South-East Asian Diabetes Summit to open up in India

South-East Asian Diabetes Summit to open up in India

The Diabetes Summit for South East Asia is being organized in Chennai from 28th to 30th November 2008, by the World Diabetes Foundation ( WDF) , in collaboration with the World Health Organization (WHO), South East Asia Regional office (SEARO), the International Diabetes Federation (IDF) and the World Bank.

The aim of this summit is to serve as a forum where key stakeholders, in the area of non communicable diseases (primarily diabetes), can interact with key opinion leaders, international media and WDF partners, with a view to encourage policy makers to prioritize prevention, care and treatment of diabetes in the developing world in a sustainable manner.

Diabetes is one of the fastest growing diseases in the world with over 230 million people already affected. It is the world’s leading cause of heart disease, stroke, blindness, kidney disease and lower limb amputation. The incidence of diabetes is five times higher among Asians than in white populations. An estimated 3.8 million people died in 2007, globally, because of diabetes. In India, unwittingly known as the ‘diabetes capital of the world’, an estimated 40.9 million people were living with diabetes in 2007. This figure is projected to rise to 69.9 million by 2025, making every fifth person living with diabetes to be an Indian. WHO estimates that mortality from diabetes and heart disease cost India $210 billion yearly in terms of lost productivity resulting from premature deaths. This is likely to increase to $335 billion yearly in the next 10 years..

What is diabetes?
It is a condition in which the body cannot regulate the amount of glucose in the blood. Glucose is produced by the liver from the food we eat and its level is regulated by several hormones, including insulin which is produced by the pancreas. Insulin allows glucose to move from blood to liver, muscle and fat cells where it is used as fuel/energy. People with diabetes either do not produce enough insulin (Type 1 diabetes) or cannot use insulin properly (Type 2 diabetes). Thus the glucose stays in the blood, harming other tissues/ organs as they are exposed to high glucose levels. At the same time, cells are deprived of glucose for energy. The normal fasting blood glucose level is about 100mg/dl and post lunch level is 140mg/dl.

Type- 1 diabetes: It is an auto immune disorder in which the body’s immune system attacks the cells producing insulin. Thus the body either does not produce any insulin or too little of it. The cause could be genetic or due to environmental triggers. It is typically recognized in childhood and adolescence, often in association with an illness—viral or urinary tract infection or some injury. In older persons it can occur due to destruction of pancreas by alcohol/ disease/ surgical removal/ progressive failure of pancreatic beta cells which produce insulin.

The warning signs are nausea, vomiting, dehydration, excessive thirst, frequent urination, constant hunger and unexplained weight loss, extreme tiredness, blurred vision.

Treatment of this type of diabetes entails daily insulin injections of correct dosage to be taken, generally before meals, coupled with a consistent healthy diet. As of now, its onset cannot be prevented, but it can definitely be controlled.

Type- 2 diabetes: It occurs when the body is unable to process the insulin produced by the pancreas. This is called insulin resistance. The pancreas try to overcome this by producing still more insulin, thus compounding the problem. It is typically recognized in adulthood, usually after 45years of age. But now it occurs in children also, which indeed is worrisome. The cause for this type of diabetes could be genetic. But in most cases it is due to a sedentary life style coupled with unhealthy dietary habits and obesity.

The symptoms of this type of diabetes are excessive thirst, frequent urination, lethargy, slow healing wounds, itching and skin infections, blurred vision, irritability, weight loss. It can usually be controlled with proper diet (which is high in fiber and low in saturated fats), weight control, physical exercise and oral medication. But sometimes, insulin is required to control the blood sugar levels.

Gestational diabetes: it occurs during the second half of pregnancy and typically goes away after delivery. But such women are more likely to develop Type- 2 diabetes later in life. There has been an eight-fold increase in its occurrence in the last two decades. This might be because women are having babies when they are older or because obesity (a risk factor for diabetes) is increasing. The extra stress on the body during pregnancy can also result in high glucose levels. As it is, insulin needs in pregnancy are two or three times greater than normal from about 24 weeks. Up to 16% of women develop gestational diabetes and it is usually detected with a routine glucose tolerance test between 24 and 28 weeks of pregnancy. Babies of women with gestational diabetes could have problems too. They are larger in size, putting them at risk during delivery. Also, they are more prone to developing Type-2 diabetes later in life.

