WHO FCTC and International Best Practices for Comprehensive Tobacco Control

WHO Framework Convention for Tobacco Control The WHO Framework Convention on Tobacco Control (WHO FCTC) is the first global health treaty negotiated under the auspices of the World Health Organization. The treaty was unanimously adopted by 192 nations at the World Health Assembly (WHA) on 21st May 2003. Ratification of FCTC confers a legal obligation on the party to implement the treaty. The WHO FCTC entered into force on 27 February 2005 after 40 countries had ratified.

Framework Convention on Tobacco Control (FCTC) - Role of India India played a leading role in FCTC negotiations to finalize its provisions and was the regional coordinator for the South- East Asian countries. Even before the World Health Assembly adopted the WHO FCTC on 21 May 2003, the comprehensive Tobacco Control Act was enacted by GOI on 18 May 2003. This Act encompasses most of the FCTC provisions. India ratified the FCTC on 5 February 2004 and is now a party to the Convention and therefore, has to implement all provisions of this international treaty. Tobacco Free Initiative

MAIN PROVISIONS OF THE FCTC Tobacco Free Initiative

General Obligations Establish a national coordinating mechanism or focal points for tobacco control Implement effective legislative, executive, administrative, and /or other measures for tobacco control Set and implement public health policies for tobacco control Raise financial resources for effective implementation of the Convention

Measures relating to the reduction of demand for tobacco

Article 6: Price and tax measures to reduce the demand for tobacco Recognizing price and tax measures are an effective and important means of reducing tobacco consumption by various segments of the population, in particular young persons. Implement tax policies and where appropriate price policies on tobacco products, aiming to reduce tobacco use Prohibit or restrict importation of tax and duty free tobacco products. To provide taxation rates for tobacco products and trends in tobacco consumption in COP reporting instrument.

Article 8: Protection from exposure to tobacco smoke To implement measures for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.

Article 9 & 10: Regulation of the contents and disclosures of tobacco products To implement measures for testing and measuring the contents and emissions of tobacco products and for the regulation of these contents and emissions. COP will propose guidelines for testing and regulation of the contents and emissions of tobacco products, to be implemented by parties to the convention. To implement measures for public disclosure of information about the toxic constituents of the tobacco products and the emissions that they may produce. Manufacturers and importers of tobacco products are required to disclose contents and emissions to the Government and to the public.

Article 11: Packaging and labelling of tobacco products To adopt and implement effective measures to ensure that packaging and labelling of tobacco products does not promote the tobacco product in any way that is false or misleading. To ensure that each unit packet and package of tobacco products and any outside packaging and labelling of such products also carry health warnings. These warnings and messages shall be: (i) approved by the competent national authority, (ii) rotating, (iii) large, clear, visible and legible, (iv) should be 50% or more of the principal display areas but shall be no less than 30% of the principal display areas, (v) may be in the form of or include pictures or pictograms.

Article 12: Education, communication, training and public awareness Parties shall promote and strengthen public awareness of tobacco control issues by ensuring: Broad access to effective educational programs on tobacco control. Effective training programs for health/community/social workers, media professionals, educators, decision makers, administrators etc. Participation of public and private agencies and NGO’s in developing tobacco control strategies Public awareness on adverse health, economic and environmental consequences of tobacco production and consumption. Public access to information on the tobacco industry.

Article 13: Tobacco advertising, promotion and sponsorship To undertake a comprehensive ban on all tobacco advertising, promotion and sponsorship. This shall include, restrictions or a comprehensive ban on advertising, promotion and sponsorship originating from its territory with cross-border effects. To prohibit all forms of tobacco advertising, promotion and sponsorship that promote a tobacco product by any means that are false, misleading or deceptive. To restrict the use of direct or indirect incentives that encourage the purchase of tobacco products by the public.

Article 14: Demand reduction measures concerning tobacco dependence and cessation Each party shall design and implement effective tobacco cessation programmes in educational institutions, health care facilities, workplaces etc. Include treatment of tobacco dependence in national health and education programmes with participation of health/community/social workers. Facilitate accessibility and affordability for treatment including pharmaceutical products.

Measures relating to the reduction of supply of tobacco

Article 15: Illicit trade in tobacco products To eliminate all forms of illicit trade in tobacco products, including smuggling, illicit manufacturing and counterfeiting. To develop a practical tracking and tracing regime that would assist in the investigation of illicit trade. To monitor and collect data on cross-border trade in tobacco products, including illicit trade. To adopt and implement further measures including licensing, where appropriate, to control or regulate the production and distribution of tobacco products in order to prevent illicit trade.

Article 16: Sales to and by minors To adopt and implement measures to prohibit the sales of tobacco products to minors. To place a clear and prominent indicator inside their point of sale about the prohibition of tobacco sales to minors. To ban the sale of tobacco products in any manner by which they are directly accessible, such as store shelves. To prohibit the manufacture and sale of sweets, snacks, toys or any other objects in the form of tobacco products which appeal to minors. Contd…

To ensure that tobacco vending machines are not accessible to minors and do not promote the sale of tobacco products to minors. To prohibit or promote the prohibition of the distribution of free tobacco products to the minors. To prohibit the sale of cigarettes individually or in small packets which increase the affordability of such products to minors.

Article 17: Provision of support for economically viable alternative activities To promote, as appropriate, economically viable alternatives for tobacco workers, growers and, as the case may be, individual sellers.

Article 18: Protection of the environment and the health of persons To protect the environment and the health of persons in relation to the environment in respect of tobacco cultivation and manufacture within their respective territories.

