Environmental Engineering Reference
In-Depth Information
the Fctc process is here viewed as indicating a paradigmatic shift in tobacco control
but which has broader roots and relevance (ruger 2005). Indeed, the Fctc is
described as 'representing a shift in global health policy that recognizes the importance
of addressing health needs on multiple fronts and integrating public policies into a
comprehensive set of health improvement strategies' (ruger 2005, 65-66). In this
vein ruger depicts the Fctc as consistent with amartya Sen's (1999) capability
approach in which development is seen as the expansion of individual freedom.
Public Health as an Independent Actor
while each of the above models of the relationship between public health and
foreign policy communities captures significant features of the FCTC, none is
entirely convincing as an account of the process. the image of public health as
supplicant implies a degree of subordination to other agendas, which, although it
may be reasonably applied to brundtland's leadership project for wHo reform
by defenders of the 1978 Alma Ata agenda (the first international declaration to
underline the importance of primary health care), does not fit well with the particular
experience of tobacco policy. brundtland was remarkably successful in establishing
wHo leadership throughout international organisations on tobacco issues, and the
comparative strength of the eventual text bears testimony to the primacy of a health
agenda within the Fctc process.
the credibility of the trojan horse interpretation is, at least from a public health
standpoint, undermined through its advocacy by tobacco companies, their apologists,
and hired hands. Many veterans of the negotiations would doubtless be happy to
include the U.S. delegation among these dubious ranks, but Jacob's status as a key
participant lends his critique greater significance. His account, however, offers a
caricature of the negotiation process that greatly exaggerates the impact of civil
society organisations, gives an inadequate (and often patronising) account of the
role of developing countries, and is silent on the controversies surrounding the U.S.
contribution to negotiations. the impact of his scathing account is also somewhat
diluted by the endorsement that he ultimately lends the prospect of U.S. ratification
of the Fctc and his approval of the broader impacts of the process.
by contrast, the partnership model accurately portrays important drivers of the
process, particularly regarding relations between Un agencies. but this interpretation
of the relationship between policy communities leaves important questions unasked
regarding the terms on which such communities are brought together, the power
dynamics between them, and the basis on which disputes are resolved (lee and
McInnes 2004).
the image of public health as an independent actor ultimately appears to offer
the most convincing depiction of the Fctc, since it most clearly recognises the
leadership role of the wHo and the primacy of public health in agenda setting and
policy formulation. at the global level, the wHo actively sought the support of
other Un agencies and particularly the world bank for an innovative health policy
agenda. brundtland's global tobacco control initiative appealed to the foreign
