Tobacco control at a global level

How has tobacco control been approached at a global level, and what challenges does it face?

Following a major epidemic in 2003, tobacco control cemented itself at global level when the World Health Organization negotiated the Framework Convention on Tobacco Control (FCTC 2013), alongside the comments made by Gro Harlem Brundtland (former PM of Norway and Director General of the UN World Health Organization) “deeming malaria and tobacco as the two most serious global health problems” (Sugarman 2001). With a variety of case studies and examples of international policy and efforts, it is evident that tobacco control has been taken as a serious issue but has meant many new and old challenges.

The WHO FCTC was adopted by the World Health Assembly in 2003 and claims to be “one of the most rapidly and widely embraced treaties in the history of the United Nations” (FCTC 2013). It reaffirms the right of all people to the highest standard of health. Immediately, the goals sought by the WHO FCTC identify what tobacco control primarily is; the attempt at limiting tobacco users and the risks smokers cause to them and others around them. The key provisions of the WHO FCTC are, as outlined by Phillip Morris International (2013), Protection, Labelling, Illicit Trade, Regulation, and Taxation. However, with the attention focussed upon health, it raises questions as to whether tobacco control is the control of tobacco supply or the attempts to reduce tobacco demand. Because of the war between health risk concerned groups and the oligopoly of the international tobacco industry, (Tobacco Atlas, 2008) what can be learned from the WHO FCTC is that ‘tobacco control’ aims to reduce the demand of tobacco through attacking the supply side. There is sufficient evidence to support this claim, such as the previously commented FCTC provisions. In 2012, one provision the group introduced was a Protocol to Eliminate Illicit Trade in Tobacco Products (FCTC, 2013). Protocol activities included establishing cooperation between the UNODC and the WCO as well as introducing a study of tracing and tracking regimes. This demonstrates a clear effort to quash supply as it makes it easier to control tobacco if the trading of tobacco happens less ‘below the table’. With many UN agencies keeping a closer eye on illegal tobacco trade, it makes products harder to obtain and therefore naturally means reducing tobacco consumption is easier. As well as this, Joossens (2012) highlighted a study on Europe which indicated that the greatest response to the demand in tobacco is the price. Consumers prefer ‘cheaper’ products (as opposed to harsher flavour, or unappealing packaging) and illicit tobacco trade is the way in which the cheapest products can be found. Thus, in an attempt at thwarting the illegal trading of tobacco, not only is the supply of tobacco reduced, but it also suggests that demand for tobacco products will fall because of the rise in price. It is suggested that this will occur through the decrease in the availability of cheaper products, meaning that less are on the market and that tobacco companies do not need to depress their prices as they can no longer be matched by the absent black market. And so, it is evident that the 2003 WHO FCTC treaty is approaching tobacco control at a global level, and with their work including the protocol to remove illicit trade of tobacco products, they are making attempts at reducing both the demand and supply side of tobacco.

When looking at the history of tobacco control, the most prevalent smoking ban legislation of each country can undoubtedly be linked back to 2003, the year of the FCTC. For example, a case study of Ireland identifies a link between the FCTC and their smoking ban legislature; a link which cannot be put down to just coincidence. Ireland were one of the world leaders in banning smoking at the workplace in 2004 (BBC, 2004), and brought in recent legislation in 2013 for a “Tobacco Free Ireland” (FCTC, 2013). Research carried out by the Health Service Executive in Ireland (2012) discovered that the effects of Ireland’s strong fight against tobacco are rapidly apparent: prevalence fell 1.8% between June 2010 and December 2012. The case study of Ireland successfully argues the claim that global tobacco control, lead by the WHO, are undeniably making a difference. On a broader context, recent EU policies under the Tobacco Products Directive give extensive backing to the claim. Headlines were hit when the EU legislated on public health operatives regarding tobacco control, for example, banning 10 pack cigarettes was a key feature of the legislation (Waterfield, 2013). The increase in laws such as this, as well as Ireland being made a clear example of by the WHO, demonstrate how tobacco control is a global movement, and a problem which will be increasingly solved by a global effort.

Moving onwards, tobacco control has also been approached at a global level by many interest groups. As previously mentioned, the Smoke Free Partnership (n.d.) is one such group which is taking similar measures to the WHO FCTC as they attempt to reduce smoking, and advocate control of tobacco within the EU. They provide extensive coverage of smoking related legislature within the EU, watching each country closely. This is especially the case in regards to exposing those countries who have disregarded article 8 of the WHO FCTC which is legal statute to ban smoking in “indoor public places, work places, and public transport”, for example, the unenforced and weak laws in Austria for smoking inside the workplace. Additionally, the Smoke Free Partnership provide detail on the bare facts of smoking, raising awareness for the problems tobacco use causes. They expose simple statistics of the global burden of tobacco; “tobacco-related illness already kills 5.4 million people a year worldwide”. Another similar interest group is the Bill & Melinda Gates foundation. A respected and recognised philanthropic force in global health, the foundation supports “full implementation of FCTC provisions” (Gates Foundation, 2013). As a result of this, a core aim of the foundation is to reduce tobacco related deaths worldwide – with a specific focus on two of the poorest regions in the world, Africa and South-East Asia, and China, a country with approximately 350 million tobacco users (The BMJ, 2013). What these interest groups show is defiance against tobacco, but what they represent is having more implications for the global control of tobacco. They highlight the broader picture towards the global attitude on smoking; reducing and controlling it. What is automatically apparent from all these interest groups is that at their heart is FCTC policies. Not only has the WHO FCTC increased the amount of interest groups, but the groups are growing in popularity. The modern tobacco movement on a global scale can be tracked back to the 70s, but it hasn’t been taken seriously since the 90s, and especially not until the WHO FCTC in 2003. It can be argued a new phenomenon is visible: an unquestionable, intentional fight against tobacco on worldwide scale. It has not been seen before. This is meant in the terms of global efforts; there have been efforts to curve tobacco use for centuries (Borio, 2010). In modern history, individual nations have attempted to reduce the use of tobacco sometimes even on an international scale, as well as nationally. However, with all nations united in tobacco control, this global front can be seen as a new phenomenon. Concurring with rapid globalization, tobacco control, predominantly outlined by the FCTC, is being met with effective deliberation at a global level. Nevertheless, this has also meant fresh challenges in addition to the long-standing challenges brought forward by the tobacco industry.

