The FCTC as a global legislative public health instrument
Let me start by telling you a little about the first and only UN tobacco control treaty, the World Health Organization Framework Convention on Tobacco Control.
In the late 20th century, it became apparent to a growing community of experts and campaigners that tobacco was a global threat.
The tobacco industry looked outwards and recognized that globalization presented an opportunity to create new markets and new production facilities in the developing world.
The public health response also needed to be global, and so campaigners, diplomats and public health officials began to consider the prospects for a framework convention on tobacco control.
This really was a revolutionary idea, and like most revolutions it took a long time – and discredit, to develop before reaching a conclusion.
But there was something more, something very moving and human about this process, a realization that the world had created something remarkable.
The creation of the FCTC was a huge moment in the history of health policy. Despite fierce resistance from the tobacco industry - always keen to protect profit at the expense of human life - the world made a very mature decision.
What they created has stood us in good stead over the past 11 years and has, I would argue, created a powerful vision of how the world can deal with manmade health threats, a vision that will be useful to those seeking to tackle the causes of NCDs.
The 180 Parties to the FCTC have made a treaty commitment to implement its provisions.
Implementation rates for FCTC articles vary a great deal. And yet, even the poorest performing Parties have made some progress, because they now have a scorecard which spells out what their tobacco control policy should look like and how to judge its success.
Before 2005, a country looking for answers to tobacco control dilemmas faced a problem.
Who could they ask for help?
What was the experience of their neighbours?
Which policies worked and which didn’t?
How should they regulate relationships with the tobacco industry?
Did it really matter or was tobacco reduction just a style?
The FCTC answered many of these issues by laying out clearly and for the first time what needed to be done.
The clarity of purpose and sense of direction provided by the FCTC is the single most important reason for the progress that has been made in the last 11 years.
More than 80% of Parties have beefed-up tobacco control legislation;
Cigarette prices rose by 150% on average;
The use of graphic health warnings, often covering 75% of the packet, and of plain packaging are increasing;
Bans on smoking in workplaces and on public transport have been imposed in many Parties;
and a few others gone yet further - taking the bold step of aiming for tobacco free status, which would require tobacco usage of less than 5%.
There have been giant strides too in other important areas, like:
restrictions on tobacco advertising,
bans on flavourings like sugar and menthol,
increases in the minimum age at which tobacco products can be purchased
alternative livelihoods for tobacco farmers,
and more developed and sophisticated cessation strategies and assistance.
Now, I’m not saying that the Convention was a magic solution, or that its entering into force marked the end of the tobacco industry’s hold over its vast legions of addicts.
Like every industry peddling products injurious to human health, the tobacco industry has an arsenal of options not open to health campaigners.
But these are also the strengths of our diverse alliance. Campaigners are motivated by a fierce desire to end the harm done by tobacco.
Many of them – myself included – have seen the terrible effects of tobacco consumption on close relatives.
While it may be slower to organize a broad movement, it ultimately emerges victorious because represents a far wider community than the tobacco companies.
That wider community is often represented by non-governmental organizations, the NGOs, including organizations like the World Health Federation.
In the early days when the FCTC was first discussed, NGOs played an important role in pressing governments and international organizations to foster the idea of a framework convention.
Once the Convention had been implemented, their role changed so that in recent times, NGOs have increasingly been taking the lead in helping Parties, especially developing countries, with FCTC implementation.
We are partly the victims of our own success. The FCTC now has 180 Parties and is one of the most widely adopted treaties in UN history.
This has generated high demand from Parties seeking assistance and frankly, this is more than the Convention Secretariat can manage on its own.
But NGOs have stepped into the breach and assisted Parties in a wide range of areas.
It’s revealing, I believe, that countries where implementation has been lowest also report that they lacked a strong NGO presence.
This work is matched by the increasing involvement of international organizations, like WHO, the UNDP and our UN sibling agencies.
Now things have become more formalized, with imaginative new programmes to harness the vast abilities of the world’s universities and research institutes.
Let me give you an example – the Knowledge Hubs which the Convention Secretariat is implementing at various sites around the world.
The hubs spread the word through meetings, but also through websites where material can be found at the click of a mouse.
We have also pursued a new programme of observatories.
This follows a pattern established by the University of Bath in the UK, which pioneered an intensive programme of tobacco industry monitoring to produce a wiki-style website which chronicles the misbehaviour of tobacco companies.
The success of this approach is now being replicated through the establishment of a chain of observatories in the five BRICS countries, which together account for about 40% of the world’s population, and in other interested Parties.
These knowledge hubs and observatories mark an exciting new era, where tobacco control data and information moves off the library shelf and into the wider world.
This will build on the already significant body of material available from the treaty instruments, and which fleshes out the its central elements.
The guidelines now run to many pages and spell out, in some detail, how governments and others involved in the making of public policy should behave.
Take an example from FCTC Article 5.3, which aims to counter tobacco industry interference. One of the guidelines state that: Parties should require government officials to declare and divest themselves of direct interests in the tobacco industry.
It sounds straightforward, doesn’t it? But you would be surprised at just how many countries lack this kind of basic rule to ensure ethical behaviour.
That same desire to create the impetus for action also lies behind the latest effort for progress, the Protocol to Eliminate Illicit Trade in Tobacco Products, or ITP.
Once in force, it will allow much greater cooperation over smuggling between different tax jurisdictions.
It may not sound like a major issue, but please bear in mind that the illicit trade deprives national treasuries of more than $30 billion annually and leads to increased accessibility, affordability and consumption of tobacco products.
The tobacco industry is presenting itself as a legitimate partner but is curiously silent about its own role in supplying the illicit market, over many years, the sort of cynical behaviour we have come to expect from this amoral business.
Eleven years after it took effect, the FCTC is unquestionably the main international forum for tobacco control.
Evidence gathered around the world indicated that the Convention had led to the creation or strengthening of legislation, that it helped highlight the visibility of tobacco control and had stimulated cooperation between the key sectors.
Just as important, the FCTC encouraged the formation of national tobacco control coordinating committees within government, which helped create national policy and raised the profile of the issue within government.
The Convention has also led to increased cooperation between the Parties. In South America, Brazil, Panama and Uruguay shared information on policy successes;
In the eastern Mediterranean, Egypt organized presentations to Jordanian colleagues;
and in Asia, Nepal supplied material to other countries including Sri Lanka following victory in a court case on graphic health warnings.
Many other cooperation projects are being implemented with support of the Convention Secretariat.
Of course, there is much more that needs to be done and much that we – by which I mean everyone involved in tobacco control – need to learn.
The effect of the treaty is currently the subject of a review by a group of independent experts and will be presented to COP in November.
This impact assessment report will also make recommendations about how we can improve our work and we welcome their ideas, because in tobacco control – as in almost every area of life – there is no monopoly on wisdom.
But perhaps, on this subject at least, there is a monopoly on virtue.
The tobacco industry has had almost five centuries to establish itself as a familiar feature of commercial and consumer life.
Anyone who thought this industry might die of shame has been proved sadly wrong.
They know what they’re doing and they just keep on doing it: wrecking families, depriving the poor of limited income, luring children into addiction, keeping the gravediggers busy.
The Framework Convention on Tobacco Control is imperfect. But it is effective, it is getting stronger, it has already helped to save the lives of hundreds and hundreds of thousands of people.
With your help, we can strengthen this Convention so that it not only saves lives, but forever buries the tobacco industry that for so long has preyed on human frailty.