Tuesday, 20 May 2014

A global convention on healthy diets? Some lessons from the WHO Framework Convention on Tobacco Control

Jonathan Liberman, director of the McCabe Centre for Law and Cancer, comments on CI's and World Obesity Federation's publication Recommendations towards a Global Convention to protect and promote healthy diets. 

On 27 February 2015, it will be ten years since the WHO Framework Convention on Tobacco Control (FCTC) entered into force. I’ve argued that the FCTC has done a number of great things, including:
  • raising the global profile of tobacco control
  • strengthening governments in their fight against the tobacco industry, politically and legally 
  • reinforcing the view that tobacco products are not normal consumer products, contributing to the ongoing denormalisation of the tobacco industry
  • catalysing the formation and deepening of transnational civil society coalitions; 
  • facilitating the sharing of experiences, expertise and capacity among and between governments and nongovernmental organisations; 
  • and bringing new resources — political, financial and human — into the field.
The FCTC has generated substantial interest in the use of treaties to advance global health (and development). I’ve suggested that it has made treaties the Holy Grail of global health governance. What might our next global health treaty be?

The proposal for a global convention to protect and promote healthy diets, which draws heavily on the FCTC, is an ambitious one – as it should be, given the scale of the health, social, economic and developmental consequences of unhealthy diets and the urgent need for the global community to act.

While it is easy to observe that food is not tobacco (or alcohol) - and the food industry is not the tobacco industry (or the alcohol industry) - it is much harder to articulate exactly what lessons from tobacco control (and the FCTC) are, and are not, applicable to diet.

Recommendations towards a Global Convention to protect and promote healthy diets does not shy away from the complexity of global and domestic food policy.

It offers definitions to distinguish between ‘healthy food’ and ‘unhealthy food’, which include both foods and beverages.

It covers food supply, production, price, marketing, standards and labelling, and consumer information and education.

It acknowledges that cross-agency coordination within the United Nations system is needed on health, trade, food security, environment, and economic and international development.

It recognises that the action and inaction of a large number of government departments and agencies affect diet, mentioning agriculture, regional development, social support, education, health services, defence, justice, telecommunications, transport, energy, trade, industry and finance.

Against this complexity, I offer a few suggestions as the idea is taken forward:
  • Make sure the proposal is manageable in the real world. If it’s too ambitious in its scale and breadth, it’s unrealistic to expect that the many government departments that need to be engaged in a treaty negotiation will be able to come to whole-of-government positions at a meaningful level of commitment. Let alone that the 194 Member States of the World Health Assembly will be able to reach agreement over a realistic number of treaty negotiation sessions (that many States will be reluctant to fund).
  • Work out whether / where you’re looking for a framework that encourages and facilitates ongoing, coordinated global action versus states agreeing to very specific detailed legal obligations (for example, on marketing unhealthy foods to children). In saying “versus”, I don’t mean to overstate the either/or quality, but trade-offs inevitably have to be made, and sometimes at the outset, rather than at the death, if the proposal is to get moving.
  • Make sure that the proposal is flexible enough to have truly global application, across the very different situations in different countries in what foods are eaten, and how they are produced and sold.
  • Think carefully through the relationships with other international agencies whose mandates affect diet. If WHO is to be (or to house) the treaty’s Secretariat, don’t burden it with responsibilities it is not functionally equipped to perform.
  • Don’t discuss the proposal through draft legal text. Focus on concepts, and discuss text at the appropriate time. Nothing can kill off meaningful conceptual discussion quite like poring over, and suggesting amendments to, legal text.
At its most recent session, in Seoul in November 2012, the FCTC’s governing body, its Conference of the Parties, expressed “a need to examine the impact of the Convention as a tool in promoting public health in general and tobacco prevention in particular”.

Just how such an “impact assessment” might best be performed will be discussed at the upcoming session of the COP  in Moscow in October this year.

This impact assessment is bound to be an interesting exercise. It should yield valuable lessons for other areas of global health governance in general, and the use of treaties for global health in particular, including the proposed Global Convention to Protect and Promote Healthy Diets.

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