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1. Opening and Welcome

Dr Bill Kean, Director, Department of Governance, WHO, opened the 6th Session of the

United Nations Ad Hoc Interagency Task Force on Tobacco Control (hereafter, "the Task Force") by stating that this is a critical and propitious time for the objectives of the Task Force, ahead of implementation of the WHO FCTC.

Mr Assane Diop, Executive Director, Social Protection Sector, ILO and host of the Task Force, emphasized in his welcome and introductory remarks that the fight against the tobacco epidemic cannot be led by one agency alone. He mentioned deaths, poverty and workplace implications of tobacco as compelling reasons for interagency cooperation.

Dr Catherine Le Galès-Camus, Assistant Director-General, NHM, WHO, cited progress on this front since the last meeting of this group in October 2003, noting that the WHO FCTC now has 114 Contracting Parties. Further ratification and implementation will require the cooperation of sister agencies at the UN, and other institutions.

2. Update of TFI's work since the fifth session of the Task Force Dr. Yumiko Mochizuki provided an overview of TFI's recent work, casting it in the context of a model of how science, knowledge and intelligence interact to inform policy development, within the constraints and opportunities presented by human, institutional and financial resources, and, ultimately, lead to a tobacco-free global network. In this paradigm of core TFI functions, communications and media play an important role in moving the entire process forward. She cites as important next steps in "climbing the Tobacco-Free Mountain": 1) supporting implementation of the WHO FCTC, 2) strengthening research, development and collaboration, 3) developing resources for advisory and training services, 4) enhancing communications around tobacco control and the WHO FCTC and 5) developing databases of key indicators for further monitoring tobacco control efforts.

WHO regional representatives then gave a summary of their progress since the last meeting.

The representative from PAHO announced that awareness raising workshops had been held in three of the four sub regions, to encourage ratification and buy in of the WHO FCTC. Among countries that had already ratified, a workshop on packaging and labelling was held. She refers to both Chile and Brazil as notable successes in the region on the tobacco-free front. In research and surveillance, she touched on the ongoing activities related to the Global Youth Tobacco Survey (GYTS), and the Pan American Tobacco Information Online System (PATIOS), a web-based information system containing country-specific data on a wide variety of tobacco control topics, which should be up and running in the first half of next year.

The representative from EURO reported three policy papers relating to taxation, cessation and smoke-free workplaces. The first two have already been published, the one on smoke-free workplaces is to come out this year. There have been workshops in the Balkans, the Baltic countries and CIS, but further work is required and expected for 2006 in these sub regions. She announced continued funding from the Norwegian government for EURO's activities in tobacco control for the coming year. She also mentioned that since 2003 EURO has a database on tobacco control on its website. Apart from data on prevalence, consumption taxation, deaths from tobacco etc., the database now includes information about the tobacco control regulations in the countries of EURO.

3. Update on agency activities related to tobacco control

ILO: External activities in tobacco are largely comprised within the SOLVE program, which tackles a number of related psychosocial issues in the workplace. However, a paper on Workplace smoking specifically was published by ILO in 2004. It reviews national and local and practical regulatory measures for smoking in the workplace; it can be found on ILO's website. Internally, the ILO promotes a smoke free policy in all of its building, but for three designated areas. ILO officer will be looking at this policy and how it serves the health needs of ILO workers.

UNICEF: The representative from UNICEF stated that the organization has been actively working on the issue of tobacco and child and adolescent health since the World Summit on Children, in many countries including Jordan, Sri Lanka, China and Central Eastern Europe. He reminded the audience that tobacco use is a serious concern for children as 250 million children alive today will die from tobacco use in later life. He highlighted the CIS region as being of particular concern, given its increasing consumption trend. He also raised UNICEF's concern with the increasing trend in tobacco use among the youth in the European region.

FAO: The FAO highlighted its "Projections of Tobacco Production, Consumption and Trade to the year 2010" paper, financed by the government of Sweden, as an example of the work it has done in the field of tobacco. The document presents a review of existing literature, and develops a database of basic supply, demand and trade statistics for the 1980-1999 period. It also provides projections until the year 2010. The FAO has also been involved in no less than 6 case studies (Brazil China, India, Malawi, Turkey and Zimbabwe), all of which are available on the FAO website. There are no ongoing activities for the moment, but the FAO is certainly willing to be involved if there is an expressed need, backed by funding. The representative from the FAO highlighted the need to examine alternatives to diversification.

UNESCO: Internally, UNESCO's work on the smoking front changed considerably about 2 years ago with a change in senior management. Externally, however, activities have slowed considerably, given the request of Member States that the UNESCO streamline its activities. Resources are being focused on the issue of HIV/AIDS.

World Bank: The WB policy remains fully supportive of activities in tobacco control.

Practically speaking, the question remains how to best deploy its comparative advantage.

In the past, this has meant some stand-alone initiatives, in Indonesia and Uzbekistan to list just two examples. Moving forward, the WB welcomes the opportunities for joint efforts with other UN agencies and external bodies to have maximum effect. The participant suggested that while the classic MDGs emphasized communicable diseases and maternal health, in some settings there were more health gains to be made from tackling non-communicable diseases. He cited a World Bank study on Eastern Europe and Central Asia which concludes that policies in the region must supplement the classical MDGs with indicators of adult health, in particular cardiovascular diseases and external causes of death in order to achieve a greater impact,.

The advantages of tobacco control must be clearly communicated in economic terms to the WB to ensure their involvement. To a certain extent, this buy-in is already occurring, as in the example of Russia.

UNOG: The UNOG representative remarked that the agency was moving toward a smoke free workplace, but was not there entirely.

European Commission: The representative acknowledged that the EC had been widely criticized during the negotiation phase of the WHO FCTC due to its existing tobacco subsidies. He reported, however, that these subsidies would be abolished, effective 2008.

