Some 300 million people have been protected from becoming smokers in the 15 years since WHO launched the ‘MPOWER’ package of recommended policies for reducing smoking prevalence in countries worldwide, declared Kelly Henning, of Bloomberg Philanthropies, at a press conference in Geneva this week. 

She was speaking at a WHO briefing launching the 2023 WHO report on global tobacco control. 

Bloomberg, a funder of the original MPOWER policy package and its continuing implementation, has been WHO’s leading partner in the massive tobacco control initiative.  

And Henning, head of health at Bloomberg for just as long, has been the key figure in the journey, forging this and key collaborations with the global health agency on a range of preventative health initiatives – including for healthier cities and diets, road safety, and drowning prevention. 

A former director of epidemiology in New York City’s Department of Health, Henning was the first and, so far, only head of public health at the Philanthropies since the programme’s inception. 

As such, she has shaped the collaborations with WHO, with a practical and laser-focused vision on what gaps and needs the Philanthropies can realistically address. 

Prior to the new tobacco control report’s launch, Health Policy Watch Editor Elaine Ruth Fletcher, sat down with Henning, a medical doctor and epidemiologist, to hear more about the ongoing work, and future priorities. 

Elaine Fletcher: Refreshing briefly, the things that Bloomberg has been focusing on since the inception of the health programme in 2007, have been obesity, tobacco control, road safety, drowning prevention. Is there anything else? 

Kelly Henning: Cardiovascular health. And we also have a large, what we call, ‘Data for Health’ programme, which is really about strengthening birth and death registration, and also the use of data. And, we do that collaboratively with Ministries of Health. 

We also have Mike Bloomberg [founder of Bloomberg Philanthropies] as the global ambassador for NCDs and injuries in the WHO. So since that started, we started the Partnership for Healthy Cities. 

EF: Can you talk about the successes you’ve seen with your work until now? And how do you envision going forward?

KH: In our portfolio on non communicable diseases and injury prevention, we have a big focus on policy change. And one of the reasons that we do that is because we think of it as a sustainable set of interventions. 

Sure, we want to work on assisting governments. But first, you have to have those baseline policies that are ‘best practice’ in place. 

And this has been very true in our tobacco control programme, in our road safety programme, in our food policy programme, involving ‘smoke free air’ actions, bills that raise tobacco taxes, bills that raise sugary beverage taxes, bills that require helmets for motorcycle use. 

These things are durable so that once they’re in place, they sort of take on a life of their own,  and they can be built upon over time. I think that’s a sort of principle of how the public health team works. And we do think that our issue areas do overlap with many of the issues of our time. 

“For example, I think we now know very clearly that a healthy population is critical to addressing a new viral threat. And how do you assure a healthy environment? Well, you know, you want to reduce tobacco use, you want to make sure that cardiovascular risk factors are addressed, and healthy food is very important for overall health. So we touch upon those more contemporary issues through some of the work that we’ve already done, and some of the work that we’ll be continuing to do. Similarly, there was a very major gap in mortality data during the pandemic. And so we think that our “Data for Health” programme, which is really seeing some increasing momentum now, post pandemic, is likely to have a positive impact on that. 

EF: Do you envision continuing those strands pretty much as they are those themes or do you envision adding to them or changing them? 

KH: Each time that we have reinvested in one of the topic areas where we work, we evaluate what we’ve done thus far and look for critical gaps. So for example, in tobacco control, we now see that many countries have at least one best practice tobacco policy in place and an increasing number [of countries] have multiple best practices in place like marketing bans, on-pack warnings and taxes. 

So now we’re adding smoking cessation as a focus area in that programme. Because as those policies are in place, it pushes people to quit. And, so they are increasingly asking for help in quitting. That’s an example of how each time we evaluate where we are on the trajectory of the work and then we add things that might be relevant as we go along. 

Another thing that we’re doing is we’re thinking more and more about the workforce and trying to invoke young public health leaders because it’s very important that country-based experts be developed and be able to take on new work all the time. So in all of our various initiatives, we’re engaging with public health leaders, young public health leaders. 

EF: Let’s talk about tobacco control. What would you see as outstanding examples? And are higher income countries typically stronger with respect to tobacco control?  

KH: No, not always.

EF: Okay, So, please provide some good examples. 

