The United States' Engagement in Global Tobacco Control

Abstract

TOBACCO USE ACCOUNTS FOR MORE DEATHS GLOBALLY than human immunodeficiency virus/AIDS, tuberculosis, and malaria combined—more than 5 million deaths annually—and this is expected to increase to more than 8 million by 2030, with nearly 80% of those deaths occurring in developing countries. Beyond health effects, tobacco has dramatic social and economic consequences, consuming health care budgets, depriving families of wage earners, and hindering economic development. Tobacco consumption is shifting from industrialized to developing countries, spurred by increasing incomes, trade liberalization, and intensive marketing. This shift is well established among men and in Asia, Eastern Europe, and Latin America, with smoking in Africa projected to increase over the next decade. Women are a major target of opportunity for the industry, which uses advertising tactics such as purse packs containing super-slim cigarettes. Although Congress empowered the US Food and Drug Administration to regulate tobacco domestically, the United States has failed to lead globally. The United States is among a small minority of countries that has signed, but not ratified, the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) that 171 countries have ratified, covering 87% of the world’s population. In 2009, the United States dedicated only $7 million of the more than $8 billion it spent on global health to international tobacco control, principally for surveillance and capacity building. Moreover, US trade policy supports and enables the industry to expand tobacco use overseas. Nearly every investment and trade agreement negotiated by the United States eliminates or reduces trading partners’ tobacco tariffs and protects US tobacco companies’ overseas manufacturing and investments. In this Commentary, we argue for robust US engagement in global tobacco control, first explaining why it is in the national interest of the United States and then suggesting a comprehensive strategy.