World Health Organization Framework Research Articles

Smokeless tobacco control: Litigation & judicial measures from Southeast Asia

Recourse to litigation and positive judicial interventions is one of the most effective tools to meet public health objectives. The present review envisions compiling litigation and judicial measures in Southeast Asia Region (SEAR) while assessing their role in advancing smokeless tobacco (SLT) control, and equally highlighting, how tobacco industry has used litigation to undermine tobacco control efforts in the Region. The litigation, especially from the SEAR, up to 2017, that have facilitated SLT control or have been used by the tobacco industry to challenge an SLT control policy decision were reviewed. Most of the litigation related to SLT control from the Region are on pictorial health warnings. Bhutan has imposed a complete prohibition on sale, manufacture and import of all kinds of tobacco products and the litigation there relates to the prosecution of offenders for violating the ban. Judiciary in the Region is well informed about the ill-effects of tobacco use and remains positive to tobacco control initiatives in the interest of public health. In India, several SLT-specific litigation helped in better regulation of SLT products in the country. Litigation has compelled governments for effective enforcement of the domestic tobacco control laws and the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). Parties to the WHO FCTC must now use Treaty Article 19 to strengthen their legal procedures and make the tobacco industry liable, for both criminal and civil wrongs.

Progress in Tobacco Control in Singapore: Lessons and Challenges in the Implementation of the Framework Convention on Tobacco Control

AbstractSingapore has implemented tobacco control policies since the 1970s, more than three decades before it became party to the World Health Organization (WHO) Framework Convention on Tobacco Control—the first evidence‐based global health treaty in 2005. The country's stringent policies have resulted in a 13 per cent adult smoking prevalence rate, one of the lowest in the world. This article reviews how a mix of demand‐ and supply‐reduction measures with extensive regulation and stringent enforcement has contributed to Singapore's reputation as the ‘most hostile environment’ for tobacco companies. Its tobacco control policies can offer lessons for more effective tobacco control among its neighbouring countries.

Role of World Health Organization Framework Convention on Tobacco Control Global Knowledge Hub on Smokeless Tobacco.

Smokeless tobacco (SLT) is a recognized public health challenge, having over 350 million users globally, concentrated particularly in South-East Asia. A need for research on curbing major challenges in regulating SLT use has been long felt and subsequently highlighted in several sessions of the Conference of Parties (COP) of the Framework Convention on Tobacco Control (FCTC). The sixth session of COP established a knowledge hub on SLT at the Indian Council of Medical Research- National Institute of Cancer Prevention and Research India, with a mandate to (i) generate and share expertise, information and knowledge; (ii) promote and facilitate communication among Parties, organizations and stakeholders; and (iii) support the Convention Secretariat in contributing to technical aspects of SLT control. The hub disseminates scientific evidence through an interactive website and publications and supports national and international partners in SLT research. The hub is a contributor to many events/conferences and has conducted several workshops on SLT control, including an inter-country meeting on SLT policy implementation status, which brought together representatives from across the globe, and framed recommendations for policy reform. The hub is dedicated to interaction and collaboration with relevant tobacco control organizations to generate evidence, support and policy orientation in line with its mandates and recommendations under the World Health Organization FCTC.

The World Health Organization Framework for Virus Sharing: Law, Recent Challenges and its Compliance

The World Health Organization Framework for Virus Sharing: Law, Recent Challenges and its Compliance

Tobacco Dependence Treatment Grants: A Collaborative Approach to the Implementation of WHO Tobacco Control Initiatives.

The number of global tobacco-related deaths is projected to increase from about 6 million to 8 million annually by 2030, with more than 80% of these occurring in low- and middle-income countries (LMICs). The World Health Organization Framework Convention on Tobacco Control (FCTC) came into force in 2005 and Article 14 relates specifically to the treatment of tobacco dependence. However, LMICs, in particular, face several barriers to implementing tobacco dependence treatment. This paper is a descriptive evaluation of a novel grant funding mechanism that was initiated in 2014 to address these barriers. Global Bridges. Healthcare Alliance for Tobacco Dependence Treatment aims to create and mobilize a global network of healthcare professionals and organizations dedicated to advancing evidence-based tobacco dependence treatment and advocating for effective tobacco control policy. A 2014 request for proposals (RFP) focused on these goals, particularly in LMICs, where funding for this work had been previously unavailable. 19 grants were awarded by Global Bridges to organizations in low- and middle-income countries across all six WHO regions. Virtually all focused on developing a tobacco dependence treatment curriculum for healthcare providers, while also influencing the political environment for Article 14 implementation. As a direct result of these projects, close to 9,000 healthcare providers have been trained in tobacco dependence treatment and an estimated 150,000 patients have been offered treatment. Because most of these projects are designed with a “train-the-trainer” component, two years of grant funding has been a tremendous catalyst for accelerating change in tobacco dependence treatment practices throughout the world. In order to foster such exponential growth and continue to maintain the impact of these projects, ongoing financial, educational, and professional commitments are required.

