Letter to the Editor: the World Conference on Tobacco Control – Mixed Perspectives and Controversies

Nigeria plays important economic and political roles in Africa and is a significant market for the tobacco industry. This study describes the tobacco industry's efforts to block Nigeria's early tobacco control attempts, especially the Tobacco Smoking (Control) Decree 20 of 1990, and efforts to strengthen the Decree in 1995. Analysis of documents from the Truth Tobacco Documents Library and other Internet resources related to Nigeria's Decree 20 and earlier tobacco control efforts. The World Conferences on Smoking and Health and World Health Organization in the late 1970s spurred the Nigerian government to take steps towards tobacco regulation. In response, the tobacco industry lobbied government ministries, used front groups and its trade group, the Tobacco Advisory Council of Nigeria, to block and weaken government efforts. The industry obtained a draft of Decree 20 two years before it was enacted, considered the Decree anti-business and proposed language that led to the passage of a weaker Decree in 1990. It also attempted to influence a potential review of the Decree in 1995. Decree 20 was a strong law for its time, but was weakened due to tobacco industry interference. Nigeria ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005, and enacted a comprehensive National Tobacco Control Act (NTCA) in May 2015. Lessons learned from Decree 20's experience should be applied to protect NTCA 2015, and in compliance with WHO FCTC Article 5.3 which require parties to protect tobacco control policies from tobacco industry interference. This is the first detailed account of tobacco industry interference with tobacco legislation in Africa. The emergence of tobacco control in Nigeria threatened the tobacco industry, which believed that success in Nigeria would have a "domino effect" in Africa. The industry used lobbying and front groups to successfully block and weaken Nigeria's tobacco control, especially the Tobacco Smoking (Control) Decree 20 of 1990 and efforts to strengthen it in 1995. Nigeria and other African countries must learn from this history to protect tobacco control policies from the tobacco industry's vested interests and vigorously implement Article 5.3 of the WHO FCTC.

BackgroundThe World Conference on Tobacco or Health (WCTOH) is held every three years to foster communication and collaboration on global tobacco control. Very little is known about the nature of interactions between WCTOH attendees and their linkages to tobacco control organizations, so knowing this information could help improve tobacco control efforts.MethodsAt the 2015 WCTOH, we implemented an online survey to assess barriers to global tobacco control activities, which information sources they use for tobacco control information, and with whom they interact regarding tobacco control.ResultsA total of 169 respondents completed the survey, with responses from all six World Health Organization (WHO) regions. Respondents worked in all areas of tobacco control; the most common were research (29.2%) and patient care/treatment (23.3%). The top barriers faced regarding tobacco control activities were: funding is weak (56.8%), government commitment (45.0%), tobacco industry interference (43.8%), and lack of coordination (34.3%). The network analysis identified Framework Convention Alliance (FCA) and Society for Research on Nicotine and Tobacco (SRNT) as the two most prominent groups that people belonged to and where they went to exchange information and best practices. Important regional and country specific groups also appear to be growing, such as the African Tobacco Control Alliance (ATCA) and the Argentinian Association of Tabacology (ASAT).DiscussionMapping and better understanding the global tobacco control network is important for informing knowledge exchange and best practices, particularly as increasing attention is being focused on global tobacco control efforts in low- and middle-income countries in particular.ConclusionsThe present study demonstrates that even a subsample of the WCTOH shows considerable collaboration. The full WCTOH network should be mapped in order to foster greater collaboration that has the the potential to improve global tobacco control efforts.

