Initial thoughts
Standing before an audience already well-versed in the dreadful realities of tobacco consumption is always a good beginning.
Happily, the World Heart Federation has an exemplary article in its statute which denies membership to those who are: associated in any way to companies [or] organizations which have a detrimental impact on public health (in particular tobacco, alcohol or firearms).
It is absolutely right to put tobacco in the category of deadly man made products, given the numbers of people affected.
Firearms kill upwards of 350,000 people a year and alcohol about 2.5 million. Tobacco kills 6 million a year; up to half its users.
This unfolding human catastrophe brought the nations of the world together in 2005, when the WHO Framework Convention on Tobacco Control entered into force.
Now, more than a decade later, the United Nations tobacco control treaty has impressive number of 180 Parties, covering more than 90% of the world’s population.
Now, more than a decade later, the United Nations tobacco control treaty has impressive number of 180 Parties, covering more than 90% of the world’s population.
And we will soon mark the entry into force of our first Protocol, which targets the illicit trade in tobacco products.
The Convention’s goal has been to outline the global principles and guidelines for tobacco control and then to monitor, encourage and assist the work of the governments which actually implement its provisions. We can – and do – press Parties to make a greater effort and to follow best practice
The Convention Secretariat, which I lead, works with governments but it also engages and allies itself with organizations such as the World Heart Foundation.
Numbers and NCDs global mechanisms
The treaty fits broadly within the area of NCDs prevention, and the fight against tobacco is a critical part of that struggle.
I have mentioned that tobacco kills about 6 million people a year, part of the barely imaginable loss of 38 million lives every year from NCDs.
The Global Action Plan for the Prevention and Control of NCDs envisages a 25% reduction in premature NCD deaths by 2025 (the 25 by 25 policy).
But given tobacco’s outsized role in causing NCDs, it also has an outsized reduction target, so we aim to cut tobacco use by 30% in those aged 15 and above by 2025
There’s another reason for this ambitious target. Tobacco control is one of the most advanced areas of NCD activity on a global level.
NCDs as a whole were not taken seriously enough for too long, not perhaps until 2011 with the UN High-Level Conference on Prevention and Control of NCDs, but the world came together on the tobacco issue several years earlier, through the entry into force of the Framework Convention.
Two years ago, the FCTC’s Conference of the Parties, or COP, responded to the UN General Assembly’s criticism of NCD progress, which it termed “slow, insufficient and highly uneven.”
Multisectorality
The COP asked the Convention Secretariat to further strengthen involvement with other international organizations to reinvigorate our links in several areas of joint action, including the UN Interagency Task Force on the Prevention and Control of NCDs.
We have worked with the United Nations Development Programme to ensure that development planning includes key elements of tobacco control.
We have worked with the United Nations Conference on Trade and Development to examine the tobacco chain and intellectual property and tobacco packaging.
We have joined hands with the International Labour Organization on tobacco sector employments and we hope to launch a programme soon in cooperation with the Food and Agriculture Organization.
Our work with the World Customs Organization stretches back several years and likewise we have a solid relationship with the World Bank.
And we have a growing role in encouraging Parties to engage in South-South and triangular co-operation, where they can support one another.
This is a fundamental element of our work and provides a useful path for everyone working on NCDs.
The Convention Secretariat is, I think it’s fair to say, a dedicated body, but it’s also fair to say that we don’t command the vast resources of our powerful opponents.
Only by utilizing the commitment and expertise of other likeminded organizations and Parties can we make progress.
And that process of making the FCTC more familiar and relevant at a country level also feeds back into the major international conferences where global policy for future years and decades is made such as the 2030 Agenda for Sustainable Development, which includes Target 3.a, calling on member states to “strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate.”
But let's look into other facts:
In low- and middle-income countries, misuse of limited family wealth fosters poverty, lowers worker productivity and raises the burden on inexperienced healthcare systems often struggling to cope with communicable diseases, let alone NCDs.
