Deltoid

International Public Health Strategy

For a variety of reasons (not fully discussed here) western public health officials are pursuing objectives which may be incompatible with sound science, economic efficiency and even social justice. My work till now has focused on highlighting the dangers for governments of concentrating on minuscule risks to health, primarily because of pressure from loud interest groups. Policies such as the removal of the last nanogram of whatever pollutant from water supplies, or food products, reduce wealth and freedom, and indirectly can be harmful to health (see Pfizer Forum article for expansion of these ideas). Books like What Risk? have attempted to explain the folly of chemophobia and the lack of sound scientific basis for these pressure group demands, and have developed arguments to show the indirect harms to health of policies.

We have had significant media attention to our ideas and have supporters within political circles. The idea of sound science, thresholds and tradeoffs, have been enhanced, and appear periodically in circles of opinion formers. However, we have been, and will probably remain, largely unsuccessful in changing policy for several reasons:

• Our ideological supporters are believed to have hidden agendas - the vested interests of industry and pro-industry politicians.
• Our arguments are often too complex, and cannot be simplified easily.
• We have chosen difficult issues on which to make our case, often reacting to our opponents' arguments.
• Changing opinions on deeply-held beliefs can take decades.
• Our victories are small, and our opponents often use them to raise even more funds in support of their case.
• Our opponents are quite disparate, yet we have not divided them and shown each how the other's agenda is damaging their own.

To be more successful we need to do the following:

• Simplify our arguments.
• Pick issues on which we can divide our opponents and win. Make our case on our terms, not on the terms of our opponents - malaria prevention is a good example.
• Show our opponents where their alleged allies are harming their cause
• environmental regulations often harm public health in the west and western policies often harm health in Less Developed Countries (LDCs).
• Target messages to show politicians and journalists how to make political capital out of supporting our ideas.
• Involve opinion formers in LDCs to make our case.

How to achieve our objectives.

The last suggestion in the above list is probably the most important in the short run, The environmental movement has been successful in most of its campaigns as it has been 'politically correct', if not always ethical. Opposing dumping waste/oil platforms at sea, makes little scientific sense, but when put in terms of "desecrating the oceans, and killing defenceless fish", it is a media winner. Similarly, fighting against culling elephants is a simple case to make in the media - defenceless animals being shot by callous poachers. It is, superficially at least, surprising that this is an issue that the greens have lost (for the moment). However, they lost because black southern Africans with emotional appeals of eco-imperial-induced poverty, backed by sensible intellectual arguments, overturned a ban on ivory trading in the face of opposition by nearly every western politician and all environmental groups. In short they had the correct blend of political correctness (they were oppressed blacks) and arguments (eco-imperialism was undermining their future and their right to self-determination).

In the public health issues that I have been involved in we have never won a battle like this, not because we have not had the best arguments, but because we did not have the right people telling them. Bearing this in mind I propose to do the following:

1. Provide the intellectual arguments to make our case (details below)
2. Disseminate these arguments to people in LDCs who could in principle, be motivated to help scientists, media, politicians in LDCs
3. Work with public affairs agencies to develop arguments that mobilise public support in LDCs to put pressure on politicians.
4. Work with those in the west who have reasons to promote these arguments.

Intellectual arguments

The first stage is to develop some literature which explains the harm that a preoccupation with virtual risks in the west is causing in LDCs (to create support in the LDCs). At the same time we must continue to explain the dangers this preoccupation has for those in the west (to increase support in the west). The aim of the papers will be to highlight two tensions : between the actions of environmental and public health policies, and between OECD and LDC aims. It will also question what the aims of international health agencies (primarily WHO) should be.

A book is proposed, "Environmental Health : third world dangers, first world preoccupations" (outline attached). Authors are already contacted and commissioned. The publisher will be Butterworth Heinemann who published What Risk? This will address, third world problems such as Cholera and Malaria, and first world preoccupations such as chemophobia (and fears of endocrine disruption) and food additives.

Dissemination of ideas.

We would disseminate this book widely in English speaking LDCs. Starting in Southern Africa (South Africa, Zimbabwe, Botswana), and probably Kenya in the East, then moving elsewhere. Hopefully recruiting supporters, potential authors, and even political support. Perhaps follow up the dissemination of the books with a speaking tour to shore up support.

