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A growing gulf in the terrain of tobacco control

The theme for World No Tobacco Day on May 31, an annual initiative of WHO and the Secretariat of the Framework Convention on Tobacco Control (FCTC), is plain packaging of tobacco products. Plain packaging prohibits the use of logos, colours, and promotional labelling on cigarettes and hand-rolled tobacco and gives graphic health warnings more prominence. In the FCTC, the legally binding international treaty to curb tobacco use signed by 180 nations, a ban on branded cigarette packaging is considered a key demand reduction strategy.

On May 31, WHO calls on countries to “get ready” for plain packaging, following the example of Australia, which introduced plain packs in 2012 and has since seen declines in smoking. France, Ireland, and the UK will imminently require plain packaging, and Canada, India, New Zealand, South Africa, and other European countries are considering tougher packaging laws for tobacco.

Plain packaging is a big step forward on the journey to reducing tobacco use and its associated health risks. But it has not been an easy road. The Government of Australia spent AUS$50 million fighting a court battle against tobacco giant Philip Morris, which argued that plain packs threatened the company’s intellectual property. The French subsidiary of Imperial Tobacco is planning a similar lawsuit. Last month, however, the European Court of Justice said the new EU law on plain packaging and a forthcoming ban on menthol cigarettes were legal. And on May 19, a high court in London ruled against four major tobacco companies who argued the plain packaging move violated UK and European law.

These recent victories against Big Tobacco are another triumph for public health. However, they also put into stark focus the massive gap between countries in delivering tobacco control.

For the bulk of the world’s lower income countries, implementation of agreed commitments in the FCTC has been staggeringly slow and may be at risk of stalling. The least compliant countries are often the ones with the highest rates of tobacco use, which compounds growing disease and cost burdens of tobacco. The Pan American Health Organization (PAHO), for example, released a report last week revealing uneven headway across the Americas. Just 17 of the region’s 35 member countries have smoke-free public spaces and workplaces, and only five have banned tobacco advertising and sponsorship. Only 16 countries mandate full graphic health warnings. Tobacco taxation is the most effective cessation and prevention strategy, but only one American nation has implemented the treaty’s agreed measure. Although 12 countries have some form of tobacco tax, only Chile levies taxes greater than 75% of the retail sale price of cigarettes. The USA has yet to even ratify the FCTC.

Progress in Africa and Asia, both key markets for tobacco companies where epidemics may be worsening, is similarly poor, as a series in The Lancet last year documented.

Smoking remains the number one cause of preventable disease and early death. It is the single common risk factor for the priority non-communicable diseases whose burdens are exploding in the very countries where tobacco use runs largely unabated. Without fuller implementation of the FCTC, no country will reach the global target of a 30% reduction in the prevalence of tobacco use by 2025, nor contribute substantially to the one-third reduction in premature deaths from non-communicable diseases targeted in the Sustainable Development Goals.

The basic ingredients of the framework convention—advertising bans, smoke-free spaces, graphic warnings, and taxation—are effective and cost little. So lack of implementation is not a matter of financial resources, it is political. Overcoming the inability to galvanise political will to fight for tobacco control should be the real focus of World No Tobacco Day.

Although we are encouraged by and celebrate the progress several countries have made to limit tobacco’s appeal through the use of plain packaging, the global community must remain vigilant to ensure a robust and even implementation of strategy across all countries. The FCTC is supposed to equip countries with policies and practices to fight against tobacco. We renew our call for a high-level UN summit on tobacco control, with stronger accountability mechanisms to bridge the gap between countries on-track and off-track for a tobacco-free world.

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