Cost-effectiveness of health systems strengthening interventions in improving maternal and child health in low- and middle-income countries: a systematic review

Health systems strengthening (HSS) interventions are increasingly being implemented to improve maternal and child health (MCH) services in low- and middle-income countries (LMICs). This study reviews global literature on cost-effectiveness of HSS interventions in improving MCH. A systematic review was conducted. Keywords, based on World Health Organization framework on health systems and prior studies, were applied to search in bibliographic databases and on the web. Articles that estimated cost-effectiveness of HSS interventions in LMICs were included in the analysis. Each of the 24 selected studies from 15 countries was assessed in terms of quality and biases using Cochrane's criteria. Review Manager and an Excel template were used to extract data and synthesize findings. HSS interventions concentrated on the components of service delivery, health financing, human resources and quality improvement. Within each component, there existed diverse strategies to strengthen health systems. Among the 24 studies, 15 were rated as high quality, 5 as medium and 4 as low quality. A majority of studies reported cost per disability-adjusted life year (DALY) averted or cost per quality-adjusted life year (QALY) gained; other studies reported cost per life saved or life year gained. However, studies used mixed perspectives of analyses. Compared with gross domestic product per capita, interventions in studies reporting cost per DALY averted or QALY gained were all cost-effective, including performance-based financing, health insurance and quality improvement. This review shows the diversity of HSS interventions in improving MCH, and their potential cost-effectiveness. However, the different perspectives employed in the studies, costing components included in the analyses, and heterogeneous measures of effectiveness and outputs, made it challenging to compare cost-effectiveness across all studies, calling for more and standardized cost-effectiveness studies. For policy making, it is critical to examine long-term cost-effectiveness of programs and cost-effectiveness of synergistic demand- and supply-side interventions.

How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study.

In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP’s agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long-term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program’s merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health-related behaviours. In the HMP’s everyday implementation, healthcare access facilitation activities were well received, performed as set out and effective. The opposite was true for most educational activities targeting health-related behaviours. The HMP fieldworkers were proactive and sometimes effective at addressing most other SDH domains beyond the HMP agenda, especially material conditions and psychosocial factors, but also selected local structural aspects. The HMP leaders supported such deliberate engagement only informally, considering the program inappropriate by definition and too unstable institutionally to handle such extensions. Reports indicate that the situation in other CEE HMPs is similar. To increase the HMPs’ impact on SDH, their theories and procedures should be adapted according to the programs’ more promising actual practice regarding SDH.

Proposing the LEGS framework to complement the WHO building blocks for strengthening health systems: One needs a LEG to run an ethical, resilient system for implementing health rights.

The aim of this paper is to present a new framework to design and run a responsive and resilient health system. It can be used by both private and public, profit and non-profit organizations in order to translate strategic goals of an organization into desirable and intended best practice, and results. This includes the health sector. The framework is based on the four pillars of leadership, ethics, governance and systems, hence called LEGS framework. It can complement the six World Health Organization building blocks that guide inputs to help a health system achieve the intended goals. Despite all the strengths of the World Health Organization building blocks for health systems strengthening, it is important to highlight a few challenges: Ethics is assumed but is not explicitly stated as part of any building block. Furthermore, the World Health Organization framework lacks the flexibility to accommodate other important factors which may differ in various settings and contexts. Hence, the World Health Organization building blocks are either difficult to apply or insufficient in certain contexts, especially in countries with rampant corruption, weak rule of law and systems. This paper explores areas to strengthen the existing framework so as to achieve the intended results efficiently in different contexts. The authors propose LEGS (Leadership, Ethics, Governance and Systems Framework). This framework is very flexible, simple to use, easy to remember, accommodates the existing six WHO building blocks and can better guide different health systems and actors to achieve intended goals by taking into consideration the contextual factors like deficits in moral capital, rule of law or socioeconomic determinants of health.

