World Health Organization FCTC Research Articles

Tobacco endgame in the WHO European Region: Feasibility in light of current tobacco control status.

To assess the feasibility of developing World Health Organization (WHO) European Region countries' goals and measures in line with tobacco endgame objectives, information on the current tobacco control context and capacity is needed. The aim of this study was to assess the implementation of the Framework Convention on Tobacco Control (WHO FCTC) and MPOWER measures in the region. In this cross-sectional study we used data from the WHO FCTC implementation reports and MPOWER from 2020 in 53 WHO European Region countries. Six domains (i.e. capacity, taxation and price policies, other national key regulations, public awareness raising and communication, tobacco use cessation, and monitoring) were formed. Subsequently, available indicators under these domains were scored and the level of implementation was computed for each country. Mann-Whitney tests were carried out to compare the scores between the group of countries with and without official endgame goals. Overall, implementation of the WHO FCTC with the selected indicators at the country level ranged from 28% to 86%, and of MPOWER from 31% to 96%. Full implementation was achieved by 28% of WHO FCTC Parties in the region in taxation and price policies, 12% in public awareness raising and communication, and 42% in monitoring. In capacity, tobacco use cessation and other national key regulations, none of the Parties in the region reached full implementation. Overall median WHO FCTC scores were significantly higher in countries with official endgame goals than in those without (p<0.001). There is unequal implementation of both WHO FCTC and MPOWER measures among WHO European Region countries. MPOWER and WHO FCTC provide all the measures for the necessary first steps, followed by innovative measures, to accomplish tobacco endgame goals.

Intellectual Property Rights and Public Policy on the Role of Plain Packaging and Health Care in India

Although tobacco is a multi-billion-dollar industry globally, its consumers are prone to various non-communicable diseases, such as cancer, heart attack, etc. Therefore, to prevent this, many states have taken initiatives to discourage the consumption of this harmful product. Many international organizations like World Health Organization (WHO) have supported these preventive measures through The WHO Framework Convention on Tobacco Control (WHO FCTC). The main objective of this convention is to encourage the concept of packaging all brands of tobacco products in a uniform standard, which is known as the Plain packaging process. This was the first initiative adopted by Australia. This research aims to determine the intellectual property rights and public policy on the role of plain packaging and health care in India as a developing country and the best strategy to tackle these issues. The authors have also made efforts to have a comparative study of New Zealand, Australia, Bangladesh, etc for better understanding.

Improving Information to Enable Effective Tobacco Control Intervention and Measure Progress Over Time: The Cambodia Country Experience.

Tobacco is a leading cause of noncommunicable diseases (NCDs) which kill about 41 million people each year. Of these, 15 million die prematurely between the ages of 30 and 69 years, most of which occur in low- and middle-income countries (LMICs). The adoption of the Sustainable Development Goals and their targets under the 2030 Agenda for Sustainable Development provides a new impetus for countries to accelerate tobacco control efforts as they specifically call for strengthening implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control and striving to achieve a one-third reduction in premature deaths from NCDs. While NCD prevention and control is a priority in the national strategic plans and policies for health in most countries in the Western Pacific Region, few have formally adopted a national target for reducing tobacco use. Article 20 of the WHO FCTC calls on all countries to improve tobacco surveillance to enable monitoring and evaluation of tobacco control efforts. The increase in timely and standardized comparable data presents new opportunities to set scientifically valid and achievable national indicators and targets for development and implementation of strong tobacco control measures. Cambodia is yet to establish national targets and full implementation of legislative measures. However, with strong tobacco surveillance mechanism in place, it can provide the country experience for a LMIC that has developed its own capacity to conduct periodic monitoring and surveillance of tobacco use and for using national data to advocate successfully for stronger tobacco control policies.

