Tobacco is the leading cause of preventable death in the world. It kills more than five million people each year. If current trends continue, tobacco is projected to kill ten million per year by 2020, with 70 percent of those deaths occurring in developing countries. These figures suggest that around 500 million people alive today may eventually be killed by tobacco if they maintain usage. In response to these trends, the member states of the World Health Organization (WHO) negotiated and have now adopted the WHO Framework Convention on Tobacco Control (FCTC). The FCTC represents the first time that the WHO member states have harnessed the organization's right to develop a binding international convention to protect and promote global public health. The FCTC also represents the first time that states have cooperated worldwide to form a collective response to the cause of an avoidable chronic disease.
The FCTC was developed as a scientific, evidence-based approach to global tobacco control. The final FCTC text commits member states to implementing proven tobacco-control measures, such as increasing prices and taxes, imposing bans on advertising, promotion, and sponsorship, disclosing tobacco product components, requiring labeling standards and health warnings, promoting public education and awareness campaigns, and conducting research and surveillance programs. On November 29, 2004, Peru became the 40th country to ratify the convention. As a result, on February 28, 2005, the world's first public health treaty came into force.
The FCTC provides a legal platform for the adoption and implementation of effective tobacco control strategies worldwide. However, its implications go far beyond tobacco production, promotion, and use. The FCTC is, in essence, an attempt to develop a form of global health governance capable of effectively regulating transnational corporations. Its negotiation entailed wrestling with fundamental questions about the social impacts of globalization, particularly the relationship between trade and health. The negotiations also illuminated the important and evolving role of low- and middle-income countries and nongovernmental organizations (NGOs) in determining the future direction of global public health policy.
At the moment, significant barriers to the treaty's long-term success remain in many countries. States that have ratified the treaty must now follow through and implement their commitments. Other states, some of which have been active leaders throughout the FCTC process, now face major challenges in ratifying the treaty at home. Some states are lagging behind the global movement toward effective international tobacco regulation. In all countries, tobacco control programs need increased investment to fulfill the FCTC's potential to save lives.
It is important to understand the environment in which the treaty has taken effect in order to outline the steps necessary to ensure its successful implementation. Community-based organizations within the borders of each country signatory to the FCTC have a critical role to play in implementing and monitoring the post-ratification phase. These organizations should be seen as the key players in translating the global political process that has taken place into effective local action. Without their active formal and informal involvement, the value of the FCTC process and the treaty itself will be greatly diminished.
The Global Tobacco Environment
The FCTC has taken effect within an international environment that promises both major challenges and significant opportunities for success. On the one hand, the FCTC faces a powerful global industry that will undoubtedly try to limit its impact. Seventy-five percent of the world's cigarette market is controlled by just four companies: Philip Morris, British American Tobacco, Japan Tobacco, and the China National Tobacco Corporation. …