Diabetes is taking a huge toll of human health and life, particularly in developing countries like India . Type 2 diabetes is assuming epic proportions and holding an entire generation to ransom. It is affecting an increasing number of children/ adolescents from all income groups. In India , there has been a tenfold increase in childhood onset of Type-2 diabetes in the last 20 years.

Diabetes in children is a global public health issue with close to 305,000 children living with diabetes world wide. In fact, Tamilnadu ( the state in which this summit is being held) is contemplating to declare those living with Type-1 diabetes as ‘metabolically challenged’, putting them at par with other disabled persons in terms of availing government benefits and schemes including reservations. This move might bring positive reinforcement into the fight against diabetes; but it may also lead to a stigmatization of those affected.

In countries like India , lack of proper health care infrastructure, rampant ignorance and absence of clear cut guidelines makes the approach to diabetes ad hoc. Lack of awareness in patients and poverty is a key factor in improper care. There is need for an integrated public health policy for screening and care of diabetes.

Drastic and immediate preventive measures are needed at the community and media level. Community action should involve improved maternal nutrition, periodical health checkup camps in schools, promoting healthy living in school, at home and at the work place.

Mass media campaigns to spread awareness about diabetes and its related complications can go a long way in educating the public. There is also the need to spread the message that diabetes can be prevented/ controlled in most cases by simply adopting healthy eating habits and an active life style.

We hope that the efforts of WDF for prevention and care of diabetes in the developing world, by acting as a catalyst to help others globally create awareness, care and relief to those impacted by the disease, will bear fruitful results.

Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).

Japan among 160 countries meeting to limit big tobacco's influence

Japan among 160 countries meeting to limit big tobacco's influence

DURBAN: Representatives from Japan are among the 160 ratifying countries meeting this week in South Africa to negotiate guidelines for a provision in the global tobacco treaty that may determine whether millions get the health protections they are now guaranteed under the treaty. And the Japanese government's 50 percent holding in Japan Tobacco International (JTI) is already threatening to slow progress in the negotiations.

The negotiations center on the implementation of Article 5.3, which protects the treaty and related public health policies from tobacco industry interference.

At stake this week is how narrowly or broadly these protections are defined. If defined broadly, ratifying countries will recognize the tobacco industry's fundamental conflict with public health, and reject collaboration with tobacco giants like JTI, Philip Morris International (PMI) and British American Tobacco (BAT). If defined narrowly, Big Tobacco could continue to gain influence with governments, and demand a seat at the table when public health policies are being developed.

"Industry interference is the number one obstacle to the implementation and enforcement of the global tobacco treaty," said Kathy Mulvey , international policy director of Corporate Accountability International. "Article 5.3 is the lynchpin of the treaty, determining whether or not countries will be able to reverse this preventable epidemic without Big Tobacco standing in their way."

The global tobacco treaty, formally called the Framework Convention on Tobacco Control (FCTC), took effect in 2005 and now protects more than 85 percent of the world's population. But efforts to implement the treaty are being systematically stymied by tobacco transnationals like JTI, reinforcing the importance of this week's third Conference of the Parties (COP) in Durban .

Mulvey's organization and its partners around the Pacific Rim are advocating for firewalls that make no special exceptions for state-owned corporations when it comes to the treaty's prohibitions on industry interference in health policy. The party from Japan has already made clear their intention to weaken any guidelines for the treaty's implementation with respect to state-owned tobacco corporations.

Since negotiations on the global tobacco treaty began in 1999, the Japanese Ministry of Finance has been heavily represented at treaty meetings, with the country often playing an obstructionist role. This has earned them multiple "Marlboro Man Awards" for actions at odds with public health and the spirit of the treaty.

"We are optimistic this time that Parties like Japan will keep the interests of our children's health closer to their heart than those of tobacco transnationals," said Network for Accountability of Tobacco Transnationals (NATT) Spokesperson Bobby Ramakant. "But we know from experience that some will act from the pocket when the circumstance demands they act from the heart."

