The making of a convention on tobacco control.

Abstract

"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. …