WHO Framework Convention on Tobacco Control

The WHO has long been active in preventing the myriad health issues that result from tobacco consumption. As the leading cause of preventable death globally, tobacco has seen an upsurge in both its consumption and its fatality rate worldwide with the increasing interconnectedness of the global economy.[10] Thus, while tobacco related-diseases differ from the communicable diseases that have traditionally been the concern of the WHO, the effects of globalization have made tobacco increasingly relevant for such intergovernmental authorities.

Under the auspices of tobacco activist and UCLA professor Ruth Roemer, the WHO urged individual countries throughout the 1980s and 1990s to adopt national laws that have been shown to reduce tobacco use. The FCTC, however, marked the first time that the WHO went so far as to enact its international legal powers to address the problem.[11] In fact, Roemer herself was among the original group of academics and tobacco activists who supported the idea of a framework-convention protocol approach (the rest of the group included Allyn Taylor, Derek Yach, and Judith Mackay).[12]

The idea for a multilateral treaty regarding tobacco control gained traction in 1994 at the Ninth World Conference on Tobacco or Health in Paris, France, when Roemer and Taylor presented their strategy for international legal action. Roemer and Allyn, along with Judith Mackay, were successful, and their proposal was adopted as one of the conference's first resolutions.[12]

In 1995, the World Health Assembly (WHA), in Resolution 48.11, requested that the director general "report to the 49th World Health Assembly on the feasibility of developing an international instrument, such as guidelines, a declaration or an international convention on tobacco control to be adopted by the United Nations".[12] In compliance with Resolution 48.11, the WHO employed Roemer and Taylor to draft a background paper on the various mechanisms available to the WHO in effectively controlling tobacco use worldwide.[12] This background paper provided a concrete recommendation for a framework convention, as opposed to alternative international legal action. According to it proponents, a framework convention would "promote global cooperation and national action for tobacco control".[12]

Roemer and Taylor's proposal was met with some skepticism. Allan M. Brandt, the esteemed Harvard University historian of the tobacco industry, reports, "some considered it unrealistic, impractical, and overly ambitious, and preferred a nonbinding 'code of conduct'".[6] However, with the support of Derek Yach, head of the Policy Coordination Committee at the WHO, the proposal gained momentum.[6] Derek Yach became the first Director of the Tobacco Free Initiative in 1998 and steered development of the FCTC from then until its adoption in March 2003. Subsequently, Gro Harlem Brundtland was elected director general of the WHO in 1998. Brundtland, a Norwegian medical doctor with a Master of Public Health degree from Harvard University, threw her full support behind the idea for a binding multilateral treaty on tobacco control. Alongside malaria treatment and prevention, the nascent Framework Convention rose to the top of her agenda at the WHO.[13]

It took three years for negotiators to come to an agreement on the terms of the FCTC. After being adopted by the World Health Assembly, the policy-making arm of the WHO, it officially went into effect in February 2005.[5]

A framework convention is typically justified for problems that necessitate international cooperation to effectively formulate policy. Prior to the FCTC, the majority of framework conventions addressed "environmental issues that were outside the control of individual nations".[6] Thus, in proving that a framework convention was needed for tobacco control, treaty advocates invoked tobacco-related issues that could not be resolved by the actions of individual countries, such as the smuggling of tobacco and the leakage of tobacco advertisements from countries which lacked stringent regulation to those with restrictions on where and to whom tobacco companies could market their products. This initial justification of the framework convention is manifested in the preamble of the final version of the FCTC, which states the following issues as central to the treaty's aims:[6]

• the dramatic increase in worldwide tobacco consumption;
• the escalation in smoking and other forms of tobacco consumption by children and adolescents
• the impact of all forms of advertising, promotion, and sponsorship aimed at encouraging tobacco use

The treaty is notable for its unprecedented inclusion of nongovernmental organizations throughout the negotiation and drafting processes.[14] According to Elinor Wilson, the past vice-president of World Heart Federation, "the FCTC is an excellent example of government/non-governmental collaboration through the Framework Convention Alliance resulting in global public health gains".[15] Such collaboration between NGOs and the WHO forever changed the way that the WHO treats nongovernmental organizations, and in 2002 the WHO constitution was amended to reflect this shift in relations.[14]

Much of the groundwork for the economic justification for the FCTC was laid by the World Bank. In order to counter concerns that international tobacco control legislation would unduly harm economies of which tobacco farming, manufacturing, and sale were an important part, the WHO cited a landmark World Bank publication entitled Curbing the Epidemic: Governments and the Economics of Tobacco Control (CTE), which asserted that tobacco control would not harm economies, other than a select few agrarian countries that were unusually dependent on tobacco production. Mamudu, Hammond, and Glantz reveal that "as a financial institution with substantial influence in developing countries, the Bank's publication of CTE threatened to undermine the tobacco companies' economic arguments" about the harmful effects of tobacco control.[13]