This article explores the internationalisation of tobacco control as a case study in the history of international health regulation. Contrary to the existing literature on the topic, it argues that the history of international anti-smoking efforts is longer and richer than the making of the World Health Organisation’s Framework Convention on Tobacco Control in the early twenty-first century. It thereby echoes the point made by other scholars about the importance of history when making sense of contemporary global health. Specifically, the article shows how the internationalisation of tobacco control started in the 1950s through informal contacts between scientists working on cancer research and how these initial interactions were followed by a growing number of more formal initiatives, from the World Conferences on Tobacco or Health to the Bloomberg Initiative to Reduce Tobacco Use. Rather than arranging these efforts in a linear narrative of progress culminating with the Framework Convention on Tobacco Control, we take anthropological claims about global health’s uneven terrain seriously and portray a history of international tobacco control marked by ruptures and discontinuities. Specifically, we identify three successive periods, with each of them characterised by specific understandings of international action, tobacco control expertise, advocacy networks and funding strategies.

Tobacco control in the 21st century: searching for answers in a sea of change.

Campaigners fight to bring down Russia's tobacco toll

Objective: To demonstrate that Philip Morris and British American Tobacco Company attempted to initiate a wide ranging campaign to undermine the success of the 8th World Conference on Tobacco or...

As I announced in the Summer 1998 issue of Tobacco Control ,1 I have stepped down as editor of the journal. Simon Chapman, deputy editor since its launch, is the...

Smoking Cessation

BackgroundObjectives of this study are (a) to develop a comprehensive and economic tool to estimate tobacco control (TC) activities in single EU member states, (b) to compare TC activities between member states of the EU. This article provides the questionnaire and gives a benchmark of EU member states according to their perceived TC activities. Methods: An international workshop was specifically initiated to develop the questionnaire "Measuring Activities in Tobacco Control (MATOC)". TC experts from 8 European countries participated and chose 40 items to cover 11 general topics of TC. At the World Conference of Tobacco or Health in Helsinki 2003 participants were asked to fill out the questionnaire. N = 142 participants from EU-member states returned questionnaires.ResultsSubjects from the tobacco field in Finland gave the highest TC values to their country, followed by Sweden, Ireland, the UK and the Netherlands. The least active countries in TC were Greece and Germany, behind Austria, Spain, Belgium and Portugal. Italy, France and Denmark constituted the middle field.ConclusionThe MATOC provides a profile of TC across European countries and delivers results that are plausible and fit into the existing findings. The data presented here fulfils the purpose to illustrate what is possible with the MATOC and underlines the value of such an approach in delivering information for policy makers and TC advocates how TC is perceived in each country. Yet, further validity testing is necessary, the number of experts per country differs and is partly rather small. Further research with the MATOC should encounter these limitations. The procedure though could serve as model of practice for alcohol and legal drug policy as well.

IntroductionDespite the importance of smoking cessation in cancer care, it remains unclear how much tobacco control and smoking-related content (TCSCR) is included in major oncology meetings. Developing an understanding of the amount of content can help to improve education and dissemination of the benefits of smoking cessation in cancer care.MethodsWe performed a scoping review of TCSCR abstracts and educational sessions using online programs and abstract books from 2018 to 2023 for 12 major oncology meetings across different disciplines and disease sites.ResultsA total of 5178 TCSCR content was identified using our search criteria; 421 abstracts and 119 educational sessions met the inclusion criteria. Between 2018 and 2023, the World Cancer Congress (WCC) and the World Conference on Lung Cancer (WCLC) had the highest mean percentage of smoking-related abstracts (WCC: 4.96 ± 3.77%; WCLC: 1.81 ± 0.77%) and educational sessions (WCC: 3.48 ± 1.30%; WCLC: 3.15 ± 1.06%). Among the included abstracts, most (79%) first authors were from high-income countries. Around 39% percent of abstracts focused on tobacco as a cancer risk factor, 34% smoking cessation, and 26% cancer outcomes. Most abstracts were presented as posters (65%), as oral abstracts (27%), or as published abstracts (8%). The distribution of topic focus (p = 0.004) and session type (p < 0.001) differed between abstracts from high-income and low-middle-income countries.ConclusionsDespite the importance of smoking cessation in oncology, TCSCR abstracts and educational content are limited at major oncology meetings. Organizers of oncology conferences should be encouraged to explore strategies to include sessions and attract submissions on these topics, particularly from underrepresented regions.