On the advertising front, he noted that a court case had recently been won on oral tobacco, reinforcing the position that Member States had to implement the directives of the WHO FCTC on this issue. He notes the existence of a concerted effort by some within the industry to promote alternative tobacco products such as chewing tobacco as a harm reduction strategy -- on this, he encourages the WHO to provide Parties to the Convention with some guidance. He would also like to see more guidance and a clear scientific position from WHO on tobacco product regulation.

4. WHO update on progress since the fifth session Main conclusions of the third Secretary General's report to ECOSOC at its Substantive Session of July 2004 and the ECOSOC Resolution on Tobacco Control (Dr Douglas Bettcher) Dr Bettcher gave an overview of the main conclusions and recommendations contained in the third Secretary General's report to ECOSOC: 1) tobacco control has to be recognized as a key component of efforts to reduce poverty, improve development and progress towards the Millennium Development Goals ; 2) with the implementation of the WHO FCTC, tobacco control should be taken into consideration at the Resident Coordinator system level to ensure technical cooperation at the country level; 3) tobacco use needs to be addressed in a multisectoral way; 4) the issue of tobacco control could be included in forthcoming activities of the UN Development Group; 5) tobacco control could also be included in the agendas of the regional economic commissions (eg. ESCAP) The resolution adopted by the Member States of ECOSOC, following the presentation of the Secretary-General's report at the Substantive Session of ECOSOC on 16 July 2004, recognizes the adverse impact of tobacco use on poverty. In light of the WHO

Framework Convention on Tobacco Control, it:

• calls upon Member States that have not yet done so, to consider becoming Parties to the Convention;

• urges Member States to strengthen tobacco control measures;

• calls upon UN agencies, funds, programmes and other international organizations to provide support for strengthening national and international tobacco control programmes.

5. Smoke free workplaces - Evidence and practical approaches.

Overview of the recommendations on Environmental Tobacco Smoke and Overview of the Smoke-free Americas Initiative (Ms Heather Selin) Ms Selin, PAHO, spoke of a domino effect amongst countries in the adoption of smoke free environment policies. The WHO FCTC has further fuelled the momentum on this front. The Smoke Free Americas program, launched on World No Tobacco Day in 2001, seeks to build awareness about Second Hand Smoke (SHS) through work shops, media campaigns, seed grants, research and its website. The representative from PAHO stated that official statements and recommendations from the WHO can prove immensely valuable in some countries. The speaker also talked about the Meeting of Experts, Montevideo, Uruguay, 1-3 November 2005. Meeting conclusions and recommendations will form part of published WHO policy recommendations; input from others will also be solicited. These comment on: the negative health effects of SHS, non-existence of alternatives to smoke free environments, the mitigating impact of smoke-free environments on tobacco use, and the positive economic effect of smoke-free environments. Policy development should follow the principles of maximum, universal and legislated protection.

Summary of the EURO report on ETS (Ms Kristina Mauer)

Ms Mauer, EURO, presented elements of the joint WHO/EURO Policy Paper "Legislating for Smoke-Free Workplaces", arguing in favor of such legislation, and highlighting experience from some of the 52 countries examined in the region. The paper finds that public opinion is favorable to workplace bans: the health consequences of exposure to tobacco smoke are widely known in the region, and thus bans on smoking in public places are widely legislated and accepted. Though the main aim is to protect nonsmokers, workplace bans also raise the motivation of smokers to quit, therefore the issue is relevant for both, smokers and non-smokers. Existing evidence indicates that: 1) a voluntary agreement is not an effective measure; 2) ventilation technology is not sufficiently effective to remove the risk of tobacco smoke to health and therefore can not be recommended as a Europe-wide measure; 3) a total ban without exemptions is the best option and easier to enforce. A key factor for successful legislation and its enforcement is the attitude of the population; therefore a proper preparation and prior public consultation process is encouraged. The evidence-based success of the implementation of smoke-free legislation in Ireland, Norway and Italy provides a convincing argument in the political debate. Recent studies indicate that smoking bans do not have an adverse economic effect on trade in the hospitality sector. Such studies should be promoted further to make the economic arguments as convincing as those in public health.

Environmental tobacco smoke (ETS) should be classified as a carcinogen for humans following the example of Finland, which has listed ETS as a workplace carcinogen in its national legislation. The strength of this study derives from the fact that was launched at the request of Member States, and from its wide consultative process. The country cases and lessons learned provided a practical tool that was much appreciated.

ILO - SOLVE: Addressing Psychosocial Problems at Work (Dr David Gold and Dr Joannah Caborn) Dr Gold and Dr Caborn, ILO, made a comprehensive presentation of the SOLVE program. SOLVE stands for Stress, tobaccO, alcohoL & drugs, hiV/aids and violencE.

SOLVE can be used to address tobacco as a stressor or as a consequence of other psychosocial problems. SOLVE is a comprehensive program to tackle psychosocial problems in the workplace In fact, SOLVE addresses 7 of the top ten health hazards cited by the WHO World Health Report of 2002, namely: underweight, unsafe sex, high blood pressure, tobacco, alcohol, iron deficiency and high cholesterol and obesity. Psychosocial problems can lead, at the individual level, to higher risk of accident, increased family or social problems, stigmatization and discrimination, deteriorating health, physical or psychological illness, pain, distress, disability and death. At the organizational level, the consequences of untreated psychosocial problems are: poor morale, increased absenteeism, presenteeism, turnover, reduced productivity, reduced profits or services, higher costs and reduced competitiveness. A study by the Health Management Resource Center of the University of Michigan concludes that the cost associated with an increase in health risk factors is more than twice the amount saved by the reduction of risk factors.

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