THE WORLD Health Organization Framework Convention on Tobacco Control (FCTC) turned 10 last Feb. 27. Given that tobacco kills six million people globally every year, the importance of celebrating this treaty cannot be over-emphasized. Today, there are 180 State Parties to the FCTC, committing themselves “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke.”
In 2005, when the FCTC came into force, the world’s nations united in saying it cannot be business as usual for the tobacco industry. Over the past decade, the world has seen many local and national governments banning smoking indoors and in workplaces and even some outdoor public places (including the Olympics and Southeast Asian Games), as well as banning tobacco advertising and promotions in mass media and at points of sale, including the retail display of tobacco products. Many countries have also banned or restricted the tobacco industry’s fake corporate social responsibility (CSR) schemes, acknowledging that an industry that inherently harms society can never be deemed socially responsible.
Regular excise tax increases that make products increasingly less affordable are also slowly gaining ground in all regions of the world based on the recognition that taxation is not only a revenue measure but also an important public health measure that encourages current smokers to quit and discourages youths from starting to smoke. Notably, within ASEAN, excise was increased by more than 300% in Brunei (2010) and the Philippines (2013). Additionally, excise surcharges have been dedicated by law to fund tobacco control in Thailand, Laos and Vietnam, while in the Philippines, incremental excise revenues are earmarked for universal health coverage and alternative livelihoods of tobacco farmers and workers.
Health warning labels have also come a long way, from absent or tiny text-only warning on the sides of packages to large pictorial warnings on the front and back of packs in more than 75 countries, with Thailand currently having the world’s largest (85%) pictorial warnings. In Australia, standardized or plain packaging enhances these graphic warnings by removing the attraction and glamor of colorful branded packages.
These are all consistent with the various evidence-based implementation guidelines that the FCTC Conference of Parties (COP) has adopted over the past several years, but 10 years later, we need to ask: are we on track to end the tobacco epidemic and its profoundly negative consequences, not just on the health of individuals, but also on human rights, social development, national economies, and the environment? Have we begun to see a decline or even a slowing of consumption in developing countries? Are the poor smoking or chewing less tobacco? Are the tobacco industry’s profits declining?
Unfortunately, smoking prevalence is still high in many countries, and cigarettes remain very affordable, including in all ASEAN countries. Consequently, the number of tobacco users and deaths continues to rise, while the tobacco industry, the vector of the epidemic, continues to make obscene profits at the expense of public health: in 2013 the profit of the four biggest companies was over $36 billion.
So while the FCTC has accelerated tobacco control progress in many countries, a more serious effort is needed to achieve the global target of reducing tobacco use prevalence by 30% by 2025 (This target was adopted in 2013 by the World Health Assembly as part of the Global Action Plan for non-communicable diseases, and subsequently by the FCTC COP in 2014.).
Based on global and country reports submitted to the COP, two of the main challenges identified are tobacco industry interference in policy development and implementation, and limited resources in countries for tobacco control. A large focus therefore must be to enlighten misguided policy makers, government officials, and media practitioners, who continue to defend industry positions, so that regulations can be as strong and effective as possible and to ensure that adequate human and financial resources are allocated to FCTC implementation at both national and global levels.
At the national level, tobacco control needs to be prioritized if countries are to tame the exponentially growing non-communicable diseases burden; without tobacco control, it will be impossible. This requires a whole-of-government approach, possibly framing tobacco control as a national development priority, so that ministries of finance, education, social welfare, agriculture, labor, and trade must support tobacco control, not just ministries of health.
Local governments also have a large role to play in implementing and enforcing smoke-free policies and educating their constituencies.
Expectedly, the tobacco industry will continue to interfere, aiming to defer, dilute and delay effective regulation. It is necessary therefore to continue raising public awareness of such tactics and working to denormalize the tobacco industry. Governments need to hold the tobacco industry accountable for the devastating consequences of its products, and — a related issue — implementation of FCTC Article 5.3, calling for governments to refuse to cooperate with the tobacco industry in formulating health policy, should be a priority in all countries.
At the global level, nations need to look seriously at accelerating FCTC implementation, so that the tobacco death clock can begin to slow down. Within the post-2015 Sustainable Development Goals, non-communicable diseases are shaping to be a priority, so this is good news, as long as global leaders remind themselves that tobacco is a major risk factor for the four major non-communicable diseases and that FCTC implementation should be a priority within the non-communicable diseases priority. Additionally, tobacco’s social, economic, and environmental harms should also be covered.
Ten years of the FCTC is a good number to celebrate, but let’s hope it doesn’t take another 10 to see even faster progress. Six million preventable deaths per year is six million too many.
Dr. E. Ulysses Dorotheo is the FCTC program director of the Southeast Asia Tobacco Control Alliance (SEATCA) and currently sits as chair of the board of the Framework Convention Alliance, a global NGO of close to 500 member organizations.