More than 80% of premature deaths from NCDs occur in low- and middle-income countries, and the picture may soon become even worse.
The tobacco industry is extending its tentacles to these new markets and enticing new victims in countries where there is generally less experience of countering its activities.
Sustainable development is a multi-faceted question, involving numerous moving parts.
So this is a part of our role: to challenge the industry’s lies about the health and economic costs of tobacco use in order that resources can be directed to where they’re most needed, and not in mopping up the human costs of the tobacco industry’s irresponsible behaviour.
The struggle against the consumption of tobacco only really moves forward when there is a robust response from a wide alliance of professionals.
Professionals involved:
Some examples include:
Lawyers are also essential
Human rights lawyers have joined the tobacco-control campaign, partly I think, because the tobacco industry’s twisted language threatens to devalue the whole concept of human rights.
Tobacco executives like to dress themselves as defenders of individual liberties and to suggest that consumption of their deadly product is a human right, a choice freely made.
Lawyers state that The “freedom to smoke” or “right to smoke”… has no basis in law; all states reserve the right to ban or regulate substances that are addictive and harmful to their populations.
These arguments about public health versus individual or commercial rights are being played out before the courts – in recent months, for example, courts in India, United Kingdom and the European Union have ruled against the tobacco industry’s attempts.
So here’s one clear message that needs to be heard by every NCD campaign – find good, motivated lawyers and ask them to work on their arguments because you can be certain that well-funded industries are never short of inventive legal minds.
Communication professionals and the media are also a relevant group
Women too have become targets, and the industry has remorselessly tried to link smoking to the ideas of female choice and personal emancipation.
The Convention Secretariat is now working to provide a response to this development, ensuring that women have a genuine choice by understanding the true costs of tobacco consumption.
Economists are key in their fight
Economic arguments have proved absolutely key to our cause, because they help to convince a wider audience beyond the medical and research community.
Tobacco taxation is a critical issue. Higher taxes are probably the single most important step to cutting tobacco consumption, as the industry well knows.
The importance of tax policy is recognised by WHO FCTC, and was further highlighted at the United Nations’ Addis Ababa Action Agenda for the financing of development.
The conference stated that: As part of a comprehensive strategy of prevention and control, price and tax measures on tobacco can be an effective and important means to reduce tobacco consumption and health-care costs, and represent a revenue stream for financing for development in many countries.
The lesson? It matters who you talk to. We need to find new allies, outside our normal circles, to create winning arguments, and we must then place them in front of the decision-makers.
The lesson learned by the FCTC Secretariat is to reach out and seek alliances with organizations that may not initially be familiar.
Yes, we can point to some truly impressive achievements, but it would not be accurate to suggest that everything is rosy.
There has been, and continues to be, a profound misunderstanding among some Parties about their formal and informal relationships to the tobacco industry.
Of course, the Secretariat actively pursues such allegations and regularly reminds Parties that they should engage with the tobacco industry only: when and to the extent strictly necessary to enable Parties to effectively regulate the tobacco industry and tobacco products and conduct any necessary interactions with full transparency.
In practical terms, this means keeping the industry at arm’s length: no so-called voluntary agreements, no sponsorship, no assistance in drafting legislation or professional rules.
Health professionals special role
So what can professional organizations do to assist in the tobacco control movement?
I think it’s important that we recognize that as professionals, we have an influence on those around us, so I’d say to those of you who still smoke – quit now! Our personal actions speak volumes.
There are also a wide range of advocacy activities which professionals can assist with, for example by making sure that health events include time to discuss tobacco health damages, prevention and cessation.
We can seek information from patients about smoke in the workplace, advise on cessation strategies, ensure that there is adequate follow-up, and seek to influence training courses so that tobacco issues are included.
It’s important to know the scale of the problem, so you can encourage health professionals to ensure that smokers are identified and logged in healthcare record systems.
Such patients can be offered short summaries on where to find additional help, the sort of information that should ideally be provided by an advice line.
