{"id":11380,"date":"2011-09-20T14:44:34","date_gmt":"2011-09-20T13:44:34","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=11380"},"modified":"2012-03-30T13:43:22","modified_gmt":"2012-03-30T12:43:22","slug":"richard-smith-a-diary-of-the-un-meeting","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2011\/09\/20\/richard-smith-a-diary-of-the-un-meeting\/","title":{"rendered":"Richard Smith: A diary of the UN meeting"},"content":{"rendered":"

\"RichardMonday 19 September. Day one<\/strong><\/p>\n

7.10<\/strong> I arrive at the junction of 47 Street East and 2nd Avenue to meet the Pepsico people who are holding a breakfast meeting in the UN dining room. I meet several cronies that I haven\u2019t seen for a long while and reflect traitorously that global health is maybe like medical ethics or medical history, places where ageing health figures go before they disappear altogether.<\/p>\n

7.20<\/strong> We head down to the UN meeting in a long crocodile. I\u2019m walking with Patti Rundall, a woman who is very bothered about conflicts of interest and wants private companies excluded from policy setting. I tell her that I think Brits are much more, and perhaps disproportionately, concerned about this than other nationalities and how I\u2019d counted up the origin of organisations on her list of those worried about conflict of interest. I saw evidence to support my hypothesis in that 28 were from the UK with no other country having more than six. I suggested that one of the reasons might be British class snobbery about those in trade. We have a spirited discussion, which passes the time as we wait in several long queues.<\/p>\n

7.50<\/strong> The UN dining room is right beside the East River, which is looking sparkling and inviting in the morning sunshine. Appropriately breakfast seems to be fruit and beans, but then I discover that the \u201cbeans\u201d are in fact porridge with various fruits added. It amuses me that Pepsi is building a \u201cporridge empire,\u201d but I\u2019m a purist when it comes to porridge. I don\u2019t like it \u201csodded about,\u201d the phrase my father used about any food that wasn\u2019t simply meat and potatoes.<\/p>\n

8.00<\/strong> I sit down beside the minister of health from Guatemala and tell him at length of my experiences in Guatemala. After a while I realise he doesn\u2019t understand a word. I tail off gracefully.<\/p>\n

8.15<\/strong> The session begins. The theme of the meeting is that agriculture is hugely important for health and yet, despite repeated calls from the UN, the worlds of agriculture, nutrition, and health have remained almost completely separate. The Chicago Council on Global Affairs, an organisation that doesn\u2019t take a position on anything (Is the sea blue? Possibly), has produced a report\u2014Bringing Agriculture to the Table: how agriculture and food can play a role in preventing chronic disease<\/em>. The report is written by Rachel Nugent, a friend, and sponsored by Pepsico. It dawned on me a while ago (why not decades ago?) that agriculture is hugely important in health. Somehow we in health have forgotten food and concentrated far too much on drugs. One billion people in the world are undernourished and two billion overnourished, and many countries have both problems at the same time.<\/p>\n

8.30<\/strong> Gary Toenniessen, managing director of the Rockefeller Foundation, held my attention and that of everybody else when he described the \u201cepidemiological transition\u201d in terms of a family. Many farmers in the world grow about a ton of food a year on one hectare. Usually they grow cereals and legumes, rice and beans perhaps. They and their families eat what they grow, and they toil in the fields, using 4000 to 5000 calories a day. At harvest time they eat well and add a little fat. Before the harvest they are often hungry and lose the fat. Their diet is often short of micronutrients, and one of the later speakers\u2014Shenggen Fan, director general of the International Food Policy Research\u2014described how his vision was poor when he was growing up on a farm in China because of shortage of vitamin A.<\/p>\n

Then the farmer might be given better seeds and fertilizer. His yield might increase to 2-3 tons per hectare, meaning that half of his farm could be diverted to fruit, vegetables, or livestock. Now he can feed his family on a better diet and sell some of his produce for cash. Perhaps too he now has a tractor, reducing his physical activity. Because everybody is producing more, the price of staple food falls, leaving even more money for richer foods, possibly processed foods dense with salt, sugar, and animal fat. He and his family may well now be the targets of marketing campaigns promoting unhealthy foods.<\/p>\n

