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The Global Tobacco/Smoking Threat

Posted by John McDonough  March 12, 2013 12:19 AM

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Oftentimes, it seems to me that tobacco and smoking prevention are yesterday's issues. Been there, done that. Sure, six million persons die every year globally due to smoking and secondhand smoke (about 440,000 in the U.S., according to the Centers for Disease Control & Prevention). Sure, when tobacco is used as intended, about half of smokers will die from causes directly related to its use. Tobacco 1.jpg

But, so few folks I see still smoke. It must be disappearing.

Or so I thought.

A few weeks ago, I had the privilege to attend a conference sponsored by the Harvard School of Public Health and the World Health Organization called: Governance of Tobacco in the 21st Century: Strengthening National and International Policy for Global Health and Development. The Conference organizer was HSPH Professor Dr. Greg Connolly who started and ran the Tobacco Control Program at the Mass. Department of Public Health back in the 1990s and a guy born to drive tobacco company executives crazy. 35 nations were represented at the two-day conference held at Radcliffe on February 26-27.

Harvard Gazette did a nice overview of the conference. I wanted to offer a few of my observations from this historic event which at times seemed like a Seneca Falls conference  (one of the first women's suffrage conferences in the U.S. in 1948) event in the global struggle against Big Tobacco. In developed nations, smoking prevalence is down about 8 percent over the past decade, yet it is up by about 14 percent in developing nations. 

I was most impressed by Margaret Chan, the head of the World Health Organization which in 2005 won United Nations adoption of the Framework Convention on Tobacco Control (FCTC), the first international treaty negotiated by WHO, and the first global treaty "to regulate a product of mass consumption," she said, with 176 nations party to the FCTC, accounting for 90 percent of the world's population. Here are some of my notes from her powerful comments:Tobacco 2.jpg

"We are experiencing the globalization of unhealthy lifestyles. Tobacco rests at the top as the biggest universal threat. It causes cancer at 15 sites and is driven by forces that lie beyond the control of health authorities. It is an economically and politically powerful industry -- our enemy -- bent on avoiding regulation and maintaining profits. But the tobacco industry needs to be worried.  Regulatory control has always been a deep fear of the industry, and it has come true.

"The WHO Framework Convention on Tobacco Control, with 176 countries representing 90% of world's population, includes the biggest growers and producers of tobacco products. Everyone, everywhere in the world deserves protection from tobacco. Efforts to subvert the treaty have been elaborate -- previously covert and nearly invisible. Not today -- out in the open and extremely aggressive.

"A disturbing trend is using trade agreements under the jurisdiction of the World Trade Organization to avoid regulation -- exploited by the industry to challenge tobacco control measures in the courts. They use lengthy and expensive litigation. It can provoke a domino effect so that when one country buckles under pressure of litigation, other countries will be intimidated. They fear that trade sanctions will be imposed by trading partners. But we have had significant recent victories. And another winning force -- the strong voice of civil society organizations. We are engaged in a very long battle between protection of public health and pursuit of private profit."

Julio Frenk, Dean of HSPH, observed:

"We are now seeing the international transfer of health risks. This has intensified with globalization. No nation, not even the strongest, is able to address single-handedly the health risks it faces. This cannot be resolved by individual countries acting in isolation."

Nicola Roxon, former Minister of Health for Australia, fought the industry over explicit warning labels on packages and won:

"We knew it would be a big fight and worth having. We had strong public backing and social permission to withstand howls of objections from the tobacco industry. Researchers were crucial and there to back us up under pressure. The Nanny state is killing free speech, they cried. 'Do you really like living in the Nanny State.'

"But non-tobacco companies ran 100 miles from the tobacco industry, as well as their fake grassroots movements, massive advertising campaigns, cash donations to opponents, and barrage of public information requests to slow us down. Standing up to them worked. The millions they poured into their devious campaigns did nothing but emphasize big tobacco's long term loss of credibility.

"I never met a smoker who hoped their children would smoke. In late 2011, four companies commenced legal action against us, challenging the constitutional validity of our law. In August 2012, by 6-1 our Supreme Court rejected the constitutional challenge. And the Court ordered companies to pay our legal costs."

Vesile Kulacoglu, Director, Trade and Environment Division of the World Trade Organization, addressed directly the tobacco industry's tactic of using trade agreements to thwart anti-tobacco laws:

"Case law confirms a policy space to take measures on justifiable public policy considerations applied in good faith, subject to certain conditions. These include non-restrictiveness of the measures, general exceptions under WTO rules, and flexibility to pursue legitimate public policies. This health dispute is not new. A number of health policies have been found to be legitimate exceptions. This includes asbestos in 2001, and retreaded tires is a recent case. WTO respects the rights of nations to determine the level of protection of health they consider appropriate in a given situation."

Lots of  compelling discussion and argument. From the conference, one truth is clear -- the tobacco wars are far from over. In some ways, we're clearly winning, and in other ways, we're clearly losing.  And the fight goes on...

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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