The world's first international tobacco control treaty

Negotiators from the World Health Organization's 191 member states meet in Geneva this week in an attempt to agree the world's first international tobacco control treaty, the Framework Convention on Tobacco Control.¹ This legally binding treaty would aim to establish principles and guidelines for international tobacco control. It follows a similar format to the 1992 United Nations' Framework Convention on Climate Change and its related protocols such as that signed in Kyoto in 1997. The development of a framework convention on tobacco is important because it is the first time in its history that the WHO has used its treaty making powers. And in the growing debate around trade and health it provides an opportunity to ensure that health is given primacy over commercial considerations when it comes to trade in a product that kills one in every two of its long term users.²

A global tobacco control treaty is now essential because the tobacco industry's use of international trade agreements, cigarette smuggling,³,⁴ and global marketing techniques has undermined national control measures and rendered them insufficient to control the tobacco epidemic.⁵,⁶ The industry uses similar tactics to penetrate new markets outside industrialised countries, where smoking rates are declining. As a result the tobacco epidemic has grown in size and gradually shifted its focus from high to low and middle income countries. By 2030 tobacco will kill 10 million people worldwide, an increase from the current 4 million.⁷,⁸ Over the same period, the proportion of these deaths occurring in the developing world will increase from 50% to 70%. This shift in disease patterns will add to growing global inequities as the burden of tobacco related disease grows in the South while profits from cigarette sales accrue to companies in the North.

Most countries, particularly the South East Asian and African nations, support a strong convention that would have the potential to halt this public health disaster. But a few key states are obstructing progress by angling for a weaker treaty. These states, most notably those that host the major tobacco transnationals, seem happy to stand by as their companies peddle death elsewhere. Criticism has rightly centred on the tobacco friendly Bush administration.⁹ But Japan, whose government is the majority shareholder in the world's third largest tobacco transnational, has been still more overt in its opposition and seems to doubt whether the reduction of tobacco consumption is a legitimate public policy objective. The European Union has also failed to argue for sufficiently comprehensive measures.¹⁰

Germany, Europe's largest tobacco manufacturer, is mainly responsible for the negative European Union position, although other states have likely sheltered behind it. The negotiating stance of the European Union is based both on its current tobacco legislation and on a shared position agreed between all 15 member states in areas that the legislation does not cover. Existing legislation is weak, largely because successive German governments (with occasional support from other European Union members) have obstructed the passage of effective legislation and, alongside their industry allies, challenged the legality of existing laws in the European courts.¹¹,¹² On other issues, agreeing a shared position inevitably produces the lowest common denominator, particularly when the most obstructive state is one of the most powerful. The problem is exacerbated as the European Union no longer speaks just for its 15 members, but increasingly for the 13 accession countries being pressured to support a position on tobacco control that is often weaker than those they have already adopted.

Despite overwhelming international support for a strong convention, these key states could have a damaging impact on the final treaty and consequently on global health. Weaknesses in some sections of the convention's current draft text reflect their influence and willingness to advance arguments from the tobacco industry. The text, for example, currently fails to advocate a complete ban on tobacco advertising—the only such measure for which there is a satisfactory evidence base. It also leaves the convention subordinate to international trade agreements, failing to treat tobacco like other uniquely harmful products such as weapons or hazardous waste that cause far fewer deaths but are already governed by specific trade rules.

This situation is no longer acceptable. It is one thing if individual countries decide to put their own citizens' health at risk, but quite another to deny other citizens of the world the right to health. The Framework Convention on Tobacco Control retains the potential to advance global health significantly, and negotiators in Geneva this week must ensure that this potential is not prematurely thwarted. The health community must now exert pressure on governments to support a strong Framework Convention on Tobacco Control and to stiffen the resolve of other governments in Europe to challenge the German position. If the health community falls at its first treaty making hurdle, how can we hope to address the challenges that globalisation poses for health in the future?