Corporate Accountability International, with observer status at the COP, and its allies in NATT believe that the following provisions of the draft Article 5.3 guidelines must be maintained:
- Prohibitions on government partnership or collaboration with the tobacco industry.
- Protections against conflicts of interest for those involved in setting and implementing tobacco control policies.

Corporate Accountability and NATT are calling for the draft Article 5.3 guidelines to be strengthened, in order to:
- Avoid government interaction with the tobacco industry, and set strict rules of engagement for any meetings determined to be necessary.
- Ensure transparency around government interaction with the tobacco industry and around tobacco industry activities and operations.
- Emphasize the tobacco industry's fundamental conflict with public health.

"If we don't lay out clear terms now about the tobacco industry's fundamental conflict of interest when it comes to health policy making, it may cost us everything we have achieved through this treaty in turn," said Akinbode Oluwafemi of Environmental Rights Action/Friends of the Earth-Nigeria, a member of the Network for Accountability of Tobacco Transnationals (NATT). "We are dealing with an industry bent on protecting its profit interest at all human expense - an industry that has written the book on policy manipulation and interference."

Addressing HIV and IDU issues vital for TB programmes in Nepal

Addressing HIV and IDU issues vital for TB programmes in Nepal

More than 90% of the diagnosed TB patients are successfully completing treatment in Nepal today. Nepal's anti-TB programme has received appreciation in the south-east Asian region which is the result of ongoing government commitment, community support, forging wide range of partnerships, and the use of innovative ways of ensuring access to Directly Observed Treatment Shortcourse (DOTS) - especially in remote areas, says Dr Dirgh Singh Bam, Secretary, Ministry of Health, Nepal, who is also the former Vice-President of Nepal's Anti-Tuberculosis Association (NATA).

However it is due to poor programme performance of DOTS that ups the drug-resistant forms of TB including the multi drug-resistant TB (MDR TB). Up to 1.8% of new TB infections in Nepal, are of MDR-TB, informs Dr Bam.

MDR-TB is resistant to at least two of the best anti-TB drugs, isoniazid and rifampicin. These drugs are considered first-line drugs and are used to treat all persons with TB disease. Resistance to anti-TB drugs can occur when these drugs are misused or mismanaged. Examples include when patients do not complete their full course of treatment; when health-care providers prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs; when the supply of drugs is not always available; or when the drugs are of poor quality, says Dr Bam.

Nepal reports up to 29% TB-HIV co-infection, says Dr Bam. He also talks about the TB and HIV co-infection, particularly among the injecting drug users (IDU). It is difficult to reach out to the IDU community to deliver healthcare services and need to work in partnerships is clearly critical. "Without addressing HIV and IDU issues, it will be very difficult to effectively respond to TB" says Dr Bam. People who use injecting drugs, and co-infected with HIV/TB, are also at increased risk of Hepatitis C (HCV) in Nepal.

Hepatitis C is a blood-borne, infectious, viral disease that is caused by the hepatitis C virus (HCV). The infection can cause liver inflammation that is often asymptomatic, but chronic hepatitis can lead to cirrhosis (scarring of the liver) and liver cancer. HCV transmission occurs when traces of blood from an infected person enter the body of a HCV-negative person. Like HIV, HCV is spread through sharing injection equipment, through needle stick or other sharps injuries, or less frequently from infected mothers to their babies.

HCV transmission rates are higher than that of HIV, and the condition is often more severe in drug users. People who share injection equipment are vulnerable to HCV and HIV infection, says Dr Bam. In Nepal, there is a separate health programme to respond to HCV, informs Dr Bam. However TB and HIV programmes in Nepal work much more collaboratively, says he.

"Community participation is very essential for effective TB/HIV care in Nepal" emphasizes Dr Bam. Patients who have successfully completed TB treatment were leading district level TB committees to improve TB programme performance in many instances in Nepal.

The Patients' Charter for Tuberculosis Care, outlines the rights and responsibilities of people with tuberculosis. It empowers people with the disease and their communities through this knowledge. Dr Bam feels if the Patients' Charter for Tuberculosis Care can be used as a tool to empower people with TB to be aware of their rights and responsibilities, then the TB programme performance will be improved furthermore.