As part of this process I have produced a cut-down version of What Risk?, with two new papers, for think tanks to publish in their own languages/countries. So far the only agreement is with the Indian Center for Civil Society who will publish a version in the fall. Countries which will probably publish a version are South Africa, Chile/Argentina and Australia. Each will provide a speaking platform for me, and work with local media - however, all will require some funding support. Other countries are still to be approached.

The second stage in the process will be to concentrate on one issue - malaria.

Malaria Strategy

A new initiative to bring interest back into combating malaria, Africa Fighting Malaria, will be collection of groups of individuals and institutes, working from a base in Cape Town, South Africa.

Cape Town is an ideal location because it has good communications, it is the site of the influential South African parliament, and several leading academics working on malaria. Also, a new WHO-backed malaria mapping initiative was established earlier in the year in Cape Town, as was the new UN Dams Commission (part of whose job is to analyse health problems (including vector borne diseases) from dam development).

Much as in the public health strategy mentioned above the initial aim will be to provide intellectual arguments for why a new campaign on malaria is desirable.

Malaria kills 2 million a year and infects 500m - of whom 90% are in Africa - more than any other disease. It can be controlled with pesticide spraying of huts, prophylactic medicines, and essentially, good water control so there are fewer breeding grounds for the malarial mosquito. It was eradicated from Southern Europe and Southern US states in 1940s.

A book on malaria, either written by one author, or as a collection of papers would be a good start. Key issues to be explored are : how malaria was eradicated in many parts of the world (WHO-backed DDT programmes), why it came back (spraying DDT was banned under pressure from US greens), why, when alternatives for DDT have been developed, and new evidence shows that DDT is less harmful than originally thought, have no new programmes been announced until now (green pressure to ban all chlorine-based replacements, lack of interest from west in 70s-90s), why countries don't use their DDT stockpiles when they could save lives (Western governments won't import crops with DDT residues, and can't under restrictive UN plans).

Like the public health book, this will create tensions between LDCs and OECD countries and between public health and environment.

Intellectual issues to be resolved

• Is the DDT problem still relevant? Who has what pesticides, stockpiles of what? Can LDCs buy the new pesticides?
• What will be impact of Brundtland's new WHO initiative, what new action and investment? What targets for eradication?
• Can African's do it alone? (Dr Basil Sharp of MARA in Cape Town believes they can)
• What will be South African DoH initiatives?
• Will Zimbabwe use DDT in 1999?

Who do we need help from and how do we recruit scientists/public health officials/journalists/politicians and others to advocate the position, once the book is done?

Scientists - ESEF name should encourage them to join as well as their professional interest.

Public Health Officials - as above plus political need to show concern

Journalists - contrast of western indifference to death in LDCs (regardless of rhetoric) and preoccupation with virtual risks in west.

Politicians - looking for an issue to make a name on, concern about misuse of government funds on issues of little relevance.

Multilateral Agencies

The third part of the strategy will be to constructively look at the future role of international agencies such as UNEP, UNDP, WHO etc. For example, WHO's new Director General Gro Harlem Brundtland comes from an environmental background. As the originator of the phrase 'sustainable development', and a guiding light in both the Montreal Protocol, and Rio Summit, she has a superb grasp on manipulating international political structures. According to one insider she is after the top job at UN. Her two targets of malaria and tobacco control if 'successful' could propel her towards that goal. The tobacco control protocol is based upon the Montreal Protocol and as such, although she did not originate the tobacco document, she is comfortable with its approach. Indeed, the tobacco control document may lead to a binding WHO/UN convention.

At UNEP, the desire to push through treaties on Persistent Organic Pollutants, Climate Change, Hazardous Waste, to name but a few draw heavily on the Montreal Protocol as well. However, the Montreal Protocol is highly flawed (like the tobacco control document). It contains inaccuracies, cost underestimation and dubious ethics. To influence the direction of future UN legislation we must criticise the Montreal Protocol. A paper is proposed to accurately apply the lessons learned from the Montreal Protocol to new or developing conventions (especially POPs, tobacco and climate change).