12th World Congress on Tobacco or Health
Beyond the Convention
On 21 May this year, the World Health Assembly, representing 192 countries unanimously adopted the WHO Framework Convention on Tobacco Control.
This is a historic landmark in tobacco control. Our Member States have spoken out against tobacco.
The process began with the Resolution adopted at the 9th World Congress on Tobacco or Health in Paris in 1994. It stated:
“National governments, Ministers of Health, and the World Health Organization should immediately initiate action to prepare and achieve an International Convention on Tobacco ….”
The continued push by the international tobacco control community, in major ways, contributed to the successful agreement in May. The negotiations for the FCTC were tough. The tougher challenge now is implementation. I believe this Convention would make a difference where it matters – in countries where people live and smoke. “Think globally – act locally” is an old health promotion slogan that still applies. The FCTC process has shown that together we are strong. And the truth is on our side.
Let us review some of the facts.
Tobacco kills 4.9 million people every year. Most of these people are in poor countries. That is where tobacco use is increasing, largely because that is where the tobacco industry is marketing it. Tobacco-related deaths are from cardiovascular diseases, cancer or chronic obstructive lung disease.
Deaths due to tobacco use are in themselves unacceptably high. But, there is also the loss of productivity and the suffering of patients and their families. Tobacco-related diseases impose a heavy burden on national health services in developed and developing countries.
Tobacco is more than a nuisance or irritation to many non-smokers. More importantly, exposure to environmental tobacco smoke often affects the health of others, especially women and children.
The FCTC text clearly recognizers the link between exposure to tobacco smoke and death, disease and disability. The countries joining the FCTC agree to implement and actively promote effective legislation and other measures, which protect people from exposure to tobacco smoke indoors at work, on public transport, and indoor public places.
Ladies and Gentlemen, Tobacco directly affects health – that is clear. But it also contributes to malnutrition - money spent on tobacco is money which cannot be spent on food. In Bangladesh, estimates show that, if poor people did not smoke, 10.5 million fewer people would be malnourished.
Widespread tobacco use is also a development issue. The links between poverty and tobacco must be addressed. I am pleased to see that international development agencies and donor countries have begun to include tobacco control in their work agendas.
About marketing of tobacco by the industry: you have seen the advertisements. Smokers are beautiful, cool and successful. The reality is a painful death, chronic coughing, troubled breathing, and discoloured fingers and teeth. Smoking is not cool.
But, we face new challenges in our interdependent and interconnected world. Take our host country for example: Finland is among the many countries that have completely banned domestic tobacco advertising. But airwaves cannot be corralled. Children and youth can easily see foreign tobacco advertising on TV, or in newspapers and magazines.
In the text of the Convention, countries recognize that a comprehensive ban on advertising, promotion and sponsorship will reduce tobacco consumption. Each country shall, in accordance with its constitution, undertake such a ban. WHO recognizes that some countries have expressed constitutional grounds for not implementing such bans, but I hope that exceptions will be minimized.
A visible consequence of the FCTC will be prominent health warnings and messages on tobacco packages. These messages should take up half the package, and no less than a third. In addition, tobacco packages should not promote products using misleading terms such as "low tar" and "ultra light" – labels we have long argued against.
When do people start smoking? Usually, when they are young people. Peer pressure, lack of knowledge and a sense of invincibility spur the young smoker. We must do more to stop young people from starting to smoke – and help everyone who wants to quit.
Quitting smoking – even at a late age – greatly reduces health risks. It is the only way smokers can avoid premature death. Secondly, adults must lead by example. You cannot tell your child not to smoke while you continue to light up. This Conference should feature effective quit and win measures, targeted at individual smokers, as well as cost-effective population-based smoking cessation programmes. How to stop people from starting or helping them to quit? Raising prices reduces demand for tobacco. On average, raising the price of a pack of cigarettes by ten per cent reduces the demand by about eight per cent in low and middle-income countries. A tax increase is one way to do this. Children and adolescents, in particular, will shy away from tobacco products if prices are higher.
Although tax and price levels of tobacco are the decision of individual governments, the countries joining the FCTC agree to implement appropriate tax and price policies on tobacco products. An increasing number of countries have decided on a levy of tobacco tax – WHO recommends one per cent – to be used for financing national tobacco control measures.
Ladies and Gentlemen,
Changes in the demand for tobacco products will not happen overnight. And, even if we see a decrease in smoking prevalence, the absolute number of smokers is expected to increase because of population growth and changes in age demographics. Indeed, the current number of some 1.3 billion tobacco users worldwide is expected to reach 1.7 billion in the year 2020. The increase will be especially among women, mainly in the developing world.
Countries should lose no time in signing and ratifying the FCTC so that we can move forward in implementing it. Forty-six Member States and one regional economic integration organization have already signed. The first country to ratify the Framework Convention was Norway, which both signed and ratified the FCTC on the first day it opened for signature. As you know, the Convention will enter into force 90 days after 40 countries have ratified. Let us make that happen. I would like to stress that the obligations of the FCTC are not the optimum for countries, but simply the agreed minimum international basis for collective action. The text clearly encourages countries to implement measures beyond those required by the Convention and its protocols.
A general obligation to every country joining the Convention is to develop, implement, periodically update and review comprehensive multisectoral national public control strategies, plans and programmes, in accordance with the Convention. This work is a key challenge to the national and international NGO tobacco control communities.
The text of the Convention includes a number of important provisions concerning smoking cessation, smuggling, tobacco products, disclosures, public education, sales to minors, protection of the environment, liability, research, and surveillance. Since it is our Convention, it is important that this Conference learn more about "our Convention". Several sessions, including one of the main sessions of today, will discuss in more detail the next steps and what actions WHO is planning to undertake for the implementation of the FCTC and future protocols. The FCTC negotiations have already unleashed a process that has resulted in visible differences at country level. The success of the FCTC as a tool for public health will depend on the energy and political commitment that we devote to implementing it, in countries in the coming years. A successful result will be global public health gains for all. At the next conference, three years from now, no doubt we will be able to report on the great strides that have been made in countries.