Tobacco laws: Are we heading in the right direction?

This year marks eight years since the World Health Organization Framework Convention on Tobacco Control (FCTC). The WHO FCTC was a milestone for the promotion of public health and provides new legal dimensions for international health cooperation.

There has been a rapid growth in the number of parties to the Convention, now up to 176 countries, covering some 90% of the world’s population. The countries themselves have been taking extraordinary steps in tobacco control, with nearly 80% adopting or strengthening tobacco control legislation.

WHO reports that the most progress in the implementation of the Convention is achieved via the introduction or strengthening of existing tobacco-control laws. The ‘2012 Global Report on the Implementation of WHO FCTC’, sites that 46 countries have adopted national legislation while 81 had strengthened existing legislation after the FCTC ratification.

Taking a look at some of the key aspects of the Convention and their implementation progress over the years, a well-used weapon of the FCTC convention is Article 6 which requires countries to implement price increases and tax policies that contribute to the reduction of tobacco consumption. The WHO reports that overall, the trends across the globe are promising.

Average reported price for a pack of cigarettes has increased from Rs. 328.90 (US$ 2.53) in 2010, to Rs. 495.30 (US$ 3.81) in 2012. This increase in pricing is seen across countries in different WHO regions. Minimum prices have also experienced significant increases, particularly in the African, European and the Americas Regions.

In the Asia region, the price of a 20s pack ranges from SL Rupees 125 to SLR. 1,212.00, with some countries like Singapore and Hong Kong selling at comparatively higher prices.

Article 16, which addresses the selling of tobacco products to minors, has one of the highest implementation rates among all sub-articles of the FCTC Convention. It requires countries to adopt and implement measures to prohibit sales of tobacco products to minors.

According to the 2012 FCTC report, nearly 90% of countries are reported to have prohibited the sale of tobacco products to minors. The legal age in most countries ranges from 16 to 21 years.  In South Asia a majority of the countries consider 18 years as the legal age to buy tobacco products.

Measures to prohibit the distribution of free tobacco products to minors were reported by more than 80% of the countries. Over half of the countries reported requiring sellers to place a clear and prominent indicator at points-of-sale about the prohibition of tobacco sales to minors.

Over half of the countries reported that they prohibit the sale of tobacco products from vending machines, while the 40% that still allow such sales, have adopted processes to ensure cigarettes are not sold to minors. In various states in Australia, the law requires vending machines be operated by a staff member, except those in bars, casinos and shops selling alcoholic beverages. In Austria, vending machines can only be unlocked by inserting a chip card (e.g. a bank card), which verifies whether the customer is of a legal age.

Article 8 of the FCTC addresses the adoption and implementation of effective measures to provide protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and other public places.

The WHO states this Article has seen an average implementation rate of 83%, taking into account complete or partial smoking bans in all types of public places.

According to the WHO, Indoor workplaces such as healthcare facilities, educational facilities (excluding universities) and government buildings are more frequently covered by a complete ban on tobacco smoking.  Indoor public places in general are settings that see a “partial” ban. The places least likely to be covered by a complete ban are pubs, bars and night clubs. Meanwhile, smoking bans on public transport vary globally, with 106 countries instituting a complete ban on smoking in airplanes, while only 10 countries reported the same for private vehicles.

In terms of Article 13 on Tobacco Advertising, Promotion and Sponsorship - more than two thirds of the countries reported having implemented a comprehensive ban.

Interestingly, the WHO reports, seven countries (Australia, France, Montenegro, Nepal, Norway, Serbia and the United Kingdom) reported extending their bans on advertising, promotion and sponsorship to the internet. However, bans on cross-border advertising on tobacco promotion, poses a challenge to many countries, as does the enforcement of a ban on promotion on the Internet.

FCTC’s Article 11 meanwhile, stipulates that each country adopts and implements effective measures concerning packaging and labelling. The WHO reports that almost three-quarter (90) of the countries have a requirement for health warnings to occupy no less than 30% of the principal display area of a pack.

According to a global report by the Canadian Cancer Society in 2012; out of 198 countries, 62 countries or 31%, currently have a Graphic Health Warning (GHW) on tobacco packs. Of these 62 countries - 76% have a 50% or lesser-sized Graphic Health Warning on packs. Some countries such as USA, Japan, Germany, China, Italy and Sweden, do not have any Graphic Health Warning. Out of the 23 countries which introduced graphic health warnings after 2012, only 1 country (Ecuador with a 60% Graphic Health Warning) has a warning in effect that is larger than 50%.

Based on the 2012 WHO FCTC progress report, the four areas attracting the highest implementation rates are: protection from exposure to tobacco smoke (Article 8); education, communication and training (Article 12); sales to minors (Article 16); and packaging and labelling (Article 11).

Sri Lanka enacted the National Authority on Tobacco and Alcohol Act in 2006, a year after the FCTC Convention came into effect. When compared regionally and globally, Sri Lanka is a successful and active signatory to this Convention.

The introduction of robust laws such as the prohibition of all tobacco advertisements, promotions and sponsorships, a ban on enclosed public place smoking, a 21-year age limit for the purchase of tobacco products, high taxation and pricing together with successful public awareness campaigns have placed the country on the right path to tobacco control.

While there is progress in implementing tobacco control legislature, where should Sri Lanka and other parties to the FCTC focus on in the coming years?    

At the 5th session held in Seoul, South Korea, in 2012, the Conference of the Parties (COP) to the WHO FCTC, adopted the Protocol to Eliminate Illicit Trade in Tobacco Products, calling upon all countries to consider bringing the Protocol into force as soon as possible.

The WHO recognises that illicit trade in tobacco products is a global problem. It increases the accessibility and affordability of tobacco products, undermining tobacco control policies and severely burdening health systems. In addition, illicit trade leads to significant revenue losses for governments.

Further, amidst millions of tobacco farmers of the world expressing concerns via the International Tobacco Growers Association (ITGA) to the WHO on the impact of the FCTC on their livelihoods and the economy of their countries. Another key area the FCTC will focus on is providing economically sustainable alternatives to tobacco growing (Articles 17 and 18 of the WHO FCTC).

The farmers in a letter making a plea to the COP, outlined the impact on their livelihood with examples of the industry’s importance in many countries. For instance, more than 50% of Malawi’s foreign exchange comes from tobacco, which contributes to almost 30% of the country’s GDP with 15% of the country’s labour depending on tobacco cultivation. In Tanzania, tobacco is the second largest agriculture export and in India more than 20 million workers are employed annually by the industry.

With the WHO seeing a continued decrease of smoking prevalence among several Parties to the FCTC, it’s important for successful signatories to the Convention to now strike a balance between implementing robust laws on tobacco control to improve national healthcare and implementing humane and practical policies to safeguard the overall interests of each country.

Article sources:

2012 GLOBAL PROGRESS REPORT: on implementation of the WHO Framework Convention on Tobacco Control.  

Cigarette Package Health Warnings International Status Report – Canadian Cancer Society (3rd Edition, Oct 2012)

http://www.who.int/fctc/reporting/party_reports/en/index.html

http://apps.who.int/gb/fctc/E/index.html

http://www.tobaccoleaf.org/

www.cigaretteprices.net

http://www.who.int/mediacentre/news/releases/2013/fctc_20130110/en/