech for commercial purposes.
But the final text stipulates that the states which sign the treaty must move towards a comprehensive ban within five years of its entering into force, and requires countries that are unable to adopt a complete ban to restrict advertising within the limits set by their national laws.
The obstacles raised by Washington's negotiators were so great that the American Cancer Society , American Heart Association , American Lung Association, and Campaign for Tobacco-Free Kids told them to pack up and go home, instead of continuing to work at weakening the draft treaty.
Given that the United States is home to the world's largest tobacco company, Philip Morris, Washington's opposition to the ban on cigarette advertising crippled the treaty at its very birth.
Philip Morris does an annual turnover of $73 billion, according to the U.S. grassroots corporate accountability organization Infact.
But the fight against tobacco use is not only an "obsession"--as tobacco companies complain--in industrialized countries. Tobacco is also produced in developing nations, like Mexico, Brazil, Argentina and Honduras in Latin America.
According to studies by Brazil's National Cancer Institute , tobacco is one of the most harmful crops, in terms of the environment and the health of rural workers.
But the worst damages are suffered by smokers, who number around 1.1 billion worldwide, according to WHO statistics. In 2001, nearly five million people died of tobacco-related cancers or cardiovascular diseases.
The European Union , in the meantime, has been pushing for multilateral measures that would guarantee access to affordable anti-HIV and anti-tuberculosis drugs. "I am hoping for a strong message from the United States," said the president of the European Commission , Romano Prodi.
The United States is the only member nation of the World Trade Organization (WTO) to block, in December 2001, a multilateral initiative for access to affordable medicines by poor countries.
Giant pharmaceutical corporations are opposed to the initiative, that would permit poor nations to import generic drugs, which are less costly than those patented by the big laboratories, in order to save lives cut short by illnesses like HIV and tuberculosis.
The differences on that issue will crop up once again at the next summit of the Group of Eight most powerful countries, scheduled for June 1-3 in France, and at the September WTO ministerial conference in Mexico.
A recent report on diet, nutrition and the prevention of chronic disease published by WHO and the United Nations Food and Agriculture Organization (FAO) pointed out that more than half of the 56.5 million deaths reported worldwide in 2001 were caused by noncommunicable diseases and chronic conditions like cardiovascular ailments, diabetes, obesity, cancer, and respiratory diseases.
The report, which was drawn up by independent experts, contains the latest scientific findings on the links between unhealthy diets, lack of physical activity, and conditions like cardiovascular ailments, different kinds of cancer, diabetes, obesity, osteoporosis, and dental disease, said Dr. Shiriki K. Kumanyika at the University of Pennsylvania.
The WHO's Gro Harlem Brundtland pointed out that deaths caused by these kinds of diseases are not exclusive to industrialized countries, and that chronic diseases are also claiming a growing death toll in developing nations.
According to the director-general, in order to come up with long-term solutions to fight the lethal cocktail of sedentary lifestyle and a diet containing excessive fats and sugar, FAO and the WHO must work with the food industry and related companies.
But the U.S. food industry, led by the sugar producers' association, was unequivocal in its response: the report produced by FAO and the WHO misleads consumers regarding the maximum amount of sugar that should be present in the daily diet.
Dr. Matthew DiFrisco, an analyst with the Gerard Klauer Mattison Institute in the United States, presented his own study on the dietary habits of the U.S. population, which led him to assert that "Grazing has become a lifestyle. It's the way a generation is learning to eat."
According to his study 'Meal Demise, Snacks Arise', people in the United States snack or "graze" continually, eating 4.3 times a day on average.
Many convenience or fast food vendors like McDonald's, Starbucks, and Panera Bread have changed their strategy in order to cater to customers who need to "eat on the run."
More than one billion adults are overweight in middle and upper income countries, and as many as 500,000 people die annually in the United States of obesity-related conditions.
The upcoming World Health Assembly will be a battleground where U.S. proposals and economic interests will clash with the health policies promoted by WHO, and the new director general's agenda for the next five years will reflect the outcome of that "war."