8.50<\/strong> Fan was optimistic that those interested in agriculture, nutrition, and health were finally coming together. He\u2019d been at several meetings that included all these people. Agriculture people, he said, were building health targets into their work, but he didn\u2019t see many health people becoming more interested in agriculture.<\/p>\n

9.05<\/strong> David Nabarro, the UN special representative on food security and nutrition, agreed with Fen that people in agriculture were becoming much more interested in health. He\u2019d been at a meeting of G20 ministers of agriculture and had never heard so much talk about health before from agriculture ministers. His main message was \u201cDon\u2019t wait for health professionals. It\u2019s the economic arguments that make the difference.\u201d<\/p>\n

9.50<\/strong> The meeting closes, and we start searching for the way out or the way to the overflow room.<\/p>\n

10.35<\/strong> After a very long and beautiful walk beside the river I arrive at conference room 4 in the North Lawn Building, the overflow room. It\u2019s a huge room with rows of desks with each space having a microphone and headphones for listening to the speeches from the plenary in your language. At the front of the room are two giant screens where we can see the people in the plenary making speeches. The speeches are broadcast in English. The people in the far from full room mostly have their computers open. They are doing their emails, writing their blogs (like me), chatting, reading newspapers, or just sleeping. Hardly anybody is listening to the speeches. It reminds me very much of the BMA annual meeting on a global scale.<\/p>\n

The first person I recognise is Richard Horton, the editor of the Lancet<\/em>. I say hallo, and we retreat to the back of the room for a chat. Richard is very familiar with these global meetings, often speaking at them, chairing sessions, or helping draft outcome documents.<\/p>\n

The outcomes document, which was shared publicly last week, has already been adopted. What then is the point of representative after representative making their three minute speech on what they are doing? At the moment a man from Israel is speaking, but since I arrived we\u2019ve heard from Belgium, Guyana, the World Bank, and somewhere else that I missed. Perhaps it\u2019s just the ritual that everybody has their say. The speeches are usually read and full of familiar material.<\/p>\n

Richard tells me that he hasn\u2019t seen a single head of state or government. Does it matter if they don\u2019t turn up? I fear that it does. (Later I learn that the president of Brazil opened the meeting and that Robert Mugabe had spoken. Oh dear, Robert Mugabe, the global leader on NCDs.)<\/p>\n

10. 54<\/strong> Now it\u2019s the turn of the woman from the International Food and Beverage Association that I just met at the Pepsico breakfast. At least she enunciates clearly. I wonder if somebody might shout her down, but I doubt it. There is no sense of a debate. Rather each country or organisation makes its contribution regardless of what previous speakers have said.<\/p>\n

10.57<\/strong> Andrew Lansley takes over the chair of the plenary session. Somewhere else a round table is taking place. What exactly is it trying to do? Maybe it\u2019ll become clearer when I attend this afternoon\u2019s round table. My hypothesis is that the plenary is about each country having its say, whereas the round table has presentations followed by discussion. (I was wrong. They seem to be indistinguishable, just speech after speech.)<\/p>\n

11.10<\/strong> Venkat Narayan tells me that the meeting reminds him of a Hindu wedding with lots of people making the same speech.<\/p>\n

11.15<\/strong> I head off for coffee and a chat. Just outside the room dozens of photographers are contained in a pen. Whom are they expecting? Suddenly we know: Mahmoud Abbas sweeps by at great speed and with a large entourage. Palestine applying to the UN is the story of the week.<\/p>\n

12. 58<\/strong> David Bloom tells the meeting that NCDs will cost the world $47 trillion over the next 20 years (see yesterday\u2019s blog<\/a>) and cracks the same joke as yesterday. No laughs but applause.<\/p>\n

1.00<\/strong>\u00a0Lunch at last.<\/p>\n

1.05<\/strong> I have a conversation with a WHO colleague about the point of the meeting. He says it\u2019s mainly for the publicity and the events that surround it. Trying to negotiate the document would be impossible. The diplomats, he says, do meeting after meeting. NCDs today. Desertification tomorrow. Fish farming on Thursday. And they trade: \u201cI\u2019ll support you on NCDs if you\u2019ll support our proposals on green mussel supplements.\u201d<\/p>\n

