Making a dramatic impact?
New Zealand prides itself for punching above its weight on the world stage. Ashley Bloomfield argues we play an important role in the international response to tobacco, alcohol and illicit drugs.
“All the World’s a Stage and all the men and women merely players” - William Shakespeare’s As You Like It (II, vii, 139-143)
New Zealand is an active participant in United Nations (UN) efforts to address the public health harms associated with tobacco, alcohol and illicit drug use. The ‘sets’ and ‘casts’ for these efforts differ, although at times the script feels remarkably similar. The World Health Organization (WHO) is the key UN organisation in the case of the (usually) legal drugs, tobacco and alcohol, while the UN Office on Drugs and Crime (UNODC) leads international efforts on illicit drugs.
Tobacco
The WHO Framework Convention on Tobacco Control (FCTC) is the first health-related international treaty. The FCTC was developed in response to the globalisation of the tobacco epidemic and clearly articulates the intention of parties to “…give priority to their right to protect public health.”
Consistent with the priority afforded our domestic tobacco control efforts New Zealand played a leading role in the negotiation of the FCTC. This process took several years, and required sustained input from both the Ministry of Health and Ministry of Foreign Affairs and Trade.
With the Treaty now ratified by around 145 countries – New Zealand was the seventh country to do so – the ‘real’ work of implementing its provisions is underway. For New Zealand, this is relatively straightforward as our only area of non-compliance relates to the size of warnings on tobacco packages. The introduction of pictorial warnings from February 2008 will address this.
I was involved in the FCTC’s first Conference of the Parties (COP) in Geneva in February 2006. Over two weeks, the parties negotiated and agreed on a work plan to start giving effect to the intent of the Treaty. Associate Minister Damien O’Connor attended the first three days, and the presence of a Minister added greatly to New Zealand’s profile.
Once the business started, it was a busy time for the remaining New Zealand delegation of two – a Geneva-based MFAT official and myself. New Zealand was instrumental in ensuring progress on several key issues, ranging from the agreement on how to progress guidelines on smokefree environments, to agreeing a clear process for establishing the FCTC secretariat. As on many issues, we worked closely with our colleagues from Australia and Pacific Island countries.
Only countries that had ratified the FCTC were able to actively participate in the decision-making. This meant a notable difference between this meeting and other UN meetings – a solitary and silent US delegate! Typically, the US has a large and vocal delegation. It has been interesting to watch the increasing influence of China at the WHO, and this was particularly notable at the COP – from the pre-lobbying to secure the Chair of the Western Pacific Region (WPRO) group, which includes New Zealand, to the slick and memorable address by the Chinese Ambassador.
Alcohol
Alcohol is a different ‘play’ from tobacco. The plot is similar but less predictable. It is more difficult to characterise the players as even the villains have some redeeming features. Likewise, the cast is somewhat larger, and the leading players have powerful and experienced agents.
A cross-government position on alcohol is essential. New Zealand’s wine exports are increasingly important, and any measures that might impinge on our trade interests or obligations require careful consultation with trade officials.
New Zealand’s previous Minister of Health, Hon Annette King, played an important role in getting alcohol onto the agenda of the World Health Assembly (WHA). She repeatedly raised the issue at regional WPRO meetings, receiving good support from the Health Ministers of Pacific Islands countries. The public health problems caused by harmful use of alcohol finally made it to the agenda of the 2005 WHA, where it rapidly became the central issue.
Multilateral action is agreed at UN meetings through the negotiation of resolutions. Agreement on an alcohol resolution in 2005 took the best part of a week, with regular meetings of a drafting group of interested countries. Of arguably more importance were the endless corridor conversations and lunchtime huddles to test and refine wording for the resolution, and gauge or seek support for different positions. New Zealand was active in these discussions, working closely with other like-minded countries – typically Canada, Norway, the UK (or EU) and Switzerland.
At one stage the delegate from Iceland, the sponsor of the resolution, requested additional time from the Chair of the responsible committee. His description of alcohol as a ‘tricky liquid’ was more than accurate, as the week’s deliberations proved.
Following eventual agreement on the resolution at WHA 2005, work began on regional responses. The WPRO region was the first to develop a draft strategy, supported in part by funding from New Zealand. The WPRO grouping has some interesting features. One member – China – has over 80 percent of the region’s population, while some Pacific Island countries have only a few thousand inhabitants, yet each country has just one vote. The US has a voice via Guam, and the UK via Pitcairn (all of 42 people).
The draft regional alcohol strategy was discussed at last year’s Regional Committee Meeting held in Auckland and chaired by our Minister of Health, Hon Pete Hodgson.
Again, it took the usual raft of meetings, corridor conversations and huddles in Auckland – as well as phone calls to MFAT to clarify New Zealand’s position – to agree the wording of the resolution accompanying the draft regional alcohol strategy. It was satisfying that the strategy was endorsed at the Auckland meeting, given the role New Zealand had played in instigating and supporting work on the topic.
Illicit drugs
The annual Commission on Narcotic Drugs (CND) in Vienna is a completely different genre from the WHO meetings. The work falls under the umbrella of the UN Office on Drugs and Crime, so approaches are weighted heavily towards enforcement and evidence is less of a driver of decisions.
Using the theatrical analogy, the CND ‘play’ sometimes appears to have the wrong script, but we press on regardless. The annual resolution on opium poppy production in Afghanistan is a case in point. While increasingly stringent enforcement measures alone appear to be having little effect to date, alternative approaches receive little consideration or are rejected outright.
The New Zealand delegation usually includes both Police and Health officials. This presents no obvious difficulties as we have an agreed National Drug Policy and interact regularly through our joint ownership (with Customs) of the National Drug Intelligence Bureau and participation on the Interagency Committee on Drugs.
While New Zealand is an observer rather than one of the 50 full CND members, we have the right to participate in discussions on resolutions. Again, we work closely with ‘like-mindeds’ such as the EU, Norway, Australia, Switzerland and Canada. It is interesting to observe tensions that arise from the very different approaches to illicit drugs supported by these countries and groupings – for example their explicit support for needle exchange schemes and other harm minimisation interventions – compared with those favoured by other developed countries such as the USA, Japan and Russia, which oppose such measures.
The quote from Shakespeare’s As You Like It accurately describes the key features of the international response to tobacco, alcohol and illicit drugs. All three are global commodities that require global action (or acting), and multilateral efforts to agree on those actions are something akin to theatre.
In my experience, New Zealand often has one of the leading or supporting roles rather than a non-speaking or walk-on role. I believe that there are three key reasons for this. First, our policy approaches are often progressive and world-leading – this was particularly evident for tobacco. Second, strong domestic political leadership provides our delegations with a clear mandate. Third, New Zealand is frequently viewed as an honest broker, able to work with different sides to find a solution when compromise is needed.
As in many areas of UN activity, New Zealand has made a strong contribution and, while those efforts have paid off, there is still much to be done to address the public health harms associated with drug use and misuse globally. There is no doubt that effective global action is in New Zealand’s interests.
Dr Ashley Bloomfield is the Chief Advisor Public Health at Ministry of Health, and chairs the Interagency Committee on Drugs.