KH: Every other year, WHO puts out the Global Tobacco Control Report. It looks, country by country, at how countries are doing, and policy by policy across the MPOWER package. Based on WHO’s latest expert review, there are now four countries in the world that have best-in-class policies around the key indicators for tobacco control: smoke free public places, marketing bands, pack warnings, mass media campaigns and [tobacco] taxes. And those are Brazil, Türkiye and now Mauritius and The Netherlands.

The  other encouraging key message here is that the number of countries with two or more MPOWER policies is going up every year. So we’re seeing more and more countries are progressing on tobacco control, which is great.

EF: In terms of obesity and healthy foods, the WHO recently updated it’s  ‘Best Buys’ to prevent diet-related NCDs, with a broader set of recommended policies on the taxation and regulation of  “unhealthy foods”. These relate not only to salt, but also to sugar, trans-fats and, as a result, to ultra-processed foods. Can you explain what this means?  

KH: We think that the WHO guidance documents and best buys are really important for our work, because countries obviously are paying very close attention to what WHO is putting out and they strengthen our ability to advocate for best practices and to push forward. 

In food policy, there’s still a lot of room to evaluate various strategies to see which ones are most impactful or what combination of strategies is most impactful? We have that evidence from tobacco control. In food policy, we’re still gaining evidence and so when WHO puts out expanded recommendations that help us engage with countries to do more, and then we also fund the evaluation pieces so that we can see what kind of impact these policies are having on diet, consumption, etc.

EF: Along with limiting unhealthy foods, can you speak about good practice examples of national policies to encourage healthier foods, such as fresh fruits and vegetables?  

KH: Many countries are doing that. For example, a number of low- and middle-income countries are improving their school food and public food policies to encourage and include more fruits and vegetables. Discussions around taxing foods with low nutrient value, foods with high sugar etc., are also bringing on board the idea of incentives for [fresh] fruits and vegetables. There’s a long way to go in this space, but it’s certainly something that’s really bubbling up as an area of major interest.

E: Can you just talk about one or two lower middle income countries that have picked up on this?

KH: Brazil has phenomenally good school food policies and they have done a lot of work in the space and are really a model for some of the thinking around school and public foods. Higher income countries are looking at that even now. The US is starting to talk about how to handle the Supplemental Nutrition Assistance Programme (SNAP) for example, which is the supplemental food programme for lower income persons in the United States. So, I think higher income countries are learning from some of these low- and middle-income country examples as well. 

EF: The US SNAP programme, at the moment, it’s neutral about the nutrient quality of foods? 

KH: It has some restrictions, but they’re pretty minimal.

EF: When it comes to traffic injuries, it seems that the emphasis is still mainly on road safety, rather than transport management to support more sustainable public transport, walking and cycling. Has there been any thinking about urging WHO to look at how public transport modes perform, in different countries, in terms of traffic injury.   Typically in high income countries bus and rail modes are safer, but this may not be true at all in lower-income countries. However, none of these issues are picked up right now in the current data collection, which looks at injuries purely in terms of  road vehicles and vehicle types, not modes of travel. 

KH: So, as you know, WHO puts out a road traffic safety report periodically. They have one coming out again in November of this year. And it’s again a country by country assessment of deaths due to bus, due to cars, due to trucks, that’s in each country. Public versus private is not there as far as I’m aware. But I think the important point here is that the largest proportion of road crash deaths are pedestrians. Pedestrians and motorcyclists and bicyclists – vulnerable road users, are the largest proportion, and so that’s the group that I think needs focus.

EF: That’s exactly my point is that if you have an overcrowded road system, no matter how good it is, you’re always going to have pedestrians marginalized.  But you’re not going to get that story data wise [in the World Traffic Report].

KH: So we definitely advocate for public transport. There’s no question about that in the Road Safety Programme. And public transport, as you know, is not always safe. So for example, in Türkiye and Mexico City, we’ve had experiences where the passengers from the bus might get off the bus right into traffic. So, addressing those things are all part of what we have advocated for in the Bloomberg supported Road Safety Programme. WHO is a partner in that as well. 

I think there’s always going to be more than we can do. I think that report is our best global snapshot at the moment and didn’t exist previously. So it’s wonderful that it exists but improvements in those reports are a continuing process for sure.  

EF: In terms of the traffic injury, apart from that particular observation, what do you see as the biggest success stories? 

