World’s First Public Health Treaty
The world’s first public health treaty becomes international law today in 40 countries and will take effect in an additional 17 countries in the near future. The World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC, resolution WHA56.1), aims to reduce tobacco consumption worldwide, thereby decreasing the health and economic impacts of tobacco products. Peru was the magical 40th ratification of the treaty required for the treaty to be put into effect.
As a framework convention, the treaty offers broad recommendations for
governance rather than addressing specific commitments to reduce the amount of tobacco produced or sold. The treaty calls for governments to:
- Protect all citizens from exposure to tobacco smoke in indoor and outdoor public places, public transport, and indoor workplaces
- Require health warnings in a country’s principal language or languages on at least 30% of the package
- Require the inclusion of a statement of origin or destination, such as “Sales only allowed in (insert name of the country, subnational, regional or federal unit)”
- Implement a comprehensive ban of all tobacco advertising, promotion and sponsorship
- Forbid the sale of tobacco to minors, including through the usage of tobacco vending machines
- Ban the distribution of free tobacco products
Two of the top three producers of tobacco have signed but have not yet ratified the treaty:
1. People’s Republic of China (signed 10 Nov 03; not ratified)
2. United States of America (signed 10 May 04; not ratified)
3. India (signed 10 Sep 03, ratified 5 Feb 04)
Being signatories to the treaty means that China and the U.S. agree to act in good faith to ratify the Convention, but there are no mandated timelines. The U.S. is reluctant to ratify the Convention without the option to opt-out of certain provisions, known as taking reservations. This treaty does not allow reservations. Two specific concerns of the U.S. include the complete ban on advertising (Article 13), seen as problematic to the First Amendment, and the inclusion of language regarding civil and criminal liability (Article 19). Thus, signatories can display political commitment to the spirit of the Convention without being bound by it.
In addition to constitutional and legal concerns that countries may have, political and economic concerns strongly influence the decision to abstain from ratification.
In China, more than 320 million people smoke, accounting for at least one-fourth of the world’s smokers. The state-owned China National Tobacco company took most of the country’s estimated US$1.5 trillion in tobacco sales last year. Moreover, China National Tobacco recently formed an alliance with UK-based Gallagher to manufacture and distribute in China and Russia, but they may face tough competition from British American Tobacco’s new China-based US$1.5 billion factory with a production capacity of 100 billion cigarettes a year.
In the U.S., where nearly one in four adults smoke and tobacco-related illnesses are the leading cause of death, tobacco companies spent a record US$12.5 billion on marketing in 2002, US$1 billion of which was used to provide promotions for free cigarettes, a practice banned under the new treaty.
Smaller nations, particularly in sub-Saharan Africa, are also reluctant to ratify the treaty. Tobacco accounts for 70% of exports in Malawi and 20% of exports in Zimbabwe. Although the Convention encourages sustainable development, these countries worry about a disruption to their already suffering economies without concurrent financing to transition to new crops and livelihoods.
Overall, the treaty, with its lack of quantifiable reduction targets and ratifications from the world’s largest producers and consumers of tobacco, offers little realistic hope of slowing recent double-digit sales growth of top tobacco companies such as the Altria Group (owner of Phillip Morris), British American Tobacco, and Imperial Tobacco Group. Still the treaty represents a significant step forward in highlighting the global health concern of tobacco-related illnesses and the need to promote sustainable development practices to further global health for all.