This is the fifth world conference on tobacco control I have attended. At my first in Winnipeg in 1983, Australians like Arthur Chesterfield-Evans inspired nearly everyone with stories about the world’s first anti-tobacco civil disobedience campaign against tobacco advertising. It’s now widely accepted that the BUGA UP graffitists reframed the entire debate on tobacco advertising in Australia. They gave it much needed humour. They politicised it. But most of all, their radicalism shifted the centre ground in tobacco control policy, causing conservative health and medical groups to embrace policies like advertising bans through fear of looking like they had lost the whole plot. The Australian Medical Association is now in the frontline against the tobacco industry, while fifteen years ago it was nowhere to be seen.

Ronald Davis, MD, aged 52, passed away on 6 November 2008 after a courageous 10-month battle with pancreatic cancer. Ron’s star shone very brightly, albeit too briefly in the medical...

“Debate” is a new series offering opposing sides of a continuing, controversial issue in tobacco control. In this and the next article, David Hill, director of the Centre for Behavioural...

"In this one bowl, there is rice from a thousand households." The saying of Zen poet Ryokan (1758-1831) well describes the contribution of many parties towards the WHO Framework Convention on Tobacco Control: WHO, other UN agencies, Member States, nongovernmental organizations (NGOs), academia, the media, and even the tobacco industry. The idea for a Framework Convention was seeded far from Geneva, in an academic paper. In 1993, Allyn Taylor, in the American Journal of Law and Medicine, called upon WHO to use legal mechanisms to attain its goal of "Health for All by the Year 2000". Ruth Roemer, the redoubtable Adjunct Professor of Health Law at the UCLA School of Public Health and author of Legislative action to combat the world tobacco epidemic (World Health Organization: Geneva; 1982 and 1993) saw the article, met with Allyn Taylor, and suggested she applied her ideas to tobacco control. On 26 October 1993, Ruth Roemer invited me for an unforgettable breakfast during a conference in San Francisco. Had WHO ever considered a convention on tobacco? she asked me. I replied that WHO had meetings all the time--some might say mo many! Ruth patiently explained that she meant a UN-style convention and asked me to convey this idea to WHO. I immediately passed on the suggestion to WHO in Geneva and to UNCTAD (UN Conference on Trade and Development and the then UN focal point for tobacco). The idea of a convention that utilized international lave to further public health was new. The initial reaction outside the tobacco unit was cautious, ranging from neutral to negative: it was just too difficult, would not get the support of Member States, would run into strong opposition from the tobacco industry, and would rake at least ten years. I replied that, having lived in China for decades, ten years seemed a short time in human history to me. But, like a toddler taking its first steps, the FCTC was off to a hesitant start. The NGOs immediately embraced the idea. In October 1994, the 9th World Conference on Tobacco or Health in Paris passed a resolution which Ruth Roemer had drafted and asked me to introduce. It read: "This conference resolves that National Governments, Ministers of Health, and the World Health Organization should immediately initiate action to prepare and achieve an International Convention on Tobacco Control to be adopted by the United Nations ...". In Spring 1995, WHO's Director-General, Dr Nakajima, asked me to conduct a formal review of the WHO Programme on Substance Abuse (which included tobacco), and I strongly recommended an FCTC as a core component of future development. In May 1995, World Health Assembly Resolution WHA48.11 outlined the concept of an international strategy for tobacco control, which marked the start of the formal WHO process. Ruth Roemer and Allyn Taylor prepared a background document for WHO, which served to direct WHO formally towards the concept of the FCTC with protocols. Myriad meetings, papers and discussions followed during and between Executive Board and World Health Assembly meetings. The process was slow, but in July 1998, Dr Gro Harlem Brundtland became the Director-General of WHO, made tobacco a cabinet project and energized the FCTC process. …

There have been momentous events in tobacco control since the first edition of Tobacco Control was launched in 1992. These include increased global awareness of the harmfulness of tobacco and...