Convention on tobacco control a triumph for public healthDr Margaret Chan, Director-General of the World Health Organization
Mr Mseleku, Dr Nikogosian, excellencies, distinguished guests, colleagues in public health, ladies and gentlemen,
Some years ago, tobacco company executives described WHO as the industry’s single biggest enemy. We have always been extremely proud of this distinction and have worked hard to improve our reputation.
That distinction turned out to be farsighted. As time would tell, the industry’s biggest enemy had some truly big things in store.
Today we are celebrating the fifth anniversary of the entry into force of the WHO Framework Convention on Tobacco Control. As we all know, the tobacco industry is ruthless, devious, rich, and powerful. As we all know, neither WHO nor public health is rich, but with the Framework Convention now in place, we are indeed powerful.
If the measures set out in the Framework Convention were fully implemented, they could overpower or at least stand up to industry tactics, even as well-financed and ruthless as these are known to be.
As we mark this fifth anniversary, we are celebrating a true triumph for public health. We are also paying tribute to a model of international collaboration, for the sake of health protection, in a world of radically increased interdependence.
This is a world in which health everywhere is being shaped by the same powerful forces, including the globalization of unhealthy lifestyles. This is a world in which threats to health are increasingly transnational in their causes and consequences.
These threats and trends are universal, but the impact is not evenly felt. Developing countries have the greatest vulnerability and the least resilience. They are hit the hardest and have the least capacity to cope.
As we all know, developing countries are the new frontier for the marketing of tobacco products. In these countries and elsewhere, girls and women are a market with attractive and lucrative growth potential, and they are likewise being targeted.
Developing countries are still struggling with infectious diseases, weak health capacities, grossly inadequate numbers of staff, shortages of medicines, and a lack of insurance schemes for social protection. Developing countries are ill-equipped to cope with the added costs and demands from the wave of chronic diseases that inevitably follows increased tobacco use.
Prevention is by far the better option.
A recent Lancet study estimates that full implementation of just four cost-effective measures set out in the Framework Convention could prevent 5.5 million deaths within a decade. These are compelling statistics. This is the Convention’s preventive power. This is a win-win opportunity for governments and the international community.
Ladies and gentlemen,
The WHO Framework Convention on Tobacco Control is a young treaty. On the positive side, it is already one of the most widely embraced treaties in the history of the United Nations. Its implementation is being closely monitored.
On the negative side, this monitoring tells us, clearly, that the full preventive power of the Convention is far from being realized. For example, just slightly more than 5% of the world’s population is protected by national smoke-free laws. Tobacco taxes are the most effective way to reduce tobacco use. Yet only 21 countries have tobacco tax rates greater than 75% of the retail price.
In many affluent countries, levels of tobacco use have dropped significantly. These drops have led to corresponding reductions in the incidence of heart disease, stroke, cancers, and many other diseases directly linked to tobacco use. But even in these countries, tobacco use remains high in lower income groups and disadvantaged populations.
Most alarming of all, tobacco use is actually increasing in many developing countries. If Big Tobacco is in retreat in some parts of the world, it is on the march in others.
While we must admit that better results are needed, today is a fitting occasion to think about what this treaty meant when it came into force five years ago, and the promise it offers for the future.
Let me look, briefly, at the significance of this treaty in the context of several trends and challenges facing public health as we begin this second decade of the 21st century.
First, as I mentioned, more and more threats to health have an international dimension. The Framework Convention, like the revised International Health Regulations, gives countries an instrument for securing collective defence against shared threats. The population-based measures work. They are highly cost-effective. And they can be implemented in any resource setting.
Second, the entry into force of the treaty shows us the power of scientific evidence to overcome some considerable opposition, largely rooted in economic arguments. During negotiations, evidence was used to overcome exaggerated fears about the livelihoods of tobacco farmers and workers, revenues in the advertising industry, business interests of restaurants and bars, and the survival of sporting and cultural events that depend on tobacco sponsorship.
This was not easy, and the battle against the opposition continues, especially in developing countries. But in the end, health interests prevailed over economic concerns. In the end, the right of the public to breathe tobacco-free air, and the right of our children to be protected from addiction to a mortal product carried the greatest weight.
In obvious ways, the Convention is a triumph for the power of prevention, representing an effort to stamp out a cause of enormous ill health, disability, and premature death at its source.
At a time when the need for a whole-of-government approach to health is recognized, the Convention demonstrates that health can indeed persuade other sectors to take action, through taxes, graphic health warnings, legislation, and marketing bans and their enforcement.