Access to Guideline-Recommended Pharmacogenomic Tests for Cancer Treatments: Experience of Providers and Patients.

Genomic tests are the fastest growing sector in medicine and medical science, yet there remains a dearth of research on access to pharmacogenomic tests and medications. The objective of this study is to explore providers’ and patients’ experiences and views on test access as well as strategies used for gaining access. We interviewed clinicians who prescribed medications that should be guided by pharmacogenomic testing and patients who received those prescriptions. We organized the themes into the four dimensions suggested by the World Health Organization framework on access to medications and health technologies. Guideline-recommended pharmacogenomic tests for cancer care are generally available, although the timeliness of return of test results is sometimes suboptimal. Accessibility of pharmacogenomic tests is made challenging by the process of ordering pharmacogenomic tests, which is time-consuming. Affordability is a barrier to some patients as expressed by both providers and patients, who noted that the cost of pharmacogenomic tests and medications is high. Acceptability of the tests is high as both providers and patients view the tests positively. Understanding challenges to accessing pharmacogenomic tests will allow policymakers to develop policies that streamline access to genomics-based technologies to improve population health.

Coding communications across time: Documenting changes in interaction patterns across adopter categories.

GLOBALink, a large online network of tobacco control professionals, was active in the promotion of the World Health Organization's Framework Convention on Tobacco Control treaty, an international treaty aimed at reducing the global burden of tobacco-related death and disease. We examined and compared the roles that different countries served in the GLOBALink community during FCTC negotiation and ratification. Previous studies of FCTC ratification found the process adhered to a diffusion of innovation model (Valente et al., 2015). We followed that work by conducting content analyses of discussion messages posted by GLOBALink members representing different countries. Based on the time when they ratified the FCTC, each country was labeled by one of the four adoption stages of the diffusion model and we investigated the amount of shared word use between the different stages. A goodness-of-fit chi-squared test indicated that content was not shared in an expected manner between stages (χ 2 = 11,856.45, N = 51,447, p < 0.001). A deeper look at the specific words shared between countries within and between adoption stages provided insight into how interactions between certain countries might have served to support the ratification process.

Adolescent Access to Information on Contraceptives: A Mystery Client Study in Mexico

PurposeWe aimed to evaluate adolescent access to contraceptive information and quality of care in a sample of primary care clinics and pharmacies in Mexico and their association with health facility and adolescent characteristics. MethodsWe selected a random sample of pharmacies (n = 434) and public-sector, primary care clinics (n = 327) in Mexico City to be visited by young women posing as “mystery clients” looking for contraception or emergency contraception. Access to contraception information was measured as the percent of times that women received the information they requested. To assess quality of care, we built an “adolescent-friendly services” (AFS) score based on the World Health Organization framework. Regression models were fitted to evaluate the associations between outcomes and health facility and client characteristics. ResultsTwenty percent of women did not receive the information they requested. Clients seeking emergency contraception information had higher odds of obtaining it than clients seeking information on contraception (odds ratio 3.08 95% confidence interval 2.03, 4.67). AFS scores were low, although higher in clinics than in pharmacies (5/9 in clinics vs. 3/9 in pharmacies). Younger age and indigenous appearance were associated with lower quality as measured by the AFS score. ConclusionsAccess to information about contraception in pharmacies and clinics is high, but efforts must be made to provide 100% coverage to adolescents. The quality of contraception services in pharmacies and clinics is poor and nonequitable, favoring older and nonindigenous adolescents. Clinics and pharmacies must strive to comply with international AFS guidelines.

Global Health Systems and Policy Development: Implications for Health Literacy Research, Theory and Practice.

