Excellencies, honourable ministers, distinguished participants, ladies and gentlemen,
I thank Shanghai for hosting this event and for making its airport terminals and railway stations smoke-free. We can all breathe more easily.
We welcome the attention being given to healthy cities, good governance that follows a whole-of-society approach, and health literacy as an enabling factor in promoting health.
City mayors can introduce health promoting measures more easily than at the national level. The 2030 Agenda for Sustainable Development provides the platform for a whole-of-society approach. Health literacy must extend from the personal to the political and policy levels.
Health promotion is essentially about changing human behaviours, and there is nothing harder to do in all of public health.
Delivering messages that change human behaviours is much harder than delivering vaccines, medicines, and bednets.
Some of the most successful strategies use population-wide interventions to reshape the environments in which people make their lifestyle choices. Evidence shows that reshaping unhealthy environments does more to promote health than campaigns that try to persuade changes using health messages alone.
At national and municipal levels, legislative and fiscal measures are among the most effective interventions, but often face stiff and well-funded resistance from powerful industries that market unhealthy products. This is why we need health literacy at the political level, in the interest of policy coherence spanning multiple sectors.
Ministries of health nearly always have their facts and evidence straight, but ministries of finance, trade, agriculture, and foreign affairs are more susceptible to persuasion by industry arguments.
The use of plain packaging to reduce tobacco consumption provides a good example. Industry’s first argument is blunt: plain packaging does not work. This argument flies in the face of the facts.
Plain packaging is a measure, under the WHO Framework Convention on Tobacco Control, pioneered in Australia. Following implementation of the country’s plain packaging law, smoking rates fell to historical lows.
The early evidence from Australia shows that plain packaging, as part of a comprehensive approach to tobacco control, is reducing the appeal of tobacco products and increasing the effectiveness of health warnings.
No wonder that France and the United Kingdom have begun implementing plain packaging laws, and New Zealand and Hungary have recently passed laws. Many other countries are close behind.
The tobacco industry tells ministries in non-health sectors a different story. As industry argues, plain packaging fuels the black market, funds organized crime, and supports international terrorism. Such arguments sound terrifying, but not a shred of evidence supports them.
This example underscores my principal advice to you. Changing the environment in which people make their lifestyle choices requires extraordinary government commitment, courage, and persistence, even when we have all the facts on our side.
We cannot let health be sacrificed in what looks increasing like a post-fact, post-truth world.
Tobacco use kills around 6 million people each year. That’s a fact.
Every single one of those deaths is an entirely avoidable tragedy. That’s the truth.
We have some recent victories to celebrate, in the courts of Australia, the European Union, the United Kingdom, and especially Uruguay.
In July, after six years of harassment by the tobacco industry and its lawyers, tiny Uruguay, with its population of 3.5 million people, defeated the world’s largest tobacco company.
This is a landmark victory, as it upholds the right of a sovereign government to protect its citizens from a deadly and addictive product. It gives precedence to that right over obligations set out in trade agreements or infringements of intellectual property rights.
In one of its strongest recommendations, the WHO Commission on Ending Childhood Obesity urged governments to implement an effective tax on sugar-sweetened beverages.
The Commission’s report further urged governments to accept their responsibility to protect children, including a responsibility to take action without considering the impact on producers of unhealthy foods and beverages.
The oft-heard argument that lifestyle behaviours are a matter of personal choice does not apply to children. Obesity in children is society’s fault, not theirs.
In October, WHO urged governments to introduce taxes on sugar-sweetened beverages to reduce their significant contribution to obesity, diabetes, and dental decay. The WHO recommendation was based on a technical report documenting the effectiveness of soda taxes and offering practical guidance on their design.
Industry’s reaction has been swift, making two predictable arguments. First, soda taxes do not work, despite evidence to the contrary. Second, soda taxes are regressive as they punish the poor.
This argument brushes aside the fact that it is precisely the poor who suffer most greatly from diet-related diseases. Soda is liquid candy that meets no nutritional needs. If fiscal policies reduce soda consumption among the poor, this is a huge and most desirable victory for health.
Again, my advice to you is straightforward. Out-shout industry with the facts.
Ladies and gentlemen,
This is the first conference on health promotion being held under the SDGs.
At both the national and international levels, the SDGs formally embrace the need for multisectoral collaboration. What they do especially well is to recognize that today’s complex health challenges can no longer be addressed by the health sector acting alone.
Curbing the rise of antimicrobial resistance requires policy support from agriculture. Abundant evidence shows that educated mothers have the healthiest families. Access to clean energy fuels economic growth, but it also reduces millions of deaths from respiratory and cardiovascular disease associated with air pollution.
The inclusion of a target for reaching universal health coverage, including financial risk protection, gives health the power to build fair, stable, and cohesive societies while also furthering the overarching objective of ending poverty.
Health is an end-point that reflects the success of multiple other goals. Because the determinants of health are so broad, progress in improving health is a reliable indicator of progress in implementing the overall agenda.
In the final analysis, the ultimate objective of all development activities, whether aimed at improving food and water supplies or making cities safe, is to sustain human lives in good health.
Thank you.