Effective tobacco control policies in Nepal shaping up

Effective tobacco control policies in Nepal shaping up

Government delegation from Nepal is among those 160 countries' delegations currently meeting in Durban, South Africa, to negotiate guidelines for provisions of the global tobacco treaty (17-22 November 2008).

The negotiations centre on the implementation of Article 5.3, which protects the treaty and related public health policies from tobacco industry interference.

The global tobacco treaty, formally called the Framework Convention on Tobacco Control (FCTC), took effect in 2005 and now protects more than 85 percent of the world's population. But efforts to implement the treaty are being systematically stymied by tobacco transnationals, reinforcing the importance of this week's third Conference of the Parties (COP3) in Durban, South Africa.

Dr Dirgh Singh Bam, Secretary for Ministry of Health and Population, Government of Nepal, heads the Nepalese delegation at the COP3 negotiations.

"Tobacco industry is very strong" said Dr Bam, sharing his personal opinion. He further adds that "we will continue to need increasingly more amount of money to support tobacco control interventions if we don't put a check on the tobacco industry".

"There is no partnership with the tobacco industry in Nepal" said Dr Bam. The revenue which the tobacco provides the government is much less than the amount of money spent on treatment of tobacco-related diseases, says Dr Bam. This amount can be two or three times of the tobacco revenue, says Dr Bam.

"The civil society in Nepal played an active role in drafting the comprehensive tobacco control parliamentary bill which is still in the parliament" says a noted anti-tobacco activist Shanta Mulmi.

"Industry interference is the number one obstacle to the implementation and enforcement of the global tobacco treaty," said Kathy Mulvey, international policy director of Corporate Accountability International. "Article 5.3 is the lynchpin of the treaty, determining whether or not countries will be able to reverse this preventable epidemic without the tobacco industry standing in their way."

To prevent abuses reported in several countries, the Network for Accountability of Tobacco Transnationals (NATT) activists insist that the following provisions of the draft Article 5.3 guidelines would help prevent abuses:
- Prohibiting government partnership or collaboration with the tobacco industry.
- Protecting against conflicts of interest for those involved in setting and implementing tobacco control policies.

They are calling for the draft Article 5.3 guidelines to be strengthened, in order to:
- Avoid government interaction with the tobacco industry, and set strict rules of engagement for any meetings deemed to be necessary.
- Ensure transparency in government interaction with the tobacco industry and in tobacco industry activities and operations.
- Emphasize the tobacco industry's fundamental conflict with public health.

Since negotiations on the global tobacco treaty began in 1999, the tobacco industry has used its political and economic influence in an attempt to undermine, delay and water down public health measures.

If the government representatives of the 160 countries draft strong guidelines for Article 5.3 at the ongoing COP-3 meeting in Durban, South Africa (17-22 November), it will not only go a long way in stopping all forms of tobacco industry interference at all levels but also increase the effectiveness of other tobacco control interventions around the world.

India agrees that Tobacco industry puts "pressure" to relax health policies

India agrees that Tobacco industry puts "pressure" to relax health policies

The Indian Ministry of Health and Family Welfare revealed before the Central Information Commission that tobacco industry is putting "pressure" to relax the tobacco control policies (source: The Hindu, 14 November 2008).

The tobacco industry interference has times and again weakened and delayed the enforcement of the public health policies - for example, the tobacco industry, Indian Hotel Association and other allied agencies had filed more than 70 court cases against tobacco control policies in Indian courts in September 2008, and due to aggressive lobbying by such agencies, the Group of Ministers (GoM) formed earlier to review the pictorial warnings on tobacco products, diluted the pictorial warnings provision and postponed the implementation of pictorial warnings on tobacco products at least six-times.

The industry interference in public health policies certainly needs urgent attention to save lives otherwise it will continue to threaten to reverse the great advancements made in forging public health policies and implementing them.

Meantime tobacco continues to kill more than a million people in India every year. Indian government delegation is among the representatives of 160 countries who are currently meeting in Durban, South Africa to negotiate guidelines for a provision (Article 5.3) in the global tobacco treaty that will determine whether millions of people get the health protections they are now guaranteed under the treaty.