KH: The Bloomberg Initiative on Road Safety has a two-part approach. One is to improve national legislation for best practice laws to reduce road crash deaths. And the other is to prove that it’s possible to do those things at a local level, at the city level. In the 28 cities that participate in the initiative, a number of those cities have done very good work, and have shown declines in road crashes.

EF: Can you provide some good practice examples here, as well?  

KH: Mexico City has always been very engaged. Mumbai [India] is another location that has done a lot of local level work showing improvement. So some of that is infrastructure, things like speed bumps, or re-organizing intersections so that pedestrians have the opportunity and time to cross. 

EF: When you talk about pedestrian sidewalk continuity, or ease of crossing, you have to talk about infrastructure investment. How does Bloomberg encourage that kind of investment?

KH: That’s why we work at city level on those pieces so that we can work directly with the mayor’s office. Because it really does involve engagement with the city and the city government more broadly, with their Transportation Department, their Infrastructure Department. Those are the bodies that we work with, using primarily local funds, to get those things done. They can be quite inexpensive. So we provide technical assistance through our partners, which include the World Resources Institute (WRI) and  NACTO (National Association of City Transportation Officials) there. We have partners that work in that space that work with the cities directly.

EF: As a philanthropy, how do you move the needle? You mentioned your work with partners is key; can you tell us a little bit more about your partnerships strategy? 

KH: So all of our initiatives are really partnerships. We have a group of partners with competitive advantages in various aspects. For example, in tobacco control, WHO is a partner, Vital Strategies is an implementation partner, Campaign for Tobacco Free Kids is a partner that does advocacy work, US CDC works on data collection, as well. Those partners in turn re-grant or provide technical assistance at the country level. That allows us to have much larger reach. Almost all of our programmes have small grant projects, so countries, or groups and countries, can apply for resources to assist in projects that relate to those initiatives. Again, that allows us to have much greater reach than we would have otherwise. 

EF: The Partnership for Healthy Cities has been another important foundation of your recent work – with both cities and WHO. But for some time, there seemed to be hesitation about including air quality interventions into that programme, which was more focused on traffic injury, healthy diets, and other classical areas of Bloomberg engagement in urban health. Has that changed at all?  

KH: Air pollution is on the list. But it’s really about data collection through air sensors and helping the city use low- cost air quality sensors to help guide their city policy. So that’s a new array and several cities have taken that up. Beyond that, we have a team that focuses just on the environment, and our environment team also works on air pollution. 

EF: In the wake of the pandemic, there has been much more talk about fostering more sustainable and healthy food systems – that curb ecosystem destruction and concurrent disease risks, associated with industrialized agriculture. Is this on your radar?  

KH: We don’t have much focus on agriculture right now. Although I think if we do have, the only way that we really bump up against agricultural practices is that the tobacco industry will often use tobacco growing as in certain countries as a key reason why tobacco control cannot be done and that is not correct. There’s a little piece of that. But not in terms of a larger agricultural policy right now.

EF: Any other under-represented topics you’d like to address? 

KH: I just want to say something about drowning prevention because it’s under-appreciated.

Even in the US, among children under five, after the neonatal period, drowning is the leading cause of death. So we’re very excited about our work in this space. We’ve been working in Bangladesh for a long time in those communities there. We’ve seen reductions of 85% of drowning deaths among children under five. 

EF: What is the major thrust of prevention here? 

KH: In Bangladesh it is very young children. So it’s about community daycare. During the hours of 9 a.m.-1 p.m., when the mothers are in the fields or otherwise occupied, there’s a mother who watches young children. It is about supervision. And it has had enormous impact. 

In Vietnam, the peak age [for drowning] was more school aged children. So there, we are partnering with the government to implement school based swimming lessons, survival swimming lessons. And now we’re looking at a couple of countries in Sub-Saharan Africa where there’s a lot of work to do in this space. We’re very excited about it.

EF: Looking forward, what would you like to see out of the rest of this year’s health calendar?

KH: I would love to see a continued emphasis on noncommunicable diseases. we can’t lose sight of the fact that we have to continue to work in this space. Premature death from non communicable diseases is important and it’s going to rise. We know that there’s the next high level meeting on non communicable diseases coming up at the UN General Assembly in 2025. So the more that we can do to mobilize heads of state and these ministers around this issue, the better.

Megha Kaveri contributed editing to this story. 

Image Credits: WHO, WHO , USDA.