Voir page 935 le resume en francais. En la pagina 936 figura un resumen en espanol
A feature of the global cigarette market during the present decade has been the fall in demand in industrialized countries which has been coupled with a rapidly growing demand in other parts of the world, in particular among the emerging countries of Eastern Europe and Asia. As a consequence, there has been fierce competition among major multinational companies to establish a foothold in markets where cigarette sales are continuing to grow and this has been accompanied by a drive towards internationalizing brands (1). At the same time, mergers and acquisitions have led to a few tobacco companies becoming more dominant in the world cigarette market. The merger of the British American Tobacco company and Rothmans, the acquisition of RJR International by Japan Tobacco, and the merger of the French company Seita with the Spanish Tabacalera this year have dramatically changed the face of the industry worldwide. Four companies now dominate the list of the world's top cigarette manufacturers and account for more than 70% of the market (2).
The enormity and the gravity of the worldwide tobacco epidemic make it urgent that an international instrument for tobacco control be adopted. Although 91 countries have enacted national tobacco control legislation, many countries still have weak legislation or none at all and many have produced only a limited response to the dangers of tobacco use. The aggressive marketing practices of the multinational tobacco companies threaten the lives and health of the people in both developing and industrialized countries (3).
Four factors support the efforts being made towards adopting a collective international response to the death and disease caused by tobacco: the scope of the damage makes tobacco a public heath tragedy of the first order; the problem exists in every country; key elements -- smuggling, for instance -- transcend national boundaries; and the proven inability of controlling the tobacco problem by countries acting in isolation (4).
Multilateral organizations have developed a variety of mechanisms to encourage international agreement and action on matters of global concern. In general, there are two categories of international agreement that can be used to promote tobacco control strategies: non-binding international resolutions and legally binding international instruments (3).
The "convention-protocol" is recognized as a legally binding instrument and it is used in numerous human rights and environmental treaties (4). An important advantage of the convention-protocol is its flexibility: all substantive issues do not have to be resolved in a single document, rather each issue is dealt with under separate agreements. States first adopt a framework convention that calls for cooperation in achieving broadly stated goals, and there is the possibility that the parties to the convention will conclude separate protocols containing specific measures designed to implement these goals (3).
Underlying the framework, or protocol, approach is the premise that a division of the obligations into smaller, more manageable pieces advances the overall goal (4). Most framework treaties organize protocols primarily along thematic lines. This paper will discuss eight areas and how they relate to tobacco control. These areas include prices and taxes, smuggling, duty-free tobacco products, advertising and sponsorship, testing and reporting of toxicity and other constituents, the design and labelling of tobacco packaging, agricultural policies towards tobacco, and cooperation and information sharing. All of the proposals contained in this article are based on public health considerations and must be evaluated on the basis of their political and legal feasibility.
Prices and taxes
Taxation has often been considered as one of the most effective means of reducing consumption (5). …