Ideally, these advice lines should be able to refer to specialized tobacco dependence treatment services, where individually tailored advice and possibly medication can be prescribed as part of a cessation strategy.
Once established, cessation and tobacco treatment strategies should constantly be reviewed and updated so that the authorities can see what’s working and how to capitalize on such tactics.
It’s also worth ensuring that the organizations you’re involved will develop a policy on relations with the tobacco industry, or those who work with them, which contemplates not receiving funds from the industry and tobacco-free portfolios.
And there are the broader areas where your support can make a difference, such as pressing politicians to implement the FCTC and ensuring that adequate resources are made available to fund tobacco control programmes. At the end, every president, minister, congress person, has a cardiologist!
Final comments
As I near the end of this presentation, let me reflect on two final issues.
Firstly, this battle is long and it is hard, but it will be won.
Let’s remember where we came from. There was a time when the science of tobacco-related illness was disputed, when our medical forefathers suggested that tobacco might be good for health, when the world’s leaders were rarely seen without a tobacco product in their hands.
Those days are long gone. Tobacco is almost universally accepted as a profound social evil which must be stamped out before it afflicts yet more generations.
Tobacco regulation was once questioned but is now so widely embraced that some FCTC Parties have set out plans to end tobacco use altogether. Imagine that!
Secondly, I want to remind you of the defining role played by health professionals like cardiologists.
People in most parts of the world may question the honesty of professionals like politicians, journalists and real estate agents, but they still trust in the integrity and fundamental decency of doctors.
So when they are told by a cardiologist that smoking will cause serious illness, many sensible patients will consider a change in lifestyle.
This is what weighs in the balance against the money and advertising of the tobacco industry, their paid-for friends and their front groups, their marketing specialists and dark tactics.
The advocacy of cardiologists and health campaigners is our low-cost response to this powerful enemy, and yet it is invaluable.
So I do urge you to take every available opportunity to speak out on the issue, whether that be aimed at the public or other professional groups or to policy makers.
Don’t underestimate the power of your voice and your public image.
We have a great cause. We must never flag or tire in our determination to end the curse of tobacco consumption and the terrible human waste that it causes.
Jeff Cancerous Lung and Lupita Corazón Partido
Back in 2015, "Jeff Cancerous Lung" was created to make people aware about the damage that tobacco products can cause. Jeff Cancerous Lung personified a famous cowboy who used to promote tobacco products. To this day, Lung Cancerous Jeff, is a symbol of the fight against smoking habits.
Today,the civil society that keeps fighting to strengthen anti-tobacco policies have created “Lupita Corazón Partido” whom I have the pleasure to introduce to you today. “Lupita Corazón Partido” represents the cardiologists sector and the harmful effects that second hand smoke has on human's health.
This two characters, Jeff and Lupita, will get married today at 14:00 (Mexico City time) at the exhibition room, to show the struggle and commitment of the cardiologists to promote people’s health over harmful tobacco smoking.
The message of Jeff Cancerous Lung and Lupita Corazón Partido is profound and goes beyond parody of these two characters.
In Mexico, more than 66,000 people die each year from diseases caused by the consumption of tobacco, of which 10% have never smoked. To reduce tobacco-consumption related deaths, it is necessary to implement effective and efficient tobacco control public policies. One of these measures is the implementation of smoke-free policies throughout the country; it is important to note that these are already being discussed in the Chamber of Deputies of Mexico, as part of the proposed amendments to the General Law for the Control of Snuff.
In the framework of the World Congress of Cardiology and Cardiovascular Diseases, cardiologists from around the world unite in a common cause to make a strong appeal to the Congress of Mexico to strengthen the "General Law for tobacco control" and to immediately approve the amendments to the law for "a smoke-free Mexico".
And lets make this the great legacy of all those attending this event in a country that has welcomed them with open arms.
Please welcome Jeff and Lupita, and do not forget to attend to their wedding to sign the petition.
I thank you for listening, for your work, and for supporting this great campaign.