Accessible and responsive health systems are critical to population health and human development. While progress has been made toward global health and development targets, significant inequities remain within and between countries. Expanding health inequities suggest a widespread and systemic neglect of vulnerable citizens, and a failure to enshrine within policies a responsibility to tailor care to the variable capabilities of citizens. Implementation of health and social policies that drive the design of accessible health systems, services, products and infrastructure represents the next frontier for health reform. Within this chapter we argue the need to consider health and health literacy across policy domains, to operationalize the intent to address inequities in health in meaningful and pragmatic ways, and to actively monitor progress and impact within the context of the Sustainable Development Goals (SDGs). We contend that viewing and developing policies and systems within a health literacy framework will assist in placing citizens and equity considerations at the center of development efforts. In this chapter, we explore the relationship between health literacy and equitable access to health care, and the role of health system and policy reform. We first explore international policies, health literacy, and the SDGs. We then explore national policies and the role that national and local services and systems play in building health literacy, and responding to the health literacy challenges of citizens. We discuss the World Health Organization's (WHO) Framework for Integrated People-Centered Health Services and the way in which health services are being encouraged to understand and respond to citizen health literacy needs. Each section of the chapter ends with a summary and a review of health literacy research and practice. Throughout, we illustrate our points through 'vignettes' from around the world.

German EstSmoke: estimating adult smoking-related costs and consequences of smoking cessation for Germany.

We compared predicted life-time health-care costs for current, never and ex-smokers in Germany under the current set of tobacco control polices. We compared these economic consequences of the current situation with an alternative in which Germany were to implement more comprehensive tobacco control policies consistent with the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC) guidelines. German EstSmoke, an adapted version of the UK EstSmoke simulation model, applies the Markov modelling approach. Transition probabilities for (re-)currence of smoking-related diseases were calculated from large German disease-specific registries and the German Health Update (GEDA 2010). Estimations of both health-care costs and effect sizes of smoking cessation policies were taken from recent German studies and discounted at 3.5%/year. Germany. German population of prevalent current, never and ex-smokers in 2009. Life-time cost and outcomes in current, never and ex-smokers. If tobacco control policies are not strengthened, the German smoking population will incur €41.56 billion life-time excess costs compared with never smokers. Implementing tobacco control policies consistent with WHO FCTC guidelines would reduce the difference of life-time costs between current smokers and ex-smokers by at least €1.7 billion. Modelling suggests that the life-time healthcare costs of people in Germany who smoke are substantially greater than those of people who have never smoked. However, more comprehensive tobacco control policies could reduce health-care expenditures for current smokers by at least 4%.

Policy options for extending standardized tobacco packaging.

Smoking is a public health problem that will cause 1 billion deaths in the 21st century, if current smoking patterns persist. (1) Tobacco companies' aggressive marketing has fostered tobacco use by creating brands and linking these to attributes and identities that users and susceptible non-users value. Although many countries now restrict traditional marketing media, tobacco companies have developed increasingly creative strategies to encourage experimentation with tobacco among non-users and deter quitting among users. Packaging has provided an important and until recently, largely unregulated, conduit for these marketing messages and has communicated appealing imagery to young people while using known and familiar brand symbols to reassure existing tobacco users. The World Health Organization's Framework Convention on Tobacco Control (FCTC) (2) obliges Parties to address tobacco packaging. Implementation guidelines for Articles II (3) and 13 (4) include consideration of plain packaging and recognize the myriad ways in which tobacco companies have used packaging to promote tobacco use. In response, Australia, France, Georgia, Ireland, New Zealand, Norway and the United Kingdom of Great Britain and Northern Ireland have either introduced or will soon be introducing standardized or plain packaging. Hungary, Romania, Slovenia and Thailand have already passed legislation to introduce plain packaging, and several other countries (including Belgium, Canada, Chile, Singapore and Sri Lanka, among others) are formally considering this policy. Plain packaging replaces the attractive brand livery displayed on tobacco packs with an aversive colour and standardized text, and is typically combined with larger pictorial warning labels, if these are not already in place. The policy recognizes that on-pack brand imagery has positioned tobacco use as an aspirational behaviour and fostered uptake among young people, (5) transforming tobacco packages from attractive display items to highly unappealing articles. Evidence from Australia shows standardized packaging and larger pictorial warning labels have reduced smokings appeal among young people, (6) increased demand for cessation support and decreased smoking prevalence. (8) Evaluations confirm predictions from experimental and other studies used to support the introduction of this policy. (8) Despite the intuitive logic of using packaging to deter rather than facilitate experimentation with tobacco products, other countries have been cautious in following Australia's approach. The time taken for plain packaging to be more widely adopted and implemented in other countries has caused some frustration among public health researchers and advocates. Nevertheless, this time lag has also provided an opportunity to examine how tobacco companies have reacted to Australia's new policy environment, and to consider whether and where Australian legislation could be extended. We suggest that countries planning to introduce standardized packaging have an opportunity to innovate in at least four ways: (i) restricting or banning brand variant names; (ii) developing larger and more salient onpack warnings; (iii) requiring tobacco products themselves to use dissuasive colours; and (iv) using packaging to create cessation portals that direct tobacco users to quit support. First, the introduction of standardized packaging in Australia saw a rapid increase in brand variant names (or descriptors) such as Marlboro Silver Fine Scent, Winfield Optimum Crush Sky and Peter Stuyvesant New York Blend. (9) These variant names attempt to recreate connotations formerly aroused by visual brand imagery and aim to reassure smokers, deter quitting and potentially attract new users. Recent work suggests the more descriptors used, the more attractive a pack appears. (10) Variants potentially mislead users by linking tobacco to appealing attributes or by minimizing the harm caused by tobacco use and serve no purpose other than to create marketing appeals. …

