The WHO Framework Convention (FCTC) that changed tobacco control| Tabaccologia

The Framework Convention on Tobacco Control (FCTC) is 20 years since its approval (2003-2023). The FCTC is an international treaty, defined at the end of four years of negotiations and discussions among World Health Organization (WHO) members, that establishes goals and principles aimed at protecting present and future generations from the devastating health, social, environmental and economic consequences caused by tobacco use and exposure to secondhand smoke.

The treaty’s provisions include rules governing the production, sale, distribution, advertising and taxation of tobacco.

The FCTC was approved by the World Health Assembly on May 21, 2003, was signed by 192 signatories (including the European Union - EU) covering over 90% of the world’s population, and entered into force on February 27, 2005. Since then, the FCTC has become one of the most rapidly and widely adopted treaties in the history of the United Nations [1].

WHO dedicated the 2011 World No Tobacco Day to FCTC with the slogan “Three ways to save lives” where it proposes fire extinguisher for fires, life preserver for shipwrecks and FCTC for tobacco [2].

Better late than never

Italy actively took part in the preparatory process with delegations from the Ministry of Health and the Ministry of Foreign Affairs and International Cooperation, and with coordination actions to define common positions among EU countries. Among the Western countries, however, Italy was among the last countries (along with the Principality of Monaco and Liechtenstein) to ratify the FTCT after it was signed on June 16, 2003. It was obvious, in fact, how the pro-tobacco lobby in Parliament was doing everything possible not to ratify it or at least delay its ratification as long as possible. It is with pleasure and pride that we can say that SITAB and the journal Tabaccologia were the only ones to press the institutions; as an example, we recall the reminder letter sent to the President of the Republic, Giorgio Napolitano, (with a reply from the Presidency), to the Minister of Foreign Affairs, Massimo D’Alema, and to the Minister of Health, Livia Turco [3]. Finally, on July 2, 2008, came the Italian ratification authorized by Law No. 75 of March 18, 2008 and published in Ordinary Supplement No. 97 to Official Gazette No. 91 of April 17, 2008 [4].

As written in press release No. 18 of the Ministry of Health “a long administrative process was concluded”: five years were needed for the ratification of the Convention, definitely a “very long” time, but, as they say, better late than never!

FCTC, what it consists of

The WHO FCTC, developed as a response to the globalization of the tobacco pandemic, affirms the right of all people to the highest standards of health. From a legal perspective, the FCTC is the first international treaty for the protection of public health that, by recognizing the harm caused by tobacco products and the industries that manufacture them, establishes legally binding principles and goals that signatories are required to comply with.

The Convention represents a milestone for public health promotion and international health cooperation in tobacco control.

The key provisions can be summarized as follows:

1. Article 5.3. The tobacco industry shall not interfere in health policy-making.

Countries shall:

1. Article 6. Implement tax and price measures to reduce tobacco consumption.
2. Article 8. Implement measures to protect non-smokers from secondhand smoke in public places, workplaces and means of transportation.
3. Articles 9-10. Provide for the regulation and transparency of the content of tobacco products.
4. Article 11. Regulate labeling and packaging to effectively inform consumers about the health harms of tobacco use by eliminating misleading information.
5. Article 12. Provide education, communication, training and public awareness.
6. Article 13. Arrive at a general ban on advertising, promotion and sponsorship.
7. Article 14. Implement measures to encourage tobacco cessation programs.
8. Article 15. Implement measures against illegal trafficking, based on package marking, in order to trace origin and final destination.
9. Article 16. Regulate the prohibition of sales to and by minors.
10. Articles 17-18. Identify and support viable alternatives to tobacco cultivation, safeguarding the environment and the health of workers.
11. Article 19. Adopt legislative measures so that companies that engage in reprehensible behavior are prosecuted and, where appropriate, required to pay compensation for damages.

The Convention establishes the Conference of the Parties (COP), a body that includes individual countries and supranational entities such as the EU. The COP meets periodically to review progress and approve protocols and guidelines for implementing the articles of the Convention, prepared by the Secretariat under WHO.

FCTC, a necessary treaty

Although tobacco control measures implemented especially in Western countries are helping to save millions of lives, nevertheless the scale of the tobacco pandemic is tragic. Globally, the number of smokers has increased due to population growth, and the use of new tobacco products (electronic cigarettes and heated tobacco products) is increasing in some countries [5].

Tobacco smoking remains the most important cause of preventable morbidity and premature mortality worldwide.

According to WHO, with approximately 1.3 billion smokers worldwide, tobacco, through direct and indirect exposure, causes more than 8 million deaths each year from smoking-related diseases [6-7]. If current consumption patterns remain unchanged, tobacco is expected to kill about 10 million people each year between now and 2030, including 7 million in developing countries [8].

Changing the future requires timely enforcement of the FCTC and synergistic actions among countries to counter supranational phenomena such as illicit cross-border trafficking and Internet advertisements.

The actual willingness to implement the FCTC also depends on the amount of funding that is made available for the activation of contrast policies. However, a measure that can be activated without the allocation of funds and which has proven to be among the most effective in reducing the prevalence of smokers is the increase in taxation of all tobacco products (Article 6). It must be emphasized that to be effective, increased taxation must cover all products and all countries (at least by macro-areas, e.g., all European Countries) because on the contrary, inequality in tax rates facilitates tobacco consumption. In fact, when faced with an increase in the price of only one’s own product, a smoker, rather than quitting, may decide to switch to a different product with a lower price; and when faced with a lower price for the same product in a neighboring country, a smoker may be encouraged to make cross-border purchases. Therefore, to achieve the ultimate goal of the FCTC, i.e. the achievement of a tobacco-free future society, we must act immediately and in unison!

References

1. WHO. Framework Convention on Tobacco Control (FCTC).Publisher Full Text
2. World Health Organization (WHO). World no Tobacco Day 2011 – The WHO Framework Convention on Tobacco Control.Publisher Full Text
3. SITAB homepage. Ratifica Convenzione Quadro internazionale sul Controllo del Tabacco (FCTC). Tabaccologia. 2007; V(1):45.
4. Ministero della Salute. Convenzione quadro OMS per la lotta al tabagismo.Publisher Full Text
5. The Tobacco Atlas.Publisher Full Text
6. World Health Organization (WHO). Tobacco fact sheet.Publisher Full Text
7. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The health consequences of smoking – 50 years of progress: a report of the Surgeon General. Centers for Disease Control and Prevention (US): Atlanta; 2014.
8. Mackay J, Eriksen M, Shafey O. The Tobacco Atlas. American Cancer Society: Atlanta; 2006.