The negotiations center on the implementation of Article 5.3 of the World Health Organisation Framework Convention on Tobacco Control (FCTC), which protects the treaty and related public health policies from tobacco industry interference.

This Article 5.3 of the global tobacco treaty, if defined broadly, recognizes the tobacco industry's fundamental conflict with public health.

It is also vital to understand that unless the tobacco industry interference in public health policies is checked, the implementation of other health interventions (smoke-free policies, pictorial warnings on tobacco products, tobacco advertising, promotion and sponsorship bans for example) will continue to be weakened, slowed and challenged.

"Industry interference is the number one obstacle to the implementation and enforcement of the global tobacco treaty," said Kathy Mulvey, international policy director of Corporate Accountability International. "Article 5.3 is the lynchpin of the treaty, determining whether or not countries will be able to reverse this preventable epidemic without the tobacco industry standing in their way."

To prevent abuses reported in several countries, the Network for Accountability of Tobacco Transnationals (NATT) and the Corporate Accountability International (www.stopcorporateabuse.org) insist that the following provisions of the draft Article 5.3 guidelines would help prevent abuses:
- Prohibiting government partnership or collaboration with the tobacco industry.
- Protecting against conflicts of interest for those involved in setting and implementing tobacco control policies.

They are calling for the draft Article 5.3 guidelines to be strengthened, in order to:
- Avoid government interaction with the tobacco industry, and set strict rules of engagement for any meetings determined to be necessary.
- Ensure transparency around government interaction with the tobacco industry and around tobacco industry activities and operations.
- Emphasize the tobacco industry's fundamental conflict with public health.

Since negotiations on the global tobacco treaty began in 1999, the tobacco industry has used its political and economic influence in an attempt to undermine, delay and water down public health measures.

If the government representatives of the 160 countries draft strong guidelines for Article 5.3 at the ongoing COP-3 meeting in Durban, South Africa (17-22 November), it will not only go a long way in stopping all forms of tobacco industry interference at all levels but also increase the effectiveness of other tobacco control interventions around the world.

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Special on Universal Children's Day (20 November 2008): Whither The Sanity Of Parents?

Special on Universal Children's Day (20 November 2008)

Whither The Sanity Of Parents?

By resolution 836(IX) of 14 December 1954, the United Nations (UN) General Assembly recommended that all countries institute a Universal Children's Day on 20 November, to be observed as a day of worldwide fraternity and understanding between children. The day of 20 November, marks the day on which the UN General Assembly adopted the Declaration of the Rights of the Child, in 1959, and the Convention on the Rights of the Child, in 1989.

No child asks to be born. It is a conscious decision of both the parents to become instruments of bringing God’s greatest gift to this world. But, very often, the motive behind this serious decision is either just to keep their family tree blooming, and/or else to create crutches for themselves in their time of need/old age. Is this the right attitude with which to embark upon the crucial phase of parenthood?

So, parents start harbouring unrealistic expectations from day one of the arrival of ‘that bundle of joy’. They want their 'investment' to grow by leaps and bounds, in order to be cashed later on. The child starts getting seen and judged from an adult’s point of view.

Dramatic changes happening in India , within the last generation, have added to the concerns of parents and to the challenges faced by children and teenagers. But most of these changes are being thrust upon the children unwittingly by their parents. In almost every urban home, a toddler gets hooked to the Cartoon Network, courtesy parents / elders, who are either over busy or stereotypical. Their faces beam with unabashed pride as their child recites, parrot like, advertisement jingles of consumer products. The problem starts when, later on, the same kid throws tantrums to possess one or more of those very products. Very soon, efficiency of the child on the computer keyboard becomes an added family asset to boast about. Recently, at a social gathering, I found myself amidst young mothers, who were discussing the admissions of their ‘4year olds’ to nursery class. Each one of them was keen to select a school which offered computer education at the pre primary level. Not one of them considered playground facilities as a criterion for a good school. Later on, these very parents would lament that their kids have become television and computer addicts.

