Fighting the tobacco epidemic: Matthew Allen, Paul Marriott-Lloyd and John Stribling outline international action to address the health problems of tobacco use.

• Author: Allen, Matthew
• Position: Statistical Data Included

Tobacco is a significant public health issue both in New Zealand and internationally. It is estimated that approximately 4700 New Zealanders die each year as a result of tobacco-related illnesses. (1) Passive smoking contributes to the death of a further 180 to 621 New Zealanders. (2) Other developed nations such as Australia show similarly high numbers of tobacco-related deaths. However, in the developing world tobacco use is becoming an epidemic of monumental proportions. While smoking in many developed countries has reached a peak and is now declining, many developing countries are experiencing a huge increase in smoking rates and tobacco consumption, and tobacco use is quickly becoming a leading cause of death. It has been estimated that the current global death rate from tobacco use (four million people per annum) will increase to 10 million people per year by 2030 (one in six adults). (3) Of those deaths, 70 per cent will occur in developing countries. (4)

The reasons for the increasing death toll in the developing world are many and include a lack of resources and experience to tackle tobacco-related harm, legislative constraints and, in many cases, a lack of political will, influenced by powerful lobby groups. In this regard tobacco is similar to other public health issues that tap the limited resources of developing states. However, the mortality and morbidity of tobacco use is entirely preventable. Large trans-national companies, whose gross profits exceed the GDPs of many developing nations, produce a large proportion of tobacco products worldwide. These companies are extremely adept at utilising sophisticated marketing strategies and international trade agreements to promote their products to the world.

This article reports on recent efforts, the World Health Organisation's (WHO) Framework Convention on Tobacco Control (FCTC) in particular, to further international tobacco control. The FCTC would be the first WHO-initiated international convention and the first public health treaty, ever negotiated. New Zealand is a key player in these developments and in efforts to strengthen regional tobacco control.

Proposed convention

The WHO has identified tobacco use as a health issue requiring urgent action by the international community. In May 1998, in her first speech as incoming WHO Director-General, Dr Gro Harlem Brundtland, highlighted tobacco control as one of two key projects requiring immediate action. Dr Brundtland commented:

We need to address a major cause of premature death which is dramatically increasing ... the major focus of the epidemic is now shifting to the developing countries. I refer to tobacco. I am a Doctor. I believe in science and evidence. Let me state here today. Tobacco is a killer. We need a broad alliance against tobacco, calling on a broad range of partners to halt the relentless increase in global tobacco consumption. (5) The development of the FCTC is to be the cornerstone of the WHO response led by Dr Brundtland. The proposal to develop a convention was made possible by the 1996 World Health Assembly (WHA) resolution WHA49.17 and builds upon the fourteen other resolutions on both national and international tobacco control measures adopted by the WHA between 1970 and 1995. However, the proposal to develop a convention is arguably the most significant action by the international health body in the battle to reduce tobacco-related harm. The FCTC represents the first time that the full constitutional powers of the WHO to develop conventions have been employed.

Subsequent WHA resolutions established a working group to prepare proposed draft elements for the FCTC, and an Inter-governmental Negotiating Body (INB) to negotiate the proposed convention and possible related protocols. The working group and INB were open to all member states and have been well attended, with 157 countries (representing over 95 per cent of the world's population) participating at the second INB meeting in April-May 2001 in Geneva. A third negotiating meeting was held from 22 to 28 November 2001. This pattern of at least two meetings per...