Tobacco control and sustainable development: shared challenges and future opportunities

INTRODUCTION – TOBACCO CONTROL AS A DEVELOPMENT PRIORITY In May 2017, just months before the end of her second term as Director-General of the World Health Organization (WHO), Margaret Chan spoke about championing the WHO’s mission to fight tobacco use as one of her proudest achievements in office. What was surprising was the justification that followed. Dr. Chan did not focus on the usual costs associated with smoking – the millions of premature deaths globally, the US$ 1.4 trillion wasted annually in healthcare expenditure and lost productivity, or the human suffering brought by the host of cancers, heart diseases, and respiratory diseases caused by tobacco use. Instead, she declared that ‘tobacco is a deadly threat to global development’, affecting ‘every country on every level and across many sectors – economic growth, health, education, poverty, and the environment’ [1]. The slogan ‘Tobacco – a threat to development’ became the theme of the 2017 World No Tobacco Day. This was not the first time that tobacco has been recognised by the public health community as posing a threat ‘to the cause of social and environmental justice’, rather than just being a matter of individual health [2]. In 2015, the magnitude of the tobacco epidemic was acknowledged in the 2030 Agenda for Sustainable Development [3]. The agenda, which encompasses 17 Sustainable Development Goals (SDGs), directly addresses the importance of tobacco control in SDG Target 3.a, calling for the strengthening of ‘the implementation of the World Health Organization Framework Convention on Tobacco Control [WHO FCTC] in all countries’. The FCTC, adopted in 2003, was the first legally binding multilateral international public health treaty. It covers the production, sale, distribution, advertisement, and taxation of tobacco, setting an evidence-based framework of minimum requirements for the signatory states in controlling tobacco products [4]. The FCTC – as of May 2019 – was legally binding in 181 ratifying countries. While in most high-income countries (HICs) the implementation of the FCTC has advanced markedly, in some low- and middle-income countries (LMICs) the progress has been much slower [5, 6]. This is particularly alarming given that in 2018 four out of five smokers (or 880 million out of 1.1 billion smokers) lived in LMICs [7]. Drawing on evidence and examples from LMICs, in this article we explore key synergies between the SDGs and tobacco control. We demonstrate that strengthening tobacco control is not only relevant for achieving SDG 3 (Good Health and Well-Being), but also for broader social, economic, and environmental dimensions of sustainable development encompassed in several other SDGs [8]. We also point to the agenda of the transnational tobacco companies (TTCs) as a fundamental obstacle to achieving the SDGs and, more widely, to continued public health progress. To conclude, we argue that in order to drive progress in sustainable development, especially given the interference of TTCs, international tobacco control networks need to be further strengthened in LMICs. These processes need to be accompanied by greater cross-disciplinary collaboration, especially between the fields of tobacco control and development studies.

Reaching Outside the Comfort Zone: Realising the FCTC's Potential for Public Health Governance and Regulation in the European Union Comment on "The Legal Strength of International Health Instruments - What It Brings to Global Health Governance?"

In their paper, Nikogosian and Kickbusch show how the effects of the adoption by the World Health Organization (WHO) of the Framework Convention on Tobacco Control (WHO FCTC) and its first Protocol extend beyond tobacco control and contribute to public health governance more broadly, by revealing new processes, institutions and instruments. While there are certainly good reasons to be optimistic about the impact of these instruments in the public health sphere, the experience of the FCTC’s implementation in the context of the European Union (EU) shows that further efforts are still necessary for its full potential to be realised. Indeed, one of the main hurdles to the FCTC’s success so far has been the difficulty in developing and maintaining comprehensive multisectoral measures and involving sectors beyond the sphere of public health.

The Legal Strength of International Health Instruments - What It Brings to Global Health Governance?