In most Indian homes (and may be elsewhere too), even an infant is lovingly handed the ubiquitous mobile phone to play with and to enjoy its various ring tones. Yes,it is hard to imagine life without this contraption, which has become as indispensable as sliced bread. But its unrestricted use is also prompting authorities to ban mobile phones in school / college premises.Mobile phones have already become one of the main causes of childhood / teenage distractions and even a health hazard. I once watched with amused concern a 10-12 year boy choosing a mobile phone for himself. The old fashioned (?) shopkeeper did not let him handle the very expensive models, saying that they were not for kids of his age. This irritated the father of the child. He ordered the shopkeeper to satisfy the whims of his son, and not bother about the price tag. This is not a stray incident. We,as parents, are trying to outdo each other in giving our young ones too much too soon.But when silly chats / messaging /amateur pornography on their mobile phones (which we ourselves so lovingly but unnecessarily provided them) eats upon their study time / moral values, we brand them as irresponsible. Chetan Bhagat, the famous author, recently remarked, (while favouring childless couples), that ‘having a child is like owning a luxury car. They cost you Rs.20,000 to 30,000 per month.’ Now, begetting a child or not could be one’s personal choice, but to equate a child with a car! Well, what else will happen if we lavish them with rich upholstery / gizmos instead of disciplined love?

India faces new problems with obesity, as a new middle class emerges, which allows its children to trade their health with new food choices, promoted by television ads and swanky malls. On the one side we have hungry / malnourished children ( UNICEF reports about 47% of children below 5years of age to be under weight), and on the other side junk food is finding its way even to hutment shops of rural India .

Experts are of the opinion that it is best to inculcate right eating habits in children from 4 months old onwards. We need to develop in them, from an early age, a taste for food items from our traditional/ regional cuisine, which are healthy and delicious at the same time. We also need to promote them aggressively so that they reach every corner of the country and replace the likes of coca cola and ‘Lays chips’ .Unless immediate and drastic steps are taken to curb the consumption of junk/fast food, we will have a large number of sick youngsters. Already Type-2 Diabetes is spreading in children and is becoming a serious global health problem. The main cause cited for this is childhood obesity ( fuelled by high cholesterol and fat rich processed food ) and a sedentary lifestyle. We need more families and schools which promote physical activities like walking, playing, riding bicycles, dancing instead of encouraging the indiscriminate use of computer/television from an early age.

There is an urgent need to break the barrier to understand the child as a person and not as a thing. Right now there seems to be chaos everywhere. In the name of free society we are picking up wrong values. Teenagers are a confused lot and do not know the difference between modernity and westernization. In trying to be cool they are becoming fools. We have failed in our task to tell them that to be called developed,one does not have to eat junk food, experiment with sex in school, and consume drugs / alcohol.

According to psychologists, teenagers always have had the same problems---how to rebel and conform at the same time. So they defy parents and copy each other and the latest fashion/food fads, fueled by a market driven society. They have conflicting expectations from parents, teachers, peers and a westernized media. They have to negotiate traditional roles with modern choices / societal pressures. But in many cases their ability to make choices is drastically curtailed. Many families require children to work rather than go to school due to economic compulsions. For others it may mean getting married off, far too soon, so that they are not a financial/social burden on the family ( in females ) or getting an extra pair of hands to work ( in males). And yet for many it may mean to tread the chosen path and become engineers/doctors despite their genuine interest in literature or other 'not so paying' fields.

We need to curb our dangerous desires to realize our unfulfilled dreams through the achievements of our children. They should not be treated as robots, performing all assigned tasks to perfection. Rather, they are to be recognized as human beings, with their own share of imperfections. We need to tell them that faltering and missteps are okay and will inspire them to set new and higher goals. They will make terrible blunders and face disappointments/ hurts in search of their dreams, just as we did. But all this is an inevitable process of growing up.

On this year's Universal Children’s Day, let us as parents, elders and teachers, resolve to not lose our common sense and sanity. Let us neither produce rats to join the race,nor grow couch and mouse potatoes, by satisfying merely the material needs of our children. Let us devote our time, energy and love to nurture emotionally balanced human beings to make this world a better place to live in.