1.50<\/strong> Waiting to attend my \u201cin the flesh\u201d session, I wonder why the room is so empty. I look at my ticket, and it says 3.00 not 2.00. I find a hidey hole.<\/p>\n

1.55<\/strong> Outside the chamber feels much like Euston Station, people walking backwards and forwards, only perhaps with less purpose than at Euston. People there have a train to catch.<\/p>\n

2.55<\/strong> I meet Michael Marmot coming out of the loo. (For those who don\u2019t know him, Sir Michael Marmot chaired the WHO Commission on Social Determinants of Health.)<\/p>\n

3.05<\/strong> I\u2019m attending my one \u201cin the flesh\u201d session. I\u2019m so far back that I might as well be in the overflow room. I\u2019ve set up my computer and boldly I\u2019m going to try and type rather than write notes. I\u2019m not looking forward to the next three hours with great enthusiasm, but I\u2019ve promised Christine Hancock from C3 that I\u2019ll take notes. I plan to Tweet<\/a> as well.<\/p>\n

3.16<\/strong> The chair talking over the crowd calls for the start of round table 2 of the meeting on \u201cnon-communication diseases,\u201d a very appropriate malapropism.<\/p>\n

4.05<\/strong> I\u2019ve now been taking notes on every speaker for nearly an hour. It\u2019s like Pibroch, endless small variations on the same theme. NCDs are a serious health, social, and economic problem. We must do something. It\u2019s good that the UN is holding a meeting.<\/p>\n

4.45<\/strong> Trying hard to detect any controversy, I can see that some countries are keener on regulating the food industry than working with it (Hungary, France) and some are uncomfortable about corporate profits being put ahead of access to essential drugs (Brazil).<\/p>\n

5.15<\/strong> People are beginning to drift away.<\/p>\n

5.45<\/strong> I\u2019ve still managed to write something about every speech. Maybe I should think of this meeting as a huge quilt, stitched together from hundreds of small pieces that are insignificant in themselves.<\/p>\n

5.55<\/strong> Half the audience has gone.<\/p>\n

6.01<\/strong> Ann Keeling, chair of the NCD Alliance which now has 2000 member organisations, says how members of the alliance are \u201coutraged.\u201d Action is essential. Prevention is a good investment. \u201cYou [governments] lead, and we will follow.\u201d<\/p>\n

6.05<\/strong> Now three quarters of the audience have left.<\/p>\n

6.15<\/strong> The translators leave. Now the meeting is only in English.<\/p>\n

6.20<\/strong> The last speaker, an Indian cancer surgeon, demands serious action on the tobacco industry. \u201cThey are laughing at us.\u201d<\/p>\n

6.25<\/strong> I meet a French colleague who tells me that by the end of the meeting there were only two people in the overflow room.<\/p>\n

6.30<\/strong> I walk past dozens of policeman, noting how they can be short, fat, and wear glasses. Won\u2019t Tony Soprano laugh at a policeman who just touches five feet?<\/p>\n

6.50<\/strong> I arrive at the Institute of Medicine meeting in the Grand Hyatt. I\u2019m flagging. Over the next 90 minutes a succession of people appear in front of me and make speeches, but I\u2019ve heard too many speeches. They are just part of the quilt.<\/p>\n

11.25<\/strong> I\u2019m drinking a glass of Macallan (\u201cNo, not on the rocks\u201d) with a friend on the roof terrace of a hotel with the skyscrapers all around us. She\u2019s a member of one of the delegations. \u201cI asked if I had to do anything. They didn\u2019t seem to want me to do anything. They preferred that I stayed away and went to side meetings.\u201d<\/p>\n

11.50<\/strong> I\u2019m glad I\u2019m not a diplomat.<\/p>\n

Richard Smith<\/strong> was the editor of the <\/em>BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Monday 19 September. Day one 7.10 I arrive at the junction of 47 Street East and 2nd Avenue to meet the Pepsico people who are holding a breakfast meeting in […]<\/p>\n

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