I believe that the Framework Convention can also be viewed as an instrument of fairness. People everywhere, regardless of their place of birth or status in society, deserve the same protection from hazards to their health.
An international instrument such as this one helps developing countries see through and stand up to the powerful tactics of industry. A treaty like this one further allows citizens to hold their governments accountable for failures to protect public health from the hazards of tobacco.
Finally, the Convention illustrates the compelling need to strengthen capacities within countries, especially in the developing world. This is where WHO has an operational role.
Our staff are on the ground giving governments hands-on technical support to implement the treaty, whether through the crafting of legislation, the adoption of best practices, or recognition of well-known industry tactics for what they are. All countries will benefit from these efforts, which strengthen our collective defence.
Ladies and gentlemen,
I have one final comment to make. The tobacco industry, describing itself as “responsible”, continues to ask for a seat at the table as protocols to the Convention are negotiated.
As a recent story in The Economist noted, this is roughly equivalent to kindly allowing a pack of sly foxes to look after the welfare of your chickens. The answer is a firm no.
Like my predecessors, I am not on speaking terms with the tobacco industry, but I will say this: We’ve come a long way, bullies.
With the WHO Framework Convention as a support, we know how to stand our ground.
FCA press statement: (from www.fctc.org)
FCTC Anniversary Makes Public Health History
Today marks the 5th anniversary of the WHO Framework Convention on Tobacco control (FCTC), which celebrates an important milestone in public health history.
The Framework Convention Alliance (FCA) is pleased with the FCTC’s global impact. Already, 168 out of 195 eligible parties have joined the treaty through ratification or accession, and more are set to join.
As a result many countries are decreasing the prevalence of tobacco use and saving lives through banning tobacco advertising and sponsorship; protecting citizens from tobacco smoke exposure; and mandating pictorial warnings on cigarette packs.
The FCTC is a remarkable achievement because:
- It is the first treaty negotiated under the auspices of the WHO, recognising that international law has a critical role to play in global health.
- The treaty catalysed global action, elevating the importance of tobacco control as a global health and political issue, stimulating policy change at the domestic level and bringing new public and private resources into the field.
- The FCTC Conference of the Parties (COP) adopted strong guidelines on four of the convention’s key substantive articles, and work is underway on the development of a number of other guidelines and a protocol.
However, for each success there is an equally difficult challenge because universal FCTC implementation is still far away, particularly with respect to tobacco taxation, control of illicit trade of tobacco products and any measures that require resources, such as public education and cessation.
Richer parties have also made no significant effort to ensure tobacco control efforts in low and middle income countries receive appropriate technical and financial assistance. FCA would like to see countries include tobacco control in their development agendas to boost funding in this crucial area.
While tobacco kills more than 5 million people a year, tobacco control programs are grossly underfunded.
FCA’s future plans
During the next five years FCA will focus on improving FCTC implementation and increasing resources to adequately fund implementation of measures and policies that are compliant with the treaty.
FCA would also like to see more stringent measures in place such as:
- 90 per cent graphic warnings on cigarette packages;
- bans on cigarette package displays and duty free tobacco sales;
- generic packaging;
- higher tobacco taxes;
- more cessation methods; and
- an effective protocol on illicit trade in tobacco products.
Tobacco related deaths increasing
FCA director Laurent Huber said that during the past five years, the amount of deaths caused by tobacco had increased not decreased.
“Tobacco use remains high in low and middle income countries and it is increasing among women and young people,” he said. “We have five years of good progress on policy but deaths due to tobacco use continue to rise. Governments need to fund their policy promises to stem the tide of tobacco deaths.”
FCA would also like to see tobacco control treated as a development issue because the tobacco epidemic is shifting rapidly from developed to developing countries.
Tobacco addiction is a tremendous burden to poor families because it diverts money from necessities such as food and education into the pockets of the tobacco industry. Subsequent diseases from tobacco use consume already scarce health care resources.
Despite this, tobacco control has yet to make its way onto the global development agenda and receives no mention in the UN’s Millennium Development Goals. If tobacco control is treated as a global after-thought, development in the world’s poorer countries will be handicapped by rapid rises in tobacco-caused disease for decades to come.
“Our attitude should not be one of doing the bare minimum, but we should utilise the FCTC as a mechanism to escalate tobacco control efforts in order to save lives,” said Huber.
“The tobacco industry is alive and well, but health is still lagging behind. FCA challenges Parties to put action to intention, to do more, do what is needed and do it faster.”