WHO’s first global health treaty: 10 years in force

Bull World Health Organ 2015;93:211 | doi: http://dx.doi.org/10.2471/BLT.15.154823 Editorials 211 It is 10 years since the World Health Organization (WHO) Framework Con- vention on Tobacco Control entered into force.1 This binding treaty, the first to be negotiated under the auspices of WHO, is widely recognized as a major milestone in global health. Although challenges in fully imple- menting the treaty remain, it has been successful as a novel public health instrument. It has been ratified by 180 Parties – representing 90% of the global population – making it one of the most rapidly embraced treaties in the United Nations system. The treaty’s legal framework has enabled the rapid adoption of key instru- ments to promote its implementation. There are guidelines and policy options2 on most substantive articles, a reporting system and most recently, a Protocol to Eliminate Illicit Trade in Tobacco Products has been adopted. All instru- ments have resulted from formal inter- governmental processes – an important feature underlining consensus on their technical and political strengths. There has been a strong impact on national legislation. Of those that have reported, 80% (135/168) of Parties have either strengthened their laws or ad- opted new tobacco control legislation after ratifying the treaty.3 Accordingly, the global implementation rate of the Convention has steadily increased over the years. In 2014, the average rate of implementation of the substantive provi- sions of the treaty stood at almost 55%.3 There has been political recognition of the role of the Convention in achiev- ing progress in key areas such as the global action against noncommunicable diseases, addressing social determi- nants of health and strengthening the links between the development agenda and health. This has been manifested in several high-level resolutions4 and declarations5 including at the United Nations level.6,7 The Protocol to Eliminate Illicit Trade in Tobacco Products8 comple- ments the Convention in one of the most challenging areas of tobacco control. Illicit trade increases the accessibility and affordability of tobacco products, thus fuelling the tobacco epidemic and undermining tobacco-control policies; it also causes substantial losses in gov- ernment revenues, and contributes to the funding of transnational criminal activities. The Protocol, which is a new international treaty in its own right, has demonstrated the power of the Convention to further strengthen the legal dimension of international health cooperation. Challenges in fully implement- ing the treaty have also been revealed in recent years. According to Parties’ reports, the interference of the tobacco industry, including through legal chal- lenges brought against governments, remains the most prevalent obstacle.3 Lack of political support and weak inter- sectoral coordination, as well as scarce human and financial resources are still major obstacles in some countries. While smoking prevalence has started to decline in most countries that have pro- vided comparable data,3 the rising use of tobacco products that are expanding in their global reach – such as smokeless tobacco, water-pipe and electronic nico- tine delivery systems – creates further challenges in fully implementing the Convention. Another observation from the trea- ty era in tobacco control is the growing ambition of governments and societies to end the tobacco epidemic. This was demonstrated through strong measures such as extending smoking bans from indoor public spaces to certain outdoor areas; banning the display of tobacco products at points of sale; prohibit- ing the use of additives that make the products more attractive; requiring plain packages and even outlawing the sale of tobacco altogether. In a related development, several nations declared their goals, and timelines, to become tobacco-free societies.3 The WHO Framework Convention on Tobacco Control offers a model for addressing the negative effects of global- ization on health. ■ References 1. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization; 2003. Available from: http://www.who.int/fctc/ text_download/en/ [cited 2015 Feb 10]. 2. Guidelines and policy options and recommendations for the implementation of the WHO FTCT [Internet]. Available from: http://www.who.int/fctc/treaty_instruments/ en/ [cited 2015 Feb 12]. 3. Conference of the Parties to the WHO Framework Convention on Tobacco Control. Global progress in implementation of the WHO FCTC – a summary. Geneva: 2014. Available from: http://apps.who.int/gb/fctc/PDF/cop6/ FCTC_COP6_5-en.pdf [cited 2015 Feb 10]. 4. Resolution WHA 66.10. Follow up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Disease. In: Sixty-fourth World Health Assembly, Geneva, 20–27 May 2013. Resolutions and decisions, annexes. Geneva: World Health Organization; 2013. Available from: http://apps.who.int/gb/ ebwha/pdf_files/WHA66-REC1/A66_REC1-en. pdf#page=25 [cited 2015 Feb 10]. 5. Rio Political Declaration on Social Determinants of Health. In: World conference on Social Determinants of Health, Rio de Janeiro, Brazil, Oct 19–21, 2011. Geneva: World Health Organization; 2011. Available from: http:// www.who.int/sdhconference/declaration/ Rio_political_declaration.pdf?ua=1 [cited 2015 Feb 10]. 6. Resolution GA 66.2. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. In: Sixty-sixth United Nations General Assembly, New York, 16 Sept, 2011. New York: United Nations; 2011. Available from: http://www.un.org/en/ga/ search/view_doc.asp?symbol= A/RES/66/2 [cited 2015 Feb 10]. 7. United Nations system-wide coherence on tobacco control. Resolution adopted by the Economic and Social Council; E/RES/2012/4; Aug 12, 2012. Available from: http://www. un.org/ga/search/view_doc.asp?symbol=E/ RES/2012/4 [cited 2015 Feb 10]. 8. WHO Framework Convention on Tobacco Control. Protocol to Eliminate Illicit Trade in Tobacco Products. Geneva: World Health Organization; 2013. Available from: http://apps.who.int/iris/ bitstream/10665/80873/1/9789241505246_ eng.pdf?ua=1 [cited 2015 Feb 10]. WHO’s first global health treaty: 10 years in force Haik Nikogosiana & Vera Luiza da Costa e Silvaa a World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland. Correspondence to Haik Nikogosian (email: nikogosianh@who.int).