Clark (2013a) has stated the United Nations Development Programme (UNDP) position on non-communicable diseases (NCDs) in her article in a well-regarded scientific journal. The authors have contested these assertions (Lal et al. 2013). Our contention is this: United Nations (UN) agencies routinely partner with and accept funds from the tobacco industry and their front groups, which fundamentally undermines concerted global efforts to combat NCDs.
Globalisation has led to a range of increasing interdependencies across the world. With decreasing communications and transportation costs, greater financial integration and capital mobility, multinational companies have a greater degree of access to demographically burgeoning growth markets – the bulk of which are in low- and middle-income countries (LMICs). As in the case of the proliferation of tobacco use, the degree of increase in consumption of soft drinks and processed foods high in salt, fat and sugar is very high in LMICs, surpassing that of higher income countries (Stuckler et al. 2012). One study asserts that the ‘higher intake of unhealthy foods correlates strongly with higher tobacco and alcohol sales, suggesting a set of common tactics by industries producing unhealthy commodities’ (Stuckler et al. 2012). These unhealthy commodities are leading risk factors for various NCDs, and manufacturers including tobacco companies are focusing on increasing sales of their products in developing country markets. Although tobacco use has been highest in high-income countries, sustained marketing efforts in LMICs have proved to be very effective. In fact, the consumption of tobacco has shifted at a higher rate to LMICs. Between 1990 and 2009, when cigarette consumption in Western Europe dropped by 26%, it rose by 57% in Africa and the Middle East (Eriksen et al. 2012).
A compelling matrix of facts highlights the relationship between international development agencies and the tobacco industry, which is at odds with the public health priorities of the agencies. At its core, the business model of the tobacco industry is premised on the sale of addictive and disease-causing substances that fuel NCDs in the first place. This simple and well-established fact cannot be overlooked. Therefore, the UNDP must at the least consider this embedded conflict of interests and clearly distinguish its negotiables from its non-negotiables, if the trajectory of reversing the effects of NCDs is ever to be achieved.
The UN system and the tobacco industry
Since the early 1990s, UN agencies have been encouraged to generate resources from the private sector. Owing to a lack of exclusion criteria and standards for partnership and participation, companies largely responsible for causing the NCD epidemic have ironically become development partners with UN agencies. This has not gone unnoticed.
In 2009, the UN's platform for industry engagement, UN Global Compact, recognised WHO's fight against tobacco but expressed its inability to exclude the tobacco industry – ‘Since tobacco is a legal product whose use UN Member States have not yet outlawed, the Global Compact Office is not able to exclude tobacco companies from the initiative if they still wish to join’ (UN 2008a). So, India's largest cigarette manufacturer, ITC Limited (UN 2008b), tobacco leaf growers Souza Cruz of Brazil (UN 2009) and Limbe Leaf Tobacco Company, Malawi (UN 2007a), plus diversified tobacco companies (Kraft Food Mexico) (UN 2007b) are now active participants engaging in global policy development across sectors – facilitated by the openings provided by UN Global Compact.
Another UN body – the UN Framework Convention for Climate Change (UNFCCC) – provides assistance to industry through the Clean Development Mechanism (CDM), directly benefiting British American Tobacco-affiliated (BAT) and other major tobacco companies in India, Pakistan and China (UNFCCC 2013). This continues despite incontrovertible evidence that tobacco cultivation causes massive environmental degradation (Geist & Lambin 2002). As a result of this willingness to ignore such hard facts, perverse incentives end up becoming an effect of institutional design. The UNDP's involvement with the tobacco industry can be similarly illustrated through a few examples. The Global Environment Facility (GEF), jointly hosted by the UNDP and the World Bank, has the tobacco industry formally partnering with it. Several UNDP-led projects in the Philippines (GEF 2005), Uganda (GEF 2005) and Tanzania (GEF 2005) have received financial support from tobacco companies such as Philip Morris and BAT. In Tanzania, for example, the GEF supported a reforestation programme with the aim of sustaining the long-term benefits to tobacco farmers by providing them fuel for curing tobacco, where deforestation was actually caused by tobacco curing.
The tobacco industry endorsed as a partner by the UN has set a precedent by which a seriously problematic partnership has become prevalent practice. Today, influential non-governmental organisations and think-tanks, such as the World Wide Fund for Nature, World Economic Forum, the Energy Research Institute, Earthwatch and the Eurasia Group (Eurasia Foundation 2007), actively partner with tobacco companies.
Tobacco money directing public health programming
Public health is one arena where the implications and consequences of such a perverse partnership stand out. The tobacco industry offers substantial financial assistance to public health initiatives, being cognisant of the significant political mileage these partnerships bring (Philip 1982). For instance, the UN and WHO work closely with the Global Business Coalition against HIV/AIDS, which includes several tobacco companies such as British American Tobacco (GBCHealth 2008), Imperial Tobacco Group (GBCHealth 2010) and SABMiller Breweries (GBCHealth 2006), a Philip Morris International subsidiary.
The leverage gained by the tobacco industry through such associations has instrumentally diluted the WHO's intent to fight tobacco. An internal memo of British American Tobacco recorded that WHO was reluctant to expand its Tobacco or Health programme for fear of offending the United States. BAT noted that the American tobacco industry was well positioned within the US Congress and went on to describe the latter as ‘a body that loses no opportunity to threaten the UN system with cuts in funding’ (BAT 1991). BAT paid large consultancy fees to Paul Dietrich, former head of WHO's Latin American division, Pan American Health Organization (PAHO), who successfully diverted the focus away from tobacco to vaccination and HIV/AIDS (WHO 2000). Dietrich was working for the interests of the tobacco industry during his tenure at PAHO, a fact that is amply documented by the WHO's Tobacco-Free Initiative (WHO 2001) and peer-reviewed journals (Muggli & Hurt 2003). The Scientist (Godlee 2000) states that British American Tobacco ‘… give [Dietrich] credit for PAHO's decision that year to strike tobacco control from its budgetary priorities, in favour of immunisation and cholera campaigns’.
In the 1970s, Philip Morris took immunisation services to children in Guatemala (Philip 1971); WHO, UNDP and the United States Agency for International Development (USAID) partnered with India's largest cigarette maker, which distributed condoms and family planning services in hard-to-reach regions from 1992 to 1997 (USAID 1992; BAT 1993). These examples indicate that the relative openness of the UN system has afforded the tobacco industry an opportunity to gain currency and respectability at the global level and ironically influence health priorities. By partnering with the tobacco industry, the UNDP confers upon it an undeserved legitimacy, while facilitating the industry better access to global policymaking and subsidising the production of tobacco products using international aid. This inevitably calls into question the organisation's commitment to its agenda of combating NCDs.