Treaty Compliance in Low- and Middle-Income Countries: Evidence from Global Health

Abstract

The World Health Organization’s Framework Convention on Tobacco Control (FCTC) – the world’s first and only global health treaty – seeks to address the enormous challenges stemming from tobacco use, including nearly six million deaths annually. In force since early 2005, more than 175 countries have ratified and/or acceded to the FCTC. However, compliance with the treaty’s articles has varied considerably, particularly among low- and middle-income countries, begging the broader theoretical question: why do only some states comply? The research develops an integrated theoretical framework that focuses on the transnational connections among key state and non-state actors seeking to affect compliance, and tests empirically the determinants of countries’ compliance with two major provisions of the treaty: protection from exposure to tobacco smoke and warning labels on tobacco packaging. Using an Arellano-Bover/Blundell-Bond general method of moments estimator, among other important variables, we particularly examine the effect of the tens of millions of dollars in external assistance that donors give to countries and organizations to improve compliance with the agreement. We find convincing empirical evidence that the many of the variables that represent transnational connections among major global and domestic health actors – including external assistance, the size of the domestic community of health-focused non-governmental organizations and peer country compliance behavior – have positive and significant effects on compliance with key provisions of the treaty.