Should Dementia Be Accepted as a Disability to Help Restore Hope during Cognitive Decline?

Dementia is a common condition that impacts the patient, the family, and society. Currently, a diagnosis of dementia evokes hopelessness in the afflicted, and society provides few resources or systematic support for caregivers or for demented patients. In this commentary, we discuss the origins of hopelessness in dementia, the World Health Organization's six-stage framework of dementia care, and barriers to "normalizing" the experience of dementia in order to provide beneficent and humane care for patients with dementia. We also offer recommendations for clinicians who care for patients who feel that a life with dementia is not worth living.

Trends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies.

BackgroundThe 2016 Dar Es Salaam Call to Action on Diabetes and Other non-communicable diseases (NCDs) advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. We estimated trends from 1980 to 2014 in age-standardized mean body mass index (BMI) and diabetes prevalence in these countries, in order to assess the co-progression and assist policy formulation.MethodsWe pooled data from African and worldwide population-based studies which measured height, weight and biomarkers to assess diabetes status in adults aged ≥ 18 years. A Bayesian hierarchical model was used to estimate trends by sex for 200 countries and territories including 53 countries across five African regions (central, eastern, northern, southern and western), in mean BMI and diabetes prevalence (defined as either fasting plasma glucose of ≥ 7.0 mmol/l, history of diabetes diagnosis, or use of insulin or oral glucose control agents).ResultsAfrican data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. Countries with the highest number of data sources for BMI were South Africa (n = 17), Nigeria (n = 15) and Egypt (n = 13); and for diabetes estimates, Tanzania (n = 8), Tunisia (n = 7), and Cameroon, Egypt and South Africa (all n = 6). The age-standardized mean BMI increased from 21.0 kg/m2 (95% credible interval: 20.3–21.7) to 23.0 kg/m2 (22.7–23.3) in men, and from 21.9 kg/m2 (21.3–22.5) to 24.9 kg/m2 (24.6–25.1) in women. The age-standardized prevalence of diabetes increased from 3.4% (1.5–6.3) to 8.5% (6.5–10.8) in men, and from 4.1% (2.0–7.5) to 8.9% (6.9–11.2) in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association (correlation coefficient ≃ 0.9) was observed between mean BMI and diabetes prevalence in both sexes in 1980 and 2014.ConclusionsThese estimates, based on limited data sources, confirm the rapidly increasing burden of diabetes in Africa. This rise is being driven, at least in part, by increasing adiposity, with regional variations in observed trends. African countries’ efforts to prevent and control diabetes and obesity should integrate the setting up of reliable monitoring systems, consistent with the World Health Organization’s Global Monitoring System Framework.

WHO FCTC as a Pioneering and Learning Instrument Comment on "The Legal Strength of International Health Instruments - What It Brings to Global Health Governance?"

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) is a unique global health instrument, since it is in the health field the only instrument that is international law. After the 10 years of its existence an Independent Expert Group assessed the impact of the FCTC using all available data and visiting a number of countries interviewing different stakeholders. It is quite clear that the Treaty has acted as a strong catalyst and framework for national actions and that remarkable progress in global tobacco control can be seen. At the same time FCTC has moved tobacco control in countries from a pure health issue to a legal responsibility of the whole government, and on the international level created stronger interagency collaboration. The assessment also showed the many challenges. The spread of tobacco use, as well as of other risk lifestyles, is related to globalization. FCTC is a pioneering example of global action to counteract the negative social consequences of globalization. A convention is not an easy instrument, but the FCTC has undoubtedly sparked thinking and development of other stronger public health instruments and of needed governance structures.