Public health instruments have been under constant development and renewal for decades. International legal instruments, with their binding character and strength, have a special place in this development. The start of the 21st century saw, in particular, the birth of the first World Health Organization (WHO)-era health treaties – the WHO Framework Convention on Tobacco Control (WHO FCTC) and its first Protocol. The authors analyze the potential impact of these instruments on global health governance and public health, beyond the traditional view of their impact on tobacco control. Overall, the very fact that globally binding treaties in modern-era health were feasible has accelerated the debate and expectations for an expanded role of international legal regimes in public health. The impact of treaties has also been notable in global health architecture as the novel instruments required novel institutions to govern their implementation. The legal power of the WHO FCTC has enabled rapid adoption of further instruments to promote its implementation, thus, enhancing the international instrumentarium for health, and it has also prompted stronger role for national legislation on health. Notably, the Convention has elevated several traditionally challenging public health features to the level of international legal obligations. It has also revealed how the legal power of the international health instrument can be utilized in safeguarding the interests of health in the face of competing agendas and legal disputes at both the domestic and international levels. Lastly, the legal power of health instruments is associated with their potential impact not only on health but also beyond; the recently adopted Protocol to Eliminate Illicit Trade in Tobacco Products may best exemplify this matter. The first treaty experiences of the 21st century may provide important lessons for the role of legal instruments in addressing the unfolding challenges in global health.

Tracking WHO MPOWER in South East Asian region: An opportunity to promote global tobacco control

Introduction: Tobacco use is a major public health challenge worldwide and to counter the global tobacco epidemic, the World Health Organization (WHO) developed the WHO Framework Convention on Tobacco Control (WHO FCTC) to provide new legal dimensions for international health cooperation. Further WHO introduced the MPOWER package to monitor the tobacco control programs among the countries to accomplish the FCTC objective. Aim: The aim is to quantify the implementation of MPOWER tobacco control policies in South East Asia Region (SEAR) from the year 2008 to 2015. Materials and Methods: Information was collected from the WHO report on the Global Tobacco epidemic program SEAR from 2008 to 2015 using MPOWER. This assessment was based on the checklist which was designed previously by Iranian and International tobacco control specialists in their study on tobacco control. Results: Various countries of SEAR were ranked by scores and these scores were obtained from each indicator for each activity. Among SEAR region, Thailand got the highest scores and significant positive change was seen from a score of 8 in 2008 to 32 in 2015 where certain countries like Korea and Timore-Leste showed no significant positive change. Conclusion: Tobacco control policies have reduced the tobacco consumption, but still multisectoral efforts are needed toward effective enforcement of the law to bring about a significant decline in the prevalence of tobacco use.

Prevalence of Smokeless Tobacco Use and Number of Users in 121 Countries

Background: In 2010, a study estimated the number of smokeless tobacco (SLT) users in 70 countries at 302.4 million. These countries represented 70% of the global population. We aimed to update this information and widen the scope to estimate the global prevalence of SLT use by including a larger number of countries. Methods: Data on the prevalence of current SLT use in 121 countries were obtained from various sources. Country-wise and gender-wise breakdown of the adult population in these countries was derived from the UN World Population for 2015. To translate prevalence rates into an estimate of the number of adult SLT users, we multiplied the adult male and female SLT prevalence rates by the corresponding male and female adult population in the respective countries. We then added the Short Research Article Sinha et al.; BJMMR, 9(6): 1-20, 2015; Article no.BJMMR.16285 2 estimated number of male and female SLT users to get an overall estimate of SLT use. Results: There were 352 million SLT users (351.9 million) in 121 countries. Of these, 67% were men (232.7 million) and 33% were women (119.2 million). Nearly 95% (333.1 million) of global SLT users lived in developing countries and only 5% (918.8 million) lived in developed countries; 82.7% of global SLT users lived in the World Health Organization (WHO) South-East Asia Region. Globally, 90.4% of SLT users live in 11 countries of the world: India (237.4 million, 67.5%), Bangladesh (30.9 million), Myanmar (12.6 million), Pakistan (10.1 million), USA (9.6 million), China (4.1 million), Indonesia (3.2 million), Nepal (2.7 million), Madagascar (2.6 million), Germany and Uzbekistan (2.4 million each). Conclusion: Smokeless tobacco use is a global epidemic affecting 121 countries. All 180 countries that have ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) are obliged to monitor SLT use. Parties to the Convention should collect information periodically using standard protocols for national and international comparability. To prevent health and economic losses attributable to SLT use, countries, especially developing countries, should formulate strategies specific to SLT control.

