Global governance of tobacco in the 21st century
Dr Margaret Chan
Director-General of the World Health Organization
Colleagues in public health, ladies and gentlemen,
Let me begin by thanking the Harvard School of Public Health and its Dean, Julio Frenk, for organizing this conference.
As I was travelling here, I heard two pieces of good news. First, two days ago, President Putin signed into law comprehensive legislation for tobacco control. Second, the Japanese government sold its shares in Japan Tobacco International for $10.3 billion to help cover reconstruction costs following the 2011 earthquake. This is good news.
Health all around the world is increasingly shaped by the same powerful trends: demographic ageing, rapid urbanization, and the globalization of unhealthy lifestyles.
The continuing spread of tobacco use ranks at the top of the list of universal threats to health. It is a huge cause of disease, including cardiovascular disease and cancers at 15 sites, and of premature death. And it is entirely preventable.
Like so many other threats to health in our highly interdependent world, tobacco use is fuelled by forces that lie beyond the direct control of health authorities.
These include the behaviour of an economically and politically powerful industry, with a well-documented history of dishonesty and deceit, that is bent on avoiding regulation and determined to maintain its profits.
But the tobacco industry does need to be worried, and for reasons that go beyond a reputation damaged beyond repair by the release of millions of pages of confidential company documents.
Regulatory control of tobacco has always been a deep fear, and that nightmare for the industry has now come true.
Tobacco control, in individual countries and worldwide, benefits from a uniquely powerful legal instrument for global health governance. That is: the WHO Framework Convention on Tobacco Control.
This was the first treaty negotiated under the auspices of WHO by my predecessor, Dr Brundtland. It is one of the most rapidly and widely embraced treaties in the history of the United Nations.
The Framework Convention entered into force in 2005 and currently has 176 parties, representing nearly 90% of the world’s population. These parties include some of the biggest growers of tobacco and manufacturers of tobacco products.
The treaty was developed in response to the globalization of tobacco use, which is facilitated through a variety of complex factors with cross-border effects.
These include trade liberalization, bilateral and regional trade agreements, direct foreign investment, global marketing, and transnational tobacco advertising, promotion, and sponsorship. Illicit trade in tobacco products has been another major driving force.
The treaty recognizes that tobacco use is a transnational threat to health and that control requires a coordinated response among nations.
It recognizes that the most effective way to control tobacco is through the rule of law. This means a comprehensive range of laws tackling both supply and demand, and this means strong laws.
The treaty operationalizes the principles of equity and fairness. Everyone, everywhere in the world, deserves the same level of protection from the harms caused by tobacco use and exposure to tobacco smoke.
It recognizes that control depends on the cooperation of multiple sectors of government in the name of health.
This type of collaboration also takes place at the institutional level through a United Nations Ad Hoc Interagency Task Force on Tobacco Control. That task force brings policy coherence to the work of 22 programmes and agencies, both within and outside the UN system, that are contributing to the treaty’s implementation. This shows how UN agencies can work together for a worthy cause.
I can think of no other area of public health where multisectoral collaboration is so strong and so effective.
Agreement on the treaty was a milestone for public health, as it created international legal obligations to regulate tobacco. It marked the first global treaty to regulate the marketing and trading of a product of mass consumption.
It introduced the notion that tobacco products should, and could, be regulated in the same way that governments regulate the safety of water, food, air, medicines, and industrial chemicals.
This was a game-changing notion. It gave governments the upper hand in a battle against a powerful and highly profitable industry.
For a long time, the public health community was, in effect, trying to topple a giant with a slingshot, relying largely on warnings about the health hazards of tobacco use, communicated in public information campaigns. In contrast, the treaty brought out the big gun. We need a big gun for Big Tobacco.
Ladies and gentlemen,
It should come as no surprise that efforts to subvert the treaty have been elaborate, sophisticated, and above all very well financed.
In the past, these efforts were covert and largely invisible. Not anymore. Today, efforts to weaken the impact of the treaty are out in the open, and they are extremely aggressive.
A particularly disturbing trend is use by the tobacco industry of international trade and investment agreements as a vehicle to seek enhanced market access and protection from regulation. Such agreements are being exploited to directly and openly challenge tobacco control measures in the courts.
