CHICAGO (Reuters Health) - The varied and often conflicting interests that affect the development of national tobacco control policies were illustrated in a mock cabinet debate played out in front of delegates to the 11th World Conference on Tobacco OR He

With US Department of Health and Human Services Secretary Donna Shalala playing the part of Prime Minister of a fictitious tobacco-producing nation, WHO Director-General Dr. Gro Harlem Brundtland took the role of a Health Minister proposing a comprehensive anti-tobacco program that included steep tax hikes. Other dignitaries playing the roles of ministers of finance and agriculture and an attorney general raised economic, political and legal objections to tobacco tax increases and advertising bans. Shalala commented afterwards that the role-playing session was similar, if not identical, to actual government meetings she has attended. ``I think the point was very clear though,'' Shalala said. ``There are a variety of interests. This is not just a narrow health issue. It's an economic issue. It's a budget issue for many countries. And the need for the leadership of countries to bring together the appropriate finance, agricultural and health officials, and in this case the attorney general, because there are legal and constitutional issues, for an integrated plan.'' Brundtland, who was Norway's Prime Minister before taking the reins of the World Health Organization agreed with Shalala's assessment of the session. ``I think this was quite realistic with regards to how it could sound in a cabinet meeting, according to my own experience.'' She added that effective tobacco control will require even more than the support of individual nations. ``Support is necessary for global action, because without that support, taxation, fighting smuggling, (and) avoiding advertising is impossible. You need to have that support across borders in order to have effective policies.'' At the other end of the governmental spectrum, Shalala conceded that although the Clinton administration is in favor of strong tobacco control policies, many state governments have not yet taken up the issue. For instance, most states are simply funneling funds from legal settlements with the tobacco industry into their general funds rather than building tobacco control programs. ``That is true and deeply disappointing,'' Shalala commented. But she predicted that local anti-tobacco coalitions around the country would boost the fortunes of state tobacco control programs. ``States are increasingly, because of local pressures, going to take on this issue; and in more states than not, I think, the pressure is going to build up as these coalitions get stronger and stronger in states.''

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