Questions About Cervical and Breast Cancer Screening Knowledge, Practice, and Outcomes: A Review of Demographic and Health Surveys.

United Nation's Sustainable Development Goals and the World Health Organization's Global Monitoring Framework support a strong global commitment to reducing the high burden of cervical and breast cancers among low- and middle-income countries. Strategies include vaccination, screening, and early diagnosis. Population-based surveys, such as those conducted by the Demographic and Health Surveys (DHS) Program, can collect the information needed to guide cancer control efforts in a standardized comparable manner. We identified and evaluated the breadth of breast and cervical cancer screening information that was collected by the DHS from 1984 through 2015. Then, we determined if these surveys currently provide the specific and measurable data about both the quantity and quality of cancer screening needed to guide national efforts to reduce the overall effects of cervical and breast cancers. We searched the DHS website to identify surveys conducted between the start of the DHS Program in 1984 and November 2015 that included questions about breast and cervical cancer screening. The relevant questions were extracted from the questionnaire, translated into English, and grouped by themes. Of the 90 countries where DHS surveys have been implemented, cervical cancer screening questions were included in 22 countries (24.4%) and breast cancer screening questions in 18 countries (20.0%). The common themes identified were disease knowledge, screening knowledge, screening practice, and screening outcomes. Most countries with survey questionnaires available for review addressed at least one aspect of screening practice (88.9% of cervical and 87.5% of breast), although few countries queried knowledge and outcomes. Questions that assess varied aspects of breast and cervical cancer screening have been incorporated into relatively few DHS surveys. The themes identified could guide the design of a standard set of questions for use in future population-based surveys and enable evaluation beyond the existence of screening, which would include assessment of the quality and impact of cervical and breast cancer screening.

Promoting Human Health and the Functioning of the Internal Market: The Reaffirmation of the Tobacco Products Directive’s Key Objectives in Poland v. Parliament and Council, Pillbox 38 and Philip Morris Brands and Others

The regulation of tobacco in the EU has a history of tough negotiations and legal challenges and the new 2014 Tobacco Products Directive has already proven to be no exception. Striving to promote the functioning of the internal market, yet at the same time maintain high level of health protection, this piece of legislation proliferated from international standards under the World Health Organization (WHO) Framework Convention on Tobacco Control and introduced more stringent marketing requirements for tobacco and its products than its predecessor. However, the Directive was immediately challenged by the industry and some Member States, which claimed that the new requirements on packaging and labelling as well as trade of tobacco and related products were inconsistent with the primary law. This analysis provides an insight into three recent parallel judgments of the European Court of Justice in cases Poland v. Parliament and Council, Pillbox 38 and Philip Morris Brands and Others, which upheld the legality of the Tobacco Products Directive and reaffirmed the importance of preserving the balance between the smooth functioning of the internal market and the promotion of human health within the EU.

An analysis of trends in publications on ‘tobacco control’

Objectives: Publications on tobacco control were quantitatively analysed to gain insight into the essential characteristics of the research field and trends and patterns in publication activities. The goal was to detect changes in the number of publications before and after the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) was introduced. Study design: A bibliometric analysis was performed to assess the current status and research themes of tobacco control papers listed in the Web of Science database published between 1990 and 2015. Methods: Quantitative analyses were conducted to investigate publication activities, geographic distribution and individuals’ research fields within tobacco control. Results: The number of publications on tobacco control was over 81 times higher in 2015 than in 1990. At least 50% of the papers were published by authors in high-income countries. In addition, in the first 5 years after the WHO FCTC was introduced, publications on tobacco control increased considerably and the first publications from authors from Malaysia and Uruguay appeared. Researchers from the Americas Region of WHO contributed to the field much more frequently than those from the other five WHO regions. Conclusion: Findings from this study suggest that researchers’ interest from most countries increased after the WHO FCTC was introduced. However, research outputs from low- and middle-income countries remained comparatively low. Promoting more interest in tobacco control among researchers in these countries may help control the future prevalence of smoking.