Consumers International/IBFAN speeches at the WHO Executive Board Meeting, Geneva. January 2011, WHO Geneva
Prevention and Control of non-communicable diseases (NCDs)
Patti Rundall, Policy Director, Baby Milk Action, UK
Thank you Mr Chairman for allowing me the opportunity to speak on behalf of Consumers International, the global federation of consumer organisations worldwide and an IBFAN founding member.
We congratulate WHO on seeking to raise the profile of the prevention and control of NCDs and support the call to integrate them into policies across all government departments. If interventions with the best health outcomes are to be prioritized, health ministry’s should take the lead in the development of heath policy and implementation. Providing guidance on the role of different stakeholders is critical, especially if the private commercial sector is considered as an actor, as the risk of conflicts of interest is high. We therefore urge the WHO to give Member States practical guidance on how to minimize or avoid conflicts of interest in relation to the development of key public health policies.
This becomes even more critical considering the proposal for a multi-stakeholder forum for global health. This seems to amount to a restructuring of global health governance. The notion of actors with commercial interest sharing policy making and governance platforms is worrying. In our experience of multi-stakeholder platforms, it is hard to ensure that strong policies to protect health do not take a back seat to market-led initiatives that mainly benefit industry. Did the DG herself not warn that policies are “influenced by the action of powerful industries and multinational corporations”?
Member states count on the WHO's impartial and authoritative advice to protect the health of their citizens. Therefore the WHO's independence in the preparation, implementation and follow-up to the high-level meeting on prevention and control of NCDs must not be compromised by inappropriate partnerships and funding.
The food industry is keen to be involved and fund education, specifically seeking out children, teenage girls and young mothers. While some governments may welcome such assistance, they should be reminded that there is no such thing as a free lunch. ‘Education’ is all too often used by industry as a subtle and pervasive form of marketing to build trust and to promote ”better for you” junk foods to children. Since few governments have legislation to control health and nutrition claims, the door is left wide open for these market-led strategies leading to dependence on unnecessary products and undermining of sustainable local healthy feeding practices and skills. CSR initiatives should be carefully evaluated and should not be seen as an alternative to regulation.
The Global Strategy on IYCF clearly defines the role of industry: comply with the International Code and manufacture products in line with Codex standards. Given the double burden of malnutrition facing many countries today, WHO must ensure that work on NCDs does not undermine this Global Strategy. The role of industry in the NCD prevention and control needs to be more strictly scrutinized and regulated.
Support to breastfeeding is now recognised as a key strategy to prevent obesity in children, as illustrated in this weeks Call to Action on Breastfeeding by the US Surgeon General.. We would urge WHO and members states to include protection promotion and support of breastfeeding, including implementation of and compliance with the International Code, as a key strategy to protect the health of citizens globally- both for under- and over-nutrition.
Health related MDGs (Millennium Development Goals) - Rebecca Norton, GIFA
Chairperson, Director General, honourable delegates, Ladies and Gentlemen, Thank you for letting me address the 128th Session of the EB. We appreciate the opportunity to speak on behalf of Consumers International, the global federation of consumer organisations worldwide, and a founding member of IBFAN, and on behalf of the International Lactation Consultants Association, an organisation of health care professionals protecting, promoting and supporting breastfeeding.
At the 31st annual session of the UN Standing Committee on Nutrition in 2005, the Breastfeeding and Complementary Feeding working group presented an analysis showing the important contribution the early and exclusive breastfeeding and continued breastfeeding with complementary feeding provide to all MDGs.
The 2003, 2005 and 2008 Lancet series on Neonatal, Child and Maternal Survival underscored that interventions related to improved early, exclusive and continued breastfeeding are cost-effective and have an important impact on health and poverty reduction. In the countdown to 2015 decade report (2000-2015) exclusive breastfeeding was recognized as a major contributor to child survival. The report underlines that improving infant and young child feeding practices will save lives and that available evidence demonstrates that child growth and development are optimized when breastfeeding is initiated within one hour after birth and with exclusive breastfeeding being continued up to the age of six months. Continued breastfeeding with complementary feeding with safe and age-appropriate food started at six months is another important contribution to child health. Some countries are progressing in these areas but most countries have much room for improvement.
The 2009 World Bank study identified breastfeeding as one of the 13 evidence based direct interventions to prevent and treat undernutrition and the Secretary General’s 2010 Strategy for Women’s and Children’s Health highlighted the importance of exclusive breastfeeding for meeting the MGD 4 and 5. How much more evidence is needed to persuade the international community to finally include breastfeeding data on the list of the indicators for tracking the MDG progress?
We urge WHO and its Member States to ensure inclusion of these indicators in order for this essential public health practice to become a norm. An given the gap between the health related MDGs and the reality in many countries, we believe that the UN agencies and donor countries have a responsibility to step up their financial and technical support for training of health workers and for breastfeeding support, promotion and protection. Thank you for your attention.
