Assuming the mantle: the balancing act facing the new WHO Director-General.
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Biomedical subjects
Publications and source records attributed to Kelley Lee.
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BACKGROUND: Cigarette smuggling is a major public health issue, stimulating increased tobacco consumption and undermining tobacco control measures. China is the ultimate prize among tobacco's emerging markets, and is also believed to have the world's largest cigarette smuggling problem. Previous work has demonstrated the complicity of British American Tobacco (BAT) in this illicit trade within Asia and the former Soviet Union. METHODS AND FINDINGS: This paper analyses internal documents of BAT available on site from the Guildford Depository and online from the BAT Document Archive. Documents dating from the early 1900s to 2003 were searched and indexed on a specially designed project database to enable the construction of an historical narrative. Document analysis incorporated several validation techniques within a hermeneutic process. This paper describes the huge scale of this illicit trade in China, amounting to billions of (United States) dollars in sales, and the key supply routes by which it has been conducted. It examines BAT's efforts to optimise earnings by restructuring operations, and controlling the supply chain and pricing of smuggled cigarettes. CONCLUSIONS: Our research shows that smuggling has been strategically critical to BAT's ongoing efforts to penetrate the Chinese market, and to its overall goal to become the leading company within an increasingly global industry. These findings support the need for concerted efforts to strengthen global collaboration to combat cigarette smuggling.
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The term "globalisation" tends to be misused and overused. We need greater clarity in our understanding of the globalisation process, including the distinct changes involved and their relation to human health. The health impacts of globalisation are simultaneously positive and negative, varying according to factors such as geographical location, sex, age, ethnic origin, education level, and socioeconomic status. Globalisation is not an unstoppable force. Our key challenge is to create socially and environmentally sustainable forms of globalisation that provide the greatest benefits and least costs, shared more equitably than is currently the case. The health community must engage more directly in current research and policy debates on globalisation and encourage values that promote human health. At the same time, those at the helm of globalisation processes must recognise that attending to health impacts will strengthen the long-term sustainability of globalisation.
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The globalization of the world economy and changing trade relations have major public health implications. The trading community's foremost concern has been to minimize the perceived interference by health issues with freer trade. The exploration of how trade liberalization is affecting determinants of health is well underway and has attracted worldwide attention. Importantly, the professional community has engaged trade-related organizations to ensure proper representation of public health interests. The UN's World Health Organization (WHO) is mandated "to act as the directing and coordinating authority on international health work." This responsibility obligates it to address major trends that impinge on human health. The article suggests areas of study to strengthen the WHO's role and urges that it reevaluate its traditional focus on working with the health ministries of its member states. In many ways, public health is still playing "catch up" with powerful vested interests. New tools and strategies are needed.
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The security and foreign policy communities have increasingly addressed global health problems as threats to national security. Global health is a humanitarian endeavour that seeks to improve the world's health including the most vulnerable peoples, while national security works to protect the interests of people within a given state. The major statements of security policy by the United States and United Kingdom link the self-protective interests of national security with the humanitarian objectives of global health. While there is potential to expand global health activities through partnership with the security and foreign policy communities, treating global health issues as national security threats may focus attention disproportionately on countries or diseases which pose security threats to wealthy nations, rather than on the greatest threats to global health. The global health community should carefully scrutinise areas where global health and national security interests overlap.