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December 5, 2001

The Worldwide Tobacco Treaty

Author Affiliations

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JAMA. 2001;286(21):2736. doi:10.1001/jama.286.21.2736-JMS1205-4-1

The negotiations on the Framework Convention on Tobacco Control (FCTC), sponsored by the World Health Organization, are an opportunity to fashion the international controls necessary to stem the worldwide increase in tobacco-related mortality. It is an opportunity that should not be squandered. We believe that a treaty that merely suggests guidelines for countries to follow will not advance global public health. It must contain concrete provisions to tackle the problems of international tobacco trade. It is also important that the FCTC not act as a restraint on countries' ability to go beyond what is negotiated by stating explicitly that it and subsequent protocols should serve as a minimum standard. While we will discuss advertising, the treatment of tobacco products in international trade,1 and the positions taken by the US delegation, action is needed in many additional areas.


Despite industry denials, tobacco advertising and promotion lead to dramatic increases in consumption and have an especially powerful effect on young people.2 Moreover, bans on tobacco advertising, sponsorship, and other promotional activities are effective in reducing tobacco use and preventing new smokers from starting.3 The World Bank examined data from 102 countries and found that per-capita cigarette consumption in countries with comprehensive advertising bans declined by about 8%, while consumption rates in other countries declined by only about 1%.4 However, limited or partial bans, such as those proposed by the tobacco industry, have little or no effect. Both the World Health Organization and the World Bank recommend that countries prohibit all forms of tobacco advertisement and promotion.4 During the negotiations, a global ban was supported by most countries with a few exceptions, including the United States.

Given the evidence, we believe that the parties to the FCTC should prohibit all tobacco advertising, sponsorship, and promotion, including all cross-border advertising, promotion and sponsorship. There should be exceptions only for countries with pre-existing constitutional constraints, and those countries should be required to enact the most stringent restrictions possible.


Historically, global trade agreements have focused on promoting and expanding trade with scant regard to the public health implications. In the case of tobacco, this oversight has resulted in a public health disaster. According to the World Bank, liberalization of trade in tobacco products has contributed significantly to increases in cigarette consumption in low- and middle-income countries.5 Since tobacco products are unique in that their promotion and expansion to additional markets merely raises the death rate and incurs a net economic loss, we believe that they can and should be treated differently in international trade. The Convention should encourage countries to modify existing trade agreements to make exceptions for tobacco. Such action is not unprecedented. Other legal but harmful products, such as guns and toxic waste, are subject to limitations on unrestrained free trade. Establishing separate treatment for tobacco products is a logical extension of these precedents.

US Involvement

In April 2001, the US delegation sought several changes to the FCTC. These included eliminating a provision prohibiting the use of dangerously deceptive terms like "low tar," "light," and "mild" to market tobacco products; deleting provisions prohibiting tax-free and duty-free sales of cigarettes and calling for "imposition of taxes on tobacco products so as to achieve a stable and continuous reduction in tobacco consumption"; reconsidering a provision encouraging governments to protect non-smokers by banning smoking in workplaces and public buildings; deleting a provision supporting the licensing of tobacco retailers as an effective means to enforce youth access laws; and weakening the overall obligations of nations to implement the provisions of the proposed treaty.

While the Convention represents hope for real progress in halting the leading preventable cause of death, the United States' recent behavior in the negotiations has been negative. We believe that the positions the United States proposed at the last negotiating session would weaken or eliminate precisely those provisions that could have a significant impact, while offering text proposals that seem favorable to the interests of tobacco companies. Because the United States is the leading exporter of tobacco products, we believe that it has an obligation to put aside the parochial interests of domestic tobacco manufacturers and be a leader in writing a strong and effective FCTC.

Not Available, Campaign for Tobacco Free Kids. Available at: http://tobaccofreekids.org/campaign/global/reports.shtml. Accessed November 14, 2001.
Evans  NFarkas  AGilpin  EBerry  CPierre  JP Influence of tobacco marketing and exposure to smokers on adolescent susceptibility to smoking.  J Natl Cancer Inst. 1995;871538- 1545Article
Saffer  H Tobacco advertising and promotion. Chaloupka  FJJha  Peds. Tobacco Control Policies in Developing Countries. Oxford, England Oxford University Press2000;
World Bank, Curbing the Epidemic: Governments and the Economics of Tobacco Control.  Washington, DC World Bank1999;
Bettcher  DWYach  DGuindon  E Global trade and health: key linkages and future challenges.  Bull World Health Organ. 2000;78521- 534