The Global Youth Tobacco Survey (GYTS): linking data to the implementation of the WHO Framework Convention on Tobacco Control

The World Health Organization (WHO), the US Centers for Disease Control and Prevention, and the Canadian Public Health Association developed the Global Tobacco Surveillance System (GTSS) to assist WHO member states in establishing continuous tobacco control surveillance and monitoring. The GTSS provides a flexible system that includes common data items but allows countries to include important unique information at their discretion. It also uses a common survey methodology, similar field procedures for data collection, and similar data management and processing techniques. The GTSS includes collection of data through three surveys: the Global Youth Tobacco Survey (GYTS) for youth, and the Global School Personnel Survey and the Global Health Professional Student Survey for adults. Countries can use data from the GYTS to monitor and evaluate National Tobacco Control Action Plans and articles from the WHO Framework Convention on Tobacco Control (WHO FCTC). The WHO FCTC was adopted by the 56th World Health Assembly in May 2003 and became international law on February 27, 2005. It is the world's first public health treaty on tobacco control and encourages countries that ratify to develop and implement tobacco control policies, such as bans on direct and indirect tobacco advertising, tobacco tax and price increases, promoting of smoke-free public places and workplaces, and placement of health messages on tobacco packaging. The WHO FCTC, National Tobacco Control Action Plans, and the GYTS share the same goal: the development, implementation, and evaluation of effective tobacco control programs in all WHO member states. What the WHO FCTC and National Tobacco Control Action Plans ask countries to monitor, the GYTS can help to measure. The GYTS provides indicators for measuring achievement of several WHO FCTC articles (surveillance and monitoring, prevalence, exposure to secondhand smoke, school-based tobacco control, cessation, media and advertising, and minor's access and availability). The synergy between the WHO FCTC, National Tobacco Control Action Plans, and GYTS offers countries a unique opportunity to develop, implement, and evaluate their comprehensive tobacco control programs. The reports included in this publication from Peru, Thailand, and Turkey are presented as examples of 'linking' GYTS data to the national tobacco control program efforts in each country.

Smoke alarm from Afghanistan to Morocco

Smoke alarm from Afghanistan to Morocco

Talking about…

Talking about…

Global Tobacco Surveillance System (GTSS): Purpose, Production, and Potential. Global Tobacco Surveillance System Collaborating Group

The World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and Canadian Public Health Association (CPHA) developed the Global Tobacco Surveillance System (GTSS) to assist all 192 WHO Member States in collecting data on youth and adult tobacco use. The flexible GTSS system includes common data items but allows countries to include important unique information at their discretion. It uses a common survey methodology, similar field procedures for data collection, and similar data management and processing techniques. The GTSS includes collection of data through three surveys: the Global Youth Tobacco Survey (GYTS) for youth, and the Global School Personnel Survey (GSPS) and the Global Health Professional Survey (GHPS) for adults. GTSS data potentially can be applied in four ways. First, countries and research partners can disseminate data through publications, presentations, and an active GTSS web site. Second, countries can use GTSS data to inform politicians about the tobacco problem in their country, leading to new policy decisions to prevent and control tobacco use. Third, GTSS can provide countries with valuable feedback to evaluate and improve Country National Action Plans or develop new plans. Fourth, in response to the WHO FCTC call for countries to use consistent methods and procedures in their surveillance efforts, GTSS offers such consistency in sampling procedures, core questionnaire items, training infield procedures, and analysis of data across all survey sites. The GTSS represents the most comprehensive tobacco surveillance system ever developed and implemented. As an example, this paper describes development of the GYTS and discusses potential uses of the data. Sample data were drawn from 38 sites in 24 countries in the African Region, 82 sites in 35 countries in the Americas Region, 20 sites in 17 countries and the Gaza Strip/West Bank region in the Eastern Mediterranean Region, 25 sites in 22 countries in the European Region, 34 sites in six countries in the Southeast Asia Region, and 25 sites in 14 countries in the Western Pacific Region.