FCTC along with the target of a 30% reduction in tobacco use
by 2025. A number of countries including Finland and New
Zealand have articulated some form of tobacco-free goal for
their countries. This global recognition of the tobacco
epidemic paired with targets and a global consensus around
what measures are effective to reduce smoking prevalence
are very positive advances in favour of public health, but
there are also a number of challenges ahead.
The FCTC is a blueprint for preventing the one billion
tobacco-related deaths that are predicted this century* but
its implementation in the ten years since its adoption has
been sporadic. From a governance standpoint - both at the
national and global levels - we have been driving with one
foot on the accelerator and one foot on the brake. This is in
part because of a lack of whole-of-government engagement
in its implementation, which has produced uncoordinated
responses to addressing tobacco control measures at both
national and international levels. This is both the cause and
the result of limited political will and inadequate resources at
the national level for the implementation of the FCTC.
In addition, a number of evidence-based national health
policies consistent with the FCTC are under attack by the
tobacco industry, which uses any available avenue to
undermine governments' efforts to protect the health of their
citizens. Our only hope for ending this epidemic is to adopt a
harmonized approach, vertically and horizontally, that
incorporates local, national, regional and global law as well as
trade, finance, health, and development processes.
Unfortunately, there are those in and out of government who
still see the tobacco industry as a legitimate stakeholder in
this realm, and argue that somehow a compromise can be
reached between the tobacco industry and public health, and
that there is an acceptable level of preventable death.
British American Tobacco (BAT) and the China National
Tobacco Corporation (CNTC) recently agreed to a joint
venture to market Chinese and British cigarettes around the
globe. CNTC is the world's largest tobacco company, but its
products - often much cheaper than brands from Japan and
the West - have been sold almost exclusively in the Chinese
market until now. BAT has decades of experience marketing
cigarettes to the global South. The combination of
marketing heft and cheap package price adds up to an
imminent public health catastrophe for the world's poorest
populations, living in countries that often lack the most
basic tobacco control measures.
At the same time, two trade agreements currently being
negotiated threaten to exacerbate the problem. The TransPacific
Partnership (TPP) Agreement includes Australia,
Brunei, Chile, Canada, Japan, Malaysia, Mexico, New Zealand,
Peru, Singapore, the United States and Vietnam. China and
other countries have indicated their interest in joining. The
TPP has been lauded as the model trade agreement for the
twenty-first century, but it goes far beyond traditional trade
issues such as tariffs and subsidies. Some analysts have even
called it a "deregulation treaty". The current draft includes
powerful new rights for corporations, including the right to
directly sue governments over regulations that they claim
harm their profits; this includes tobacco control measures.
The TPP is in its final negotiating phase and, once completed,
will be the world's biggest trading block.
Meanwhile, negotiations began in July on the TransAtlantic Trade
and Investment Partnership (TTIP) between
the United States and the European Union, with the United
States pushing the TPP as the starting point for talks. Once
completed, the TTIP would be even bigger than the TPP,
encompassing the world's two largest economies. If tobacco
companies are able to use loopholes in these trade
agreements to undermine public health polices then the
repercussions on smoking prevalence could be noticeable. To
put this into perspective, after the United States used trade
rules to force open Asian markets to western tobacco
multinationals in the 1980s, smoking prevalence jumped by
more than 10% within a year6 and those cigarettes were more
expensive than the domestic brands.
These are just a few examples of tobacco industry
partnerships and trade liberalization processes that benefit
the tobacco industry that could have devastating impacts on
global health and development: by drowning markets in highincome countries and in developing
countries in Africa, Latin
America and Asia with cheap cigarettes. With the global
NCDs epidemic on the rise - and predicted to cost US$ 47
trillion by 20307 - this is not what the world needs.
Governments must be empowered to attain their public
health objectives. However, the tobacco industry has already
taken advantage of existing trade and investment
Tobacco is the single greatest
preventable cause of death in the
world today.
1 This has been
recognized at the highest levels.
RISK FACTORS
CANCER CONTROL 2014 41
*There were 100 million tobacco-related deaths in the twentieth
century.