17 Sep 2015
With the support of FCA and the Canadian Cancer Society (CCS), in the three countries we succeeded in increasing awareness about the ties between NCDs, tobacco, poverty and development, and also got these topics onto the political agenda.
We also made efforts to have these priorities included in each country’s United Nations Development Assistance Framework (UNDAF), the document that describes how the UN will support government’s development efforts. Colombia and Uruguay will likely approve UNDAFs in 2015, Peru in 2016.
The magnitude of NCDs and their impact on countries’ development means that the UN system could play a major role in supporting governments to prevent and control these diseases. UNDP country teams also have the mandate to work to integrate the fight against NCDs into the UNDAF process and have been directed to scale up their efforts to support governments’ own work in this area.
Tobacco use a serious problem
Colombia, Peru and Uruguay are middle-income countries but still have major sectors of their populations affected by poverty, slowing the pace of development. Tobacco use remains a serious development problem in all three countries, where low-income populations have the highest rate of tobacco use, and face a disproportionate share of the NCDs burden. Coupled with major barriers for these groups to health services, this deepens social inequality in the three countries.
In the last decade, Uruguay made significant progress in strengthening tobacco control, by implementing the World Health Organization Framework Convention on Tobacco Control (FCTC), and in tackling poverty. Today, it is considered the Latin American country with the least social inequality. However, tobacco use remains a major problem among the poorest segments of society. (Read more, in Spanish).
Colombia ranks in the top three countries in the region in terms of inequality, according to the UNDP. About 30 percent of its population lives in poverty, 8.4 percent in extreme poverty. It ranks 63 among 135 countries in terms of gender equality. Although Colombia has considerably strengthened its tobacco control laws, it still faces problems putting in place some FCTC measures, such as effective health warning labels and tobacco prices that discourage consumption.
Coordinating committee formed
Among our work in Colombia was advocacy directed at stakeholders, including parliamentarians, officials from many government ministries, the UN country team (UNCT, which represents all UN agencies present in a country), as well as the Territorial Planning Council, a civil society advisory body to Parliament on the national development plan. As a result of these efforts, a coordinating committee for NCDs – which included 18 social and health organizations – was included in the process of drafting the national plan.
In Uruguay, we took our messages to high-level authorities (the President and the Minister of Health), other government officials and to the UNCT. Additionally, the national NCD Alliance was revitalised, and members were invited to participate in a discussion on national health priorities.
In Peru, the challenges were fewer thanks to existing initiatives, such as a recent law on healthy eating among children and teens, a strategy on NCDs from the Ministry of Health, and an organized civil society, represented by the national NCD Alliance. This Alliance is a key player for establishing relationships with international donor agencies and government officials.
The main lessons learned from this project include:
Messaging matters: Government authorities see tobacco use as a health issue, not a development challenge. However, demonstrating the links between tobacco (and NCDs), poverty and development, allowed us to raise the profile of tobacco control among non-health audiences. They came to understand that tobacco use is a problem that affects social and economic development, so it should be addressed by the relevant ministries.
Specifically, we held face-to-face meetings with key people from government and the UN, such as the UNDP Resident Coordinator. For the latter visit our group included an economist, who could clearly explain the economic aspects of tobacco use, including its impact on social equality.
Building connections and alliances is key: Working with other groups interested in protecting public health from transnational interests and interference was crucial to our success. It was empowering when our expanded network spoke with a unified voice.
Tobacco control civil society and the UNDP have also many overlapping interests and the sooner we start coordinating our activities, the better.
No overnight miracles: If we want to get tobacco control among national priorities, we are in for a long haul. It takes about a year for advocates to get familiar with the process of setting national priorities and to be in a position to promote the FCTC and NCDs within it. However, this is an essential first step in raising the profile of tobacco control, and can lead to mobilising additional resources and support for FCTC implementation at country level.
Ɨ NCDs cause nearly 2/3 of global deaths today, and it is estimated that they will cost the world economy US$30 trillion by 2031. Tobacco use is the one risk factor common to four major NCDs: cancers, cardiovascular and lung disease, and diabetes.
*Dr. Esperanza Cerón Villaquirán, Head of “Educar Consumidores” ( Educating Consumers), Colombia.
**Dr. Carlos Farías , President of COLAT (civil society tobacco control network), Peru
***Dr. Eduardo Bianco, FCA Latin American Director and President of CIET, Uruguay