The biggest challenge to tobacco control is the industry. As previously mentioned, there is a tension, a “war”, between the WHO FCTC and other health concerned groups, and the oligopolistic international industry. Following considerable merging in the 90s and 00s, Phillip Morris & Altria own 20.2% of the international market, British American Tobacco 12%, Japan Tobacco International 9.6%, Imperial Tobacco 4.9%, and the overwhelming China National Tobacco Co. have a staggering 37.1% of the international market (Tobacco Atlas, 2008). An oligopoly is an example of market failure (Economics Online, n.d.) and as explained by Sugarman (2001), “the increasing importance in the worldwide tobacco market of a few giant companies (all broadly transnational, apart from Chinese monopoly) is itself seen by many as a reason to view smoking and its control no longer merely as a series of separate national problems, but rather as global one”. Henceforth, the importance of global tobacco control cannot be underestimated as the industry has the power to penetrate deep within the politics and economics of every nation. The most prominent example of this is the failure of the US to ratify the FCTC treaty, with heavy, financial persuasion from the tobacco industry. Mulvey (2005) reported a $3.7million contribution from tobacco companies during the 2004 political cycle, and Tobacco-Free Kids reported direct payments to just federal candidates (through PACs) of $1.5million in the 2009-2010 political cycle, and $1.6million during the 2011-2012 cycle (Tobacco Free Kids, 2012). The industry counters many arguments raised by the tobacco control groups, as they naturally want to keep on increasing the demand for tobacco whilst maintaining the large fortunes earned by supplying it. As can be seen, this is achieved through their political and economic influence as a result of lack of competition from market failure. And so the greatest hurdle to global tobacco control is naturally the industry itself: not only is the industry logically going to oppose reduction, but their wide outstretched arms block the path to global health governance, providing a significant mountain to overcome if reduction of tobacco is to be successful.

Globalization can evidently be seen as a major driving point for the FCTC, but on the reverse of that, globalization has also been a challenge to tobacco control. As earlier cited, the large merging in the 90s and 00s resulted in bigger tobacco companies getting bigger and smaller tobacco companies getting smaller. This can be argued as a consequence of globalization, and what is predicted because of this implies how globalization is becoming an ever increasing problem as well as a good thing. As Sugarman (2001) notes, “the annual global death count is now projected to reach more than 8 million by 2020… Furthermore, the incidence of mortality is shifting from rich countries to poor countries… an estimated two-thirds of those deaths will occur in developing countries”. Another staggering point made by Sugarman is within regards to the market of potential female smokers, as developing nations reduce their gender inequalities. Mackay (1998) argues that by 2025, the estimated increase to 1.64 billion smokers worldwide will have three main causalities; one of which being an increase in the amount of women smoking. In developing nations, Mackay suggests there will be a 12% increase in female smokers. Gender Equality is a prevailing issue, but it is something many agencies are working towards; whether they are governments or local charities, there is an increase in feminism and a constant step towards equality for women. Tobacco use amongst women will grow as genders become more equal (Pampel, 2006) for example, an article published by Koutsoukis (2010) describes how women ignored a smoking ban on females in a public park in Gaza, leading to the smoking ban being lifted. It indicates that the government stronghold was weak and powerless, with women choosing to carry on their tobacco use regardless. The article exemplifies and exposes the stronger position women are taking in patriarchal communities around the globe – as well as exemplifying and exposing the stronger position global tobacco control will have to take in order to reduce the amount of tobacco users. Gender equality in patriarchal countries will only continue to become more apparent, creating a larger market for the wealthy international tobacco industry to uncover and exploit. Tackling an increase in female smokers in developing nations is just part of the picture; tackling the increase in all smokers in developing nations is a great challenge for tobacco control, regardless of socio-economic status, race, ethnicity, age and gender. Globalization is making advertising of tobacco products more accessible, and as McKarney (2010) explains, tobacco companies are targeting developing nations, illustrating Indonesia as having a “tobacco advertising overload”. The escalation of tobacco use in developing nations highlights the intensification of challenges global tobacco control is facing; the unstoppable forces of globalization providing both a stronghold for global tobacco control as well as a challenge.

In conclusion, tobacco control is met at global level through a series of partnerships and worldwide obligations. The World Health Organization on the Framework Convention on Tobacco Control has sufficiently set up a minimal level for every country to comply with, in regards to reducing tobacco consumption. It is one of the most important pieces of legislation in the 21^st century; it shapes and attempts to combat one of the biggest consumer industries in the world. Herein, the challenges that face global tobacco control are obvious. As it is one of the biggest industries in the world, trying to reduce the demand and supply of tobacco is not an easy fate for governmental and non-governmental organizations. Nonetheless, it can be summarised that tobacco control is an ever-increasing global phenomenon and it will grow as a force at the same rate the challenges will also grow.

References

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