Indeed, even before the treaty was publicly released, tobacco industry representatives embarked upon a concerted effort to thwart the efforts of FCTC drafters, in addition to participating policy-makers from individual WHO member states. Unable to argue against the overwhelming scientific evidence about tobacco's harmful health effects, the tobacco industry seized upon the FCTC's potential for economic harm. In response to the World Bank's CTE, the industry made a number of attempts to discredit the report, especially through the public relations efforts of the International Tobacco Growers' Association (ITGA) and by employing non-World Bank economists to release their own analyses.[13] Between 4–16 March of the year 2000, the ITGA, financed by the tobacco industry, set out on what they dubbed a "Roadshow", during which ITGA representatives spoke to policy-makers in the developing countries of India, Kenya, Malawi, South Africa, and Zimbabwe, in addition to two "mini-Roadshows" in Argentina and Brazil, in order to voice ITGA opposition to the FCTC on the grounds that the CTE had underestimated the threat that tobacco control would pose to developing economies.[13] Once negotiations for the FCTC were underway, the tobacco industry again made attempts to lessen the blow of international legislation on their business by lobbying delegates at the convention in Geneva. According to Mamudu, Hammond, and Glantz, however, "these efforts... did not undermine acceptance of CTE during the FCTC negotiations and CTE remained an authoritative economic analysis of global tobacco control".[13]

Nevertheless, the FCTC acknowledges that its agenda will inevitably hurt farmers who currently depend on tobacco for their livelihoods. To that end, the treaty encourages Parties to help tobacco farmers make the transition from tobacco to alternative crops. Article 17 of the Framework Convention states: "Parties shall, in cooperation with each other and with competent international and regional intergovernmental organizations, promote, as appropriate, economically viable alternatives for tobacco workers, growers and, as the case may be, individual sellers".[16] In particular, the FCTC favors sustainable development options over tobacco farming. To achieve this, Party governments and tobacco control advocates are encouraged to invest in better infrastructure, especially transportation, to ease farmers' access to new and foreign markets when making the transition, while simultaneously improving farmers' access to credit that may be necessary in converting their existing facilities.[17]

The Convention defines tobacco control as comprising demand, supply, and harm reduction (Article 1d). Significant provisions of the treaty require that parties implement the following measures:

World Map Status

The United States is a non-party to the Framework Convention on Tobacco Control.[4] When the signed treaty was put up for ratification, President George W. Bush failed to send the FCTC to the United States Senate for consideration, thereby preventing the full participation of the U.S. in the implementation of the Framework Convention.

Furthermore, the U.S. has sought to change certain provisions of the FCTC, but with limited success.[2] Among the provisions opposed successfully were a mandatory ban on the distribution of free tobacco samples (which is now optional), a narrow definition of the term "minor" regarding the sale of tobacco (which now refers to domestic or national law) and broad limitations concerning the tobacco advertising, promotion and sponsorship (which were seen as violating free speech, and are now subject to constitutional limitations). Among the provisions unsuccessfully opposed by the U.S. were the requirement for warning labels to be written in the language of the country where the tobacco products are being sold, and the ban on deceptive and misleading descriptions such as "low tar" or "ultra-light", which might infringe on trademark protections.

As of October 2022, there are 14 non-party states that are members of the UN: six that have signed but not yet ratified (Argentina, Cuba, Haiti, Morocco, Switzerland, and the United States); and eight that have not signed (Dominican Republic, Eritrea, Indonesia, Liechtenstein*, Malawi, Monaco, Somalia, and South Sudan).

• Note: Liechtenstein, although not a WHO Member State, is eligible to become a Party to the WHO FCTC as a UN Member State.

The FCTC established two principal bodies to oversee the functioning of the treaty: the Conference of the parties and the permanent Secretariat. In addition, there are over 50 different intergovernmental and nongovernmental organizations who are official observers to the Conference of the Parties.[5]

According to the FCTC in 2010, "most parties have now passed or are renewing and strengthening national legislation and policies to meet their obligations under the treaty" and that 80% of parties facilitated public information and/ or education programs on the dangers of tobacco and curb underage tobacco consumption through laws that forbid retailers from selling tobacco products to minors.[5] Furthermore, 70% of parties made "large, clear and visible health warnings" mandatory for tobacco packaging.[5] However Nikogosian warns that the treaty's effectiveness hinges on how parties implement the guidelines.[5] FCTC implementation proves most difficult for developing and transition economies, due to a rift between their need for tobacco control and the resources they can access in meeting FCTC guidelines. This also proves to be difficult for the European Union,[18] and Australia.

In 2008, the FCTC advised to introduce plain tobacco packaging, which in 2012 subsequently was adopted in Australia .[19]

In 2012, a supplementary Protocol to Eliminate Illicit Trade in Tobacco Products to the convention was concluded in Seoul, South Korea. The Protocol will enter into force after it has been ratified by 40 states that have ratified the convention. In July 2017, there are 28 signatures[28] and the Protocol is reuniting more countries every year.

Reporters and the public were forcibly removed from the October 2014 convention which occurred in Moscow.[29] Washington Times reported that the FCTC delegates were discussing a global tobacco tax in secret.[29]

• List of smoking bans
• MPOWER tobacco control
• Nicotine marketing
• Protocol to Eliminate Illicit Trade in Tobacco Products
• Tobacco control
• Tobacco Damages and Health Care Costs Recovery Act
• World No Tobacco Day

• Heather Wipfli, The Global War on Tobacco: Mapping the World's First Public Health Treaty, Johns Hopkins University Press, 2015. ISBN 978-1421416830.

• Official website
• Institute for Global Tobacco Control
• GLOBALink Tobacco Control, The International Tobacco Control Community (archived 2012)
• GlobaLink (tobacco control), part of ncdlinks.org (registration required)