Eastern Mediterranean Health Journal | Past issues | Volume 22, 2016 | Volume 22, issue 3 | Implementing the WHO FCTC: the need to scale up tobacco control

Implementing the WHO FCTC: the need to scale up tobacco control

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This article is abridged from the on the Annual Intercountry Meeting on the Implementation of the WHO Framework Convention on Tobacco Control (http://applications.emro.who.int/docs/IC_Meet_Rep_2015_EN_16717.pdf?ua=1)


The WHO Framework Convention on Tobacco Control (FCTC) was developed in response to the globalization of the tobacco epidemic. It is the first international public health treaty that provides a comprehensive approach to reduce the health and economic burden caused by tobacco.

The WHO FCTC came into force in 2005 and, in 2008, WHO introduced the MPOWER package of tobacco control measures, focusing on demand reduction, to help countries implement the WHO FCTC. MPOWER focuses on six key tobacco control measures, each corresponding to at least one provision of the treaty: Monitor tobacco use and prevention policies; Protect people from tobacco use; Offer help to quit tobacco use; Warn about the dangers of tobacco use; Enforce bans on tobacco advertising, promotion and sponsorship; Raise taxes on tobacco.

In the Eastern Mediterranean Region (EMR), 19 of the 22 member countries are party to the WHO FCTC and they have made some progress through legislations based on the Convention, including total bans on tobacco advertising, smoking bans in indoor public places, pictorial health warnings on tobacco packaging and increased tax on tobacco products.

The WHO Regional Office for the Eastern Mediterranean organizes an annual intercountry meeting to monitor progress on the implementation of the WHO FCTC in the Region, identify challenges and propose ways forward. The 2015 meeting was held on 26–28 October 2015 in Cairo, Egypt and focused on two core areas: 1) the general implementation of the WHO FCTC with its demand and supply side measures; and 2) the implementation of Article 6 of the WHO FCTC, adopted by the Conference of Parties (COP) in October 2014, with its taxation increase and price measures.

Specific objectives included: strengthening Parties’ implementation of the WHO FCTC and policies related to water pipe tobacco and tobacco industry interference; promoting ratification/accession to the Protocol to Eliminate Illicit Trade in Tobacco Products by the Parties; analysing the regional status for taxes on tobacco products; identifying the way forward for improving implementation of the WHO FCTC, including the adoption of new taxation policies in Member States.

The meeting was attended by representatives of 14 Parties to the Convention, one country observer (Morocco) and several international experts. The participants included representatives from ministries of health, ministries of finance and tax departments, tobacco control programme officers, representatives of the United Nations Development Programme (UNDP) and nongovernmental organizations and members of the Convention Secretariat (CSF).

Challenges and ways forward

With regard to taxation, there are major gaps in the countries of the Region. Many countries implement customs fees rather than excise taxes and many have a very low rate of taxes. Even in some countries where the taxation levels are high and up to the maximum recommended levels, the prices are still low and products are still very affordable.

The main factor in controlling illicit tobacco trade is governance, not pricing. Evidence shows that smuggling is not linked to taxation levels but rather to poor governance and weak enforcement in areas such as customs. Contrary to tobacco industry claims, increased smuggling does not automatically follow tax increases. Tobacco taxation is a cost-effective tobacco control policy and benefits governments from both an economic and health standpoint. The tobacco industry is making concerted efforts to stop the increase in tobacco prices and taxes, and to make it difficult for countries to revisit their taxation systems and policies.

There is a need for a balanced approach in implementing the demand and supply side measures. Countries should aim at implementing the highest level measures of all policies rather than introducing softer measures in different policies.

Implementation, ratification and entry into force of the Protocol to Eliminate Illicit Trade in Tobacco Products are a priority for the Region. Countries need to expedite the process at the national level with the support of the WHO FCTC Secretariat and the WHO Regional Office. Key element in speeding up the process at the national level in include multisectorality and protecting the process from the vested interests of the tobacco industry (in some countries where there are national monopolies the tobacco industry is involved in the decision-making process related to the protocol ratification/accession).

Tobacco advertising, promotion and sponsorship (TAPS) in movies/drama/TV is undermining other tobacco control activities in the Region and COP guidance is needed on how to control tobacco use in these media.

Needed actions

In light of these challenges, a number of actions for the countries, and WHO and CSF were identified in order to advance implementation of the WHO FCTC and effectively scale up tobacco control in the Region. Box 1 shows some of the main recommended actions.

Box 1 Actions to scale up tobacco control in the Region