Draft WHO HIV/Aids Strategy 2011-2015.
Lida Lhotska, IBFAN European Coordinator
Chairperson, Director General, honourable delegates. We appreciate the opportunity to address the 128th Executive Board on this important issue on behalf of Consumers International, global federation of consumer organisations worldwide and an IBFAN founding member.
We commend the WHO Secretariat on the development of a comprehensive draft Strategy to guide the agency’s work on HIV/AIDS and would like to share our suggestions for strengthening it:
• Science and programmatic experience highlight the importance of nutritional interventions in combating the pandemic. Yet, the strategy neither highlights the role of nutrition for those who are infected nor that of infant feeding as a child survival strategy. Nutrition is mentioned in all 55 pages only twice!- despite the fact that the 2010 meeting of the UNAIDS PCB discussed the priority of ‘ how to ensure food and nutrition security are integral parts of HIV programming’. If this Strategy is meant to be a health systems response to the pandemic, these are critical omissions. We urge WHO to foster greater involvement of all relevant departments and to ensure that infant feeding in the context of HIV is adequately reflected.
• The Strategy’s guiding principles, which catalogue vulnerable and at-risk populations, omit infants, a group unable to control the transmission risk and having to rely for protection on adults. Infants’ needs and rights should be highlighted and not be lost in the generic PMTCT terminology. WHO should not miss this opportunity to integrate infant feeding and HIV as part of the maternal and child survival concept, to reinforce breastfeeding in general populations.
• Implementation of the 2010 WHO Guidance on HIV/IF requires major efforts and sufficient resources at all levels. Yet, the strategy devotes to this crucial aspect of PMTCT only a few lines, leaving out the critical notion of protection, of counselling for best practice and of a coherent communication strategy, needed to shift mind sets of policy-makers, health professionals and parents.
• The Strategy promotes participation of industry, important for securing HIV treatment. However, it does not emphasize the need for industry to also fulfil their obligations, such as to comply with the International Code and to manufacture according to the Codex Alimentarious. No mechanisms and structures are suggested to ensure avoidance and effective management of conflicts of interest. How will WHO assist member states to ensure that efforts to reduce transmission to infants, especially in countries that opt for replacement feeding strategy, will not be used as a market opportunity for the baby food industry? How will a spillover of artificial feeding be prevented in order to avoid increased infant mortality and morbidity?
Infant and Young Child Nutrition: Implementation Plan - Lida Lhotska, IBFAN European Coordinator
Thank you Mr Chairman for allowing me the opportunity to speak on this important agenda item on behalf of Consumers International, the global federation of consumer organisations worldwide and an IBFAN founding member.
We commend the WHO Secretariat on the development of a comprehensive draft implementation plan on infant any young child nutrition. We offer some overall observations and we will also contribute to the commenting process post EB, designed for completion of the plan.
Reading the document through the lenses of infant and young child feeding, we are concerned that focus has shifted towards nutrition in general, to the detriment of breastfeeding and complementary feeding which goes beyond nutrition into health and protection. The notion of protection, promotion and support disappears as does any reference to human rights as a basis for action, with corresponding obligations. The focus is on the 5-year period towards MDGs. We strongly support the long term 10 year time frame and urge it to be developed in the framework of human rights, social justice, and in line with the Alma Ata principles.
Breastfeeding protection, promotion and support of breastfeeding has led to important achievements over the past 30 years. However, it is premature to describe this as a global success story when full implementation of the Code and resolutions through binding measures is so far from adequate and under continued threat. The just released IBFAN’s Breaking the Rules 2010 report with 500 examples of Code violations from 46 countries, and the World Breastfeeding Trends initiative report from 33 countries - leaves us unable to feel self-satisfaction. The European region, which disproportionately influences global standard setting, does not in particular meet the minimum standard given by the Code and few EU countries are carrying out their obligations to the Code.
The envisaged Industry participation in the development and implementation of the plan is also of concern. The WHO report suggests their involvement in regional and national consultations from the very outset, without any mention of guidance on the management of conflicts of interest. In the case of infant and young child feeding the role of the industry is defined by paragraph 44 in the Global strategy for IYCF as compliance with the Code and manufacturing according to the Codex Alimentarius. If the role of industry is expanded into policy setting, the effectiveness of the recommendations for policy and program implementation will be compromised from the start. This concern is shown to be justified with the recent attacks on the WHO 6 month recommendation of exclusive breastfeeding which emanate from Europe, a region with one of the lowest breastfeeding rates. The recent BMJ article is just one example of how close relationships between baby food companies and some scientists can be seen to undermine public health recommendations and practice.
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