Preeti Patel

British American Tobacco and the “insidious impact of illicit trade” in cigarettes across Africa

Objectives: To provide an overview of the complicity of British American Tobacco (BAT) in the illicit trade of cigarettes across the African continent in terms of rationale, supply routes and scale. Methods: Analysis of internal BAT documents and industry publications. Results: BAT has relied on illegal channels to supply markets across Africa since the 1980s. Available documents suggest smuggling has been an important component of BAT’s market entry strategy in order to gain leverage in negotiating with governments for tax concessions, compete with other transnational tobacco companies, circumvent local import restrictions and unstable political and economic conditions and gain a market presence. BAT worked through distributors and local agents to exploit weak government capacity to gain substantial market share in major countries. Conclusions: Documents demonstrate that the complicity of BAT in cigarette smuggling extends to Africa, which includes many of the poorest countries in the world. This is in direct conflict with offers by the company to contribute to stronger international cooperation to tackle the illicit tobacco trade.

The National Security Implications of HIV/AIDS

Feldbaum and colleagues look at evidence on the links between HIV and national security, and evaluate the risks and benefits of addressing HIV/AIDS as a national security issue.

Tracking official development assistance for reproductive health in conflict-affected countries.

Preeti Patel and colleagues report inequity in the disbursement of official development assistance for reproductive health between countries affected by conflict and those unaffected.

“The law was actually drafted by us but the Government is to be congratulated on its wise actions”: British American Tobacco and public policy in Kenya

Background and objective: British American Tobacco (BAT) has historically enjoyed a monopoly position in Kenya. Analysis of recent tobacco control debates and a case study of BAT’s response to the emergence of competition in Kenya are used to explore the company’s ability to shape public policy and its treatment of tobacco farmers. Design: Analysis of internal industry documents from BAT’s Guildford depository, other relevant data and interviews with key informants. Results: BAT enjoys extensive high-level political connections in Kenya, including close relationships with successive Kenyan presidents. Such links seems to have been used to influence public policy. Health legislation has been diluted and delayed, and when a competitor emerged in the market, BAT used its contacts to have the government pass legislation drafted by BAT that compelled farmers to sell tobacco to BAT rather than to its competitor. BAT was already paying farmers less than any other African leaf-growing company, and the legislation entrenched poor pay and a quasi-feudal relationship. BAT’s public relation’s response to the threat of competition and the ministers’ public statements extolling the economic importance of tobacco growing suggest that BAT has manipulated tobacco farming as a political issue. Conclusions: The extent of BAT’s influence over public policy is consistent with the observations that, despite ratifying the Framework Convention on Tobacco Control, progress in implementing tobacco control measures in Kenya has been limited. The benefits of tobacco farming seem to be deliberately exaggerated, and an analysis of its true cost benefits is urgently needed. Tobacco farmers must be protected against BAT’s predatory practices and fully informed about its activities to help them have an informed role in policy debates. As image, particularly around the importance of tobacco farming, seems key to BAT’s ability to influence policy, the truth about its treatment of farmers must be publicised.

Tracking humanitarian funding for reproductive health: a systematic analysis of health and protection proposals from 2002-2013

BackgroundThe Inter-agency Working Group on Reproductive Health in Crises conducted a ten-year global evaluation of reproductive health in humanitarian settings. This paper examines proposals for reproductive health activities under humanitarian health and protection funding mechanisms for 2002-2013, and the level at which these reproductive health proposals were funded.MethodsThe study used English and French health and protection proposal data for 2002-2013, extracted from the Financial Tracking Service (FTS) database managed by the United Nations Office for the Coordination of Humanitarian Affairs. Every project was reviewed for relevance against pre-determined reproductive health definitions for 2002-2008. An in-depth analysis was additionally conducted for 2009-2013 through systematically reviewing proposals via a key word search and subsequently classifying them under designated reproductive health categories. Among the relevant reproductive health proposals, counts and proportions were calculated in Excel based on their reproductive health components, primarily by year. Contributions, requests, and unfunded requests were calculated based on the data provided by FTS.ResultsAmong the 11,347 health and protection proposals issued from 345 emergencies between 2002 and 2013, 3,912 were relevant to reproductive health (34.5%). The number of proposals containing reproductive health activities increased by an average of 21.9% per year, while the proportion of health and protection sector appeals containing reproductive health activities increased by an average of 10.1% per year. The total funding request over the 12 years amounted to

Noncommunicable diseases and post-conflict countries

4.720 billion USD, of which

HIV/AIDS, Peacekeeping and Conflict Crises in Africa

2.031 billion USD was received. Among reproductive health components for 2009-2013 proposals, maternal newborn health comprised the largest proportion (56.4%), followed by reproductive health-related gender-based violence (45.9%), HIV/sexually transmitted infections (37.5%), general reproductive health (26.2%), and lastly, family planning (14.9%).ConclusionFindings show that more agencies are responding to humanitarian appeals by proposing to implement reproductive health programs and receiving increased aid over the twelve year period. While such developments are welcome, project descriptions show comparatively limited attention and programming for family planning and abortion care in particular.

Global health and national security: the need for critical engagement

In September 2011 world leaders at-tending the United Nations high-level meeting on noncommunicable diseases recognized that these diseases are one of the major challenges to international development. However, among the wide-ranging discussions at the meet-ing, one topic received scant attention: the issues facing countries emerging from armed conflict. This mirrors the virtual absence of noncommunicable diseases on the agendas of leading global institutions engaged in humanitarian and reconstruction efforts in conflict-affected countries.

Sexual violence against men in countries affected by armed conflict

This article investigates the impact of the spread of HIV/AIDS on the African military and its ability to act as an effective instrument of conflict resolution in the continent. The capacity of African militaries is particularly important at a time when major powers are reluctant to engage in greater peacekeeping operations in the region. The widespread prevalence of HIV among military personnel threatens political and social stability more generally, and this study focuses on the link between peacekeeping and the disease. It considers how HIV-positive soldiers act as a vector in communities where they are deployed, and how soldiers deployed in locations with a high prevalence rate of HIV/AIDS may spread the disease in their home communities upon return. Possible recommendations on how to tackle HIV/AIDS prevention efforts with the aid of peacekeepers are offered.

Diffusion of e-health innovations in 'post-conflict' settings: a qualitative study on the personal experiences of health workers

Abstract The security and foreign policy communities have increasingly addressed global health problems as threats to national security. Global health is a humanitarian endeavour that seeks to improve the worlds health including the most vulnerable peoples, while national security works to protect the interests of people within a given state. The major statements of security policy by the United States and United Kingdom link the self-protective interests of national security with the humanitarian objectives of global health. While there is potential to expand global health activities through partnership with the security and foreign policy communities, treating global health issues as national security threats may focus attention disproportionately on countries or diseases which pose security threats to wealthy nations, rather than on the greatest threats to global health. The global health community should carefully scrutinise areas where global health and national security interests overlap.