In this way, industry aims to erode political will through prospects of lengthy and expensive litigation with potentially significant economic and financial consequences. Another aim is to provoke a domino effect, whereby when one country buckles under the pressure of litigation, other countries considering similar measures will be intimidated and likewise fall.
For bilateral and regional free trade agreements, as well as under World Trade Organization agreements, pressure can also come from fear that trade sanctions may be imposed by trading partners.
The incentive for industry to use international trade or investment agreements in lobbying or litigation is especially high when potentially trend-setting measures are at stake. This is true for very large health warnings on packs in Uruguay, legislation mandating plain packaging in Australia, and a ban on point-of-sales advertising in Norway.
You will be hearing about some significant recent victories during this conference. They are indeed trend-setting.
We have another winning force in our favour. That is: the strong voice of civil society organizations. Their role was decisive during negotiation of the treaty and remains so as we strive for its full implementation.
As another advantage, panels arbitrating tobacco-related disputes use provisions in the WHO Framework Convention on Tobacco Control, or guidelines based on those provisions, when interpreting international law and formulating their decisions.
Significantly, this has been the case also for litigation between countries that are not parties to the Convention. These provisions imply a right of countries to recognize the special importance of public health interests over economic or trade interests.
These are the latest developments in a very long battle between the protection of public health and the pursuit of corporate wealth.
Based on this history, I can make six broad recommendations.
First, act with solidarity. For tobacco control, there really is safety in numbers. Each legal victory brings regulatory confidence and comfort for other countries seeking to introduce similarly tough control measures.
Second, promote policy coherence. Make sure that trade and investment policies, at bilateral, regional, and international levels, align with policies that protect the public’s health.
Third, stay alert and keep moving. The tobacco industry is adept at shifting policies, at finding and exploiting new opportunities when other opportunities are slammed shut.
Fortunately, the Framework Convention is well-equipped to respond. This is a living document, given vitality and a capacity to evolve by its governing body, the Conference of the Parties. That body has formulated and adopted detailed guidelines for the interpretation and implementation of ten of the treaty’s articles.
In November of last year, the Conference of the parties adopted the first protocol to the Framework Convention, a legally-binding instrument aimed at the eventual elimination of illicit trade in tobacco products. Again, this is multisectoral cooperation at its best, involving support from departments of trade, finance, the environment, customs, law enforcement, and the judicial system.
In this way, the international public health community reduces the space in which industry can operate, step by step, and backed by the rule of law.
Fourth, turn to WHO for guidance and support. We are hear to serve you. There are some good reasons why the tobacco industry regards WHO as its number one enemy. For example, WHO has assisted countries in formulating and introducing national legislation to enact specific tobacco control measures.
As another example, many countries do not fully understand their rights and obligations under international trade law and foreign investment agreements, as these are highly specialized areas of law. WHO conducts workshops and training sessions to build this capacity.
WHO also works closely with the World Trade Organization and the World Intellectual Property Organization to clarify and demystify health-specific provisions in the international systems that govern trade and intellectual property rights. These systems have numerous checks, balances, exemptions, exceptions, and flexibilities that make it possible to interpret and apply laws and rules in the interest of public health.
Fifth, keep in mind that evidence, even mountains of evidence, is not enough. Tobacco control is a political as well as a technical issue. Diplomacy is critical. All of the chairs of the treaty negotiating body were ambassadors skilled in international diplomacy.
Finally, apply the lessons from tobacco control to other problems linked to the globalization of unhealthy lifestyles. The history of tobacco use tells us that powerful corporations can sell the public just about anything.
This is demonstrated by the way the tobacco industry was able, for so long, to deceive consumers into believing that no credible evidence proved that smoking was bad for health. Remember the phrase, made famous by our NGO allies: “Trust us. We’re the tobacco industry.”
Ladies and gentlemen,
As I conclude, let me make a final plea. In your different spheres of influence, please do everything possible to support full implementation of the WHO Framework Convention on Tobacco Control. We know it works. We have documented the impact.
We are aware of some disturbing trends. Over the past ten years, smoking has decreased by about 10% in wealthy countries, but increased by around 18% in the developing world. Deadly products are being dumped on the poor.
Full implementation of the treaty would deal the greatest single preventive blow to chronic noncommunicable diseases, across the board. Doing so would rank as the greatest achievement for preventive medicine in this century.