Shobha Shukla

The author teaches Physics at India's Loreto Convent and has been writing extensively in English and Hindi media. She serves as Editor of Citizen News Service (CNS).

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Countries meet to limit big tobacco's influence

Countries meet to limit big tobacco's influence
Industry Interference seen as #1 Obstacle to Health Treaty's Enforcement

DURBAN: Representatives of 160 ratifying countries currently meeting in Durban, South Africa will negotiate guidelines for a provision in the global tobacco treaty that will determine whether millions of people get the health protections they are now guaranteed under the treaty or not.

The negotiations center on the implementation of Article 5.3 of the World Health Organisation Framework Convention on Tobacco Control (FCTC), which protects the treaty and related public health policies from tobacco industry interference.

At stake at this meeting (Third conference of parties to FCTC) is how narrowly or broadly these protections are defined. If defined broadly, ratifying countries will recognize the tobacco industry's fundamental conflict with public health, and reject collaboration with tobacco giants like Philip Morris International (PMI) and British American Tobacco (BAT). If defined narrowly, the tobacco industry could continue to gain influence with governments, and demand a seat at the table when public health policies are being framed.

"Industry interference is the number one obstacle to the implementation and enforcement of the global tobacco treaty," said Kathy Mulvey, international policy director of Corporate Accountability International. "Article 5.3 is the lynchpin of the treaty, determining whether or not countries will be able to reverse this preventable epidemic without the tobacco industry standing in their way."

The global tobacco treaty, formally called FCTC,took effect in 2005 and now protects more than 85 percent of the world's population. But efforts to implement the treaty are being systematically stymied by tobacco trans-nationals, reinforcing the importance of this week's third Conference of the Parties (COP3) in Durban, South Africa.

"Until now Kenya has been on the right track on FCTC implementation. But with recent back-pedaling of Ministry of Local Governments on smoke-free public places induced by BAT and Mastermind, Kenya has made a giant leap backwards. This confirms the need for stronger guidelines on Article 5.3 " said Samuel Ochieng of Consumer Information Network (CIN) of Kenya.

Countries with similar cases of tobacco industry interference include Nigeria, where BAT is sponsoring front groups to pose as independent stakeholders opposed to advertising bans and stringent tobacco laws, and Zambia, where the tobacco industry promotes lies that tobacco-related agriculture creates jobs and boosts economic development.

In Colombia, another country which recently ratified the global tobacco treaty, PMI and BAT are lobbying hard to pre-empt a new Health Ministry resolution on smoke-free environments. PMI bought Colombia's largest tobacco corporation in 2005 shortly after a report found that seven years was the average age when people began to smoke in the country's second largest city.

In the lead-up to the resolution's taking effect, BAT launched a so-called "youth smoking prevention" campaign as activists were organizing a series of events to expose and challenge tobacco industry's interference in public health policymaking.

To prevent abuses reported in several countries, CIN and other NATT allies and the Corporate Accountability International, a non-governmental organization with observer status at the COP, insist that the following provisions of the draft Article 5.3 guidelines would help prevent abuses:

- Prohibiting government partnership or collaboration with the tobacco industry.

- Protecting against conflicts of interest for those involved in setting and implementing tobacco control policies.

They are calling for the draft Article 5.3 guidelines to be strengthened, in order to:

- Avoid government interaction with the tobacco industry, and set strict rules of engagement for any meetings deemed to be necessary.

- Ensure transparency in government interaction with the tobacco industry and in tobacco industry activities and operations.

- Emphasize the tobacco industry's fundamental conflict with public health.

Since negotiations on the global tobacco treaty began in 1999, the tobacco industry has used its political and economic influence in an attempt to undermine, delay and water down public health measures. Japan Tobacco, for example, is 50 percent owned by the Japanese government. The Japanese Ministry of Finance is heavily represented at treaty meetings, and Japan has often played an obstructionist role.

"We are optimistic that Parties will keep the interests of our children's health closer to their heart than those of tobacco trans-nationals," said Network for Accountability of Tobacco Transnationals (NATT) Spokesperson Muyunda Ililonga, also of the Zambia Consumers Association. "But we know from experience that some will act from the pocket when the circumstance demands they act from the heart."

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