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agreements to oppose governments' efforts to protect the

health of their citizens. For example, Philip Morris

International has challenged Uruguay's graphic health

warnings and restrictions on cigarette packages under the

bilateral investment treaty (BIT) between Switzerland and

Uruguay. Given such actions, negotiators of the TPP and TTIP

must seriously consider the advice of civil society advocates

to exempt tobacco from the final agreements. Governments

must ensure that trade and investment agreements are not

used to undermine their public health policies, including

measures to combat the tobacco epidemic. Carving tobacco

out of trade rules can be an essential tactic to save millions of

lives, especially in developing countries vulnerable to the

tobacco industry's political pressure and marketing tactics.

If the global community is serious about implementing

strategies to tackle the tobacco epidemic, there is another

timely opportunity for reversing current trends.

With less than two years until the current UN Millennium

Development Goals (MDGs) expire, governments have begun

discussing what development goals they should be trying to

achieve after 2015. The post-2015 development agenda,

which will determine a new set of sustainable development

goals (SDGs), provides a unique opportunity to remind world

leaders about their health commitments and the need to

focus on reducing the global toll caused by tobacco. Tobacco

was left out of the MDGs. This was a missed opportunity to

raise awareness amongst policy-makers about the tobacco

epidemic and it limited the development resources that were

devoted to implementing the tobacco control measures in the

FCTC. However, the SDGs will focus on sustainable

development, and given that tobacco use impacts nearly all

areas of sustainable development - including health,

economic development, environmental sustainability and

social inclusion - supporting public health measures to

reduce tobacco prevalence should be a key strategy to

accelerating sustainable development.

The groundwork has been laid. United Nations Member

States could make tobacco control a global development

priority by including in the SDGs, under an overarching health

goal, the World Health Assembly target of a 30% relative

reduction in tobacco prevalence by the year 2025.

Implementing the FCTC's measures would be the next step.

These include increasing the price of tobacco products,

comprehensively banning tobacco advertising, promotion

and sponsorship, providing access to tobacco dependence

treatment, requiring smoke-free public spaces, and

mandating large, effective pictorial health warnings on

cigarette packages.

In 2003, the world's governments were unanimous in their

decision to confront the tobacco epidemic by adopting the

WHO FCTC. Unfortunately, that decision has not been

universally implemented by governments and via

intergovernmental processes. It is well past time that it was,

and that stakeholders stopped recognizing "Big Tobacco" as

just another industry and started seeing it for what it truly is:

the vector for the world's Number One cause of preventable

death. Left unchecked, the tobacco epidemic risks

undermining the progress made in global development over

the past 50 years.

If governments are willing to exempt tobacco out of trade

agreements, address the tobacco epidemic as a key

development priority in the post-2015 development agenda,

and accelerate the implementation of the FCTC, it is very

likely that we can move the tipping point in favour of health

and save hundreds of millions of lives. l

Laurent Huber, MS Ed is the Director of the Framework

Convention Alliance, a coalition of over 350 non-governmental

organizations in over 100 countries, widely recognized for its

vital role in shaping the WHO Framework Convention on

Tobacco Control, and the Director of Action on Smoking and

Health; a United States-based organization that supports

international tobacco control efforts.

Laurent holds a Master's of Science and has directed a

number of nonprofit organizations that addressed the

prevention of non-communicable diseases.

RISK FACTORS

42 CANCER CONTROL 2014

References

1. WHO Report on the Global Tobacco Epidemic, 2013.

http://apps.who.int/iris/bitstream/10665/85380/1/9789241505871_eng.pdf

2. United Nations Development Program. Discussion Paper. Addressing the Social

Determinants of Noncommunicable Diseases; October 2013.

3. The World Health Organization. Global Health Risks. WHO Mortality and burden of

disease attributable to selected major risks http://www.who.int/healthinfo/

global_burden_disease/GlobalHealthRisks_report_part2.pdf

4. Goodland JA, Watson C, Ledec G. Environmental management in tropical agriculture.

Boulder, CO, Westview Press, 1984.

5. The International Labour Organization conventions on child labour are available from:

http://www.ilo.org/ipec/facts/iloconventionsonchildlabour/lang--en/index.htm;

information on international conventions on child labour is available from:

http://www.un.org/en/globalissues/briefingpapers/childlabour/intlconvs.shtml.

6. Wen, CP et al, The impact of the cigarette market opening in Taiwan, Tob Control 2005.

7. The Global Economic Burden of Non-communicable Diseases. Harvard School of Public

Health. The World Economic Forum. 2011.

http://www.weforum.org/reports/global-economic-burden-non-communicable-diseases

8. Marquez PV, Farrington, J. L. . The Challenge of Non-Communicable Diseases and Road

Traffic Injuries in Sub-Saharan Africa. An Overview. Washington, DC: The World Bank;

2013.

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