Article 20: Research, surveillance and exchange of information To integrate tobacco surveillance programmes into national, regional and global health surveillance programmes. To establish progressively a national system for the epidemiological surveillance of tobacco consumption and related social, economic and health indicators.

Article 21: Reporting and exchange of information To submit periodic reports to the Conference of the Parties, on implementation of this Convention, which should include the following: information on legislative, executive, administrative or other measures taken to implement the Convention; (b) information on taxation, surveillance and research. Each Party shall make its initial report within two years of the entry into force of the Convention for that Party. The frequency and format of such reports by all Parties was determined by the Conference of the Parties. India submitted its first report in February 2007 and the next report will be submitted in three years (2010).

International Best Practices for Tobacco Control

Smoke Free Environments

Smoke free countries Uruguay New Zeeland Bermuda Iceland Ireland England Wales Norway Sweden New Zeeland Iceland Most Australian territories Most Canadian territories Many of US states In Ireland after going smoke free there is 83% less air pollution and 80% fewer airborne carcinogens Other smoke free jurisdictions report similar results Tobacco Free Initiative

Smoke free laws- impact Country Decline in Tobacco Sales Ireland 16% in first 6 months Italy 5.7% in first 11 months New Zeeland 1.5% in first year Norway 14.1% in first year Jurisdictions Compliance Ireland 94% New York City 97% New Zeeland Italy 98.2% Massachusetts 96.3% Scotland 95.9% Tobacco Free Initiative

Smoke free laws: no loss of Business Independent studies in Canada, Ireland, Italy, Norway and cities like New York show that, on average, business remains at the same level or even increases after the smoking bans. Studies have found either no impact or positive impact with the hospitality sector after the implementation of the smoke free laws.

Smoke free New York The expanded Clean Indoor Air Act of 2003 expands the 1989 Clean Indoor Air Act and further protects all New Yorkers at work and in public from deadly secondhand smoke. The expanded law applies Restaurants and bars All places of employment All schools, colleges, universities and other educational and vocational institutions; All general hospitals; residential health care facilities All commercial establishments All indoor arenas; zoos; etc.

Protection from exposure to Second Hand Smoke Level of protection Description Examples among countries Complete protection Countries with a national smoking ban in all indoor workplaces, public transport, and public places, without exceptions, and with high levels of compliance and enforcement New Zealand, Uruguay Incomplete Countries with smoking bans in all indoor workplaces and public places in multiple states, provinces, or cities, or with a partial national smoking ban that allows for exceptions (e.g., bars and nightclubs), and with high levels of compliance or enforcement Australia, Canada, Fiji, Norway Lack of effective protection for most of the population Countries where smoking policies are lacking or are based on separated areas, ventilation systems, or other measures different from smoke-free environments Armenia, Bangladesh, Ghana, Hungary, India, Japan, Jordan, Mauritius, Mexico, Mongolia, Pakistan, Palau, Panama

Inspection and enforcement protocol: Scotland’s example Developed and agreed upon by all agencies charged with inspections and enforcement Delineates agencies charged with inspection and enforcement Sets criteria for which businesses to inspect Sets criteria for investigating complaints Provides guidance on what to assess to determine compliance Source: http://www.clearingtheairscotland.com/faqs/enforcement.html

Scotland’s protocol…………cont’d Describes inspection options Proactive In response to complaints Official, announced Covert Areas to assess for compliance Signage requirements-number, size, location, etc. Presence of ashtrays Management controls in place Policies and procedures Staff awareness

Tobacco free cities- India Chandigarh has become the first smoke free city of India from July 15, 2007 onwards. A "Smoke-Free Cities” workshop was organized by a civil society organization, Burning Brain Society (BBS) in December in Chandigarh to share the Chandigarh “smoke free city” model and experience with stakeholders from other states and to encourage replication of the same in other cities. Cities like Delhi and Chennai will go smoke free by year 2010. Gen. (Retd.) S. F. Rodrigues along with other participants and dignitaries at the inaugural session of the ‘Smoke Free Cities’ workshop

Comprehensive ban on Advertising, Promotion and Sponsorship

Comprehensive ad ban reduces cigarette consumption Source: Safer Henry, The control of tobacco advertising and promotion. Background Paper, cited by Jha and Chaloupka The study was done in 102 countries compared consumption trends over time in countries with relatively complete bans on advertising and promotion , and those with no such bans.

Tobacco advertising ban in Thailand “All forms of Tobacco Advertising, Promotion and Sponsorship, including point of sale advertising and displaying cigarette packs at point of sale are banned.” (Tobacco Product Control Act, 1992 of Thailand)

Sponsorship of sports events by tobacco companies Tobacco companies are traditional sponsors of the Formula-1 Hungarian Race. The Hungarian Grand Prix is called for several years ‘Marlboro Hungarian Grand Prix’. Billboards, newspaper ads, contests for consumers are used year by year to suggest that smoking and driving are both everyday activities.

Price $ 11.20 Minimum amount of cartons 2 Promoting tobacco products through internet Marlboro Camel Winston Parliament L&M Virginia Slims Dunhill Davidoff Pall Mall Chesterfield Lucky Strike Vogue Rothmans More Salem Kent Gauloises Bond Monte Carlo Mild Seven West Magna Viceroy Sobranie Dallas Epique Karelia R1 555 Esse Belomorkanal Sovereign Peter I Russian Style                             L&M Menthol Lights Box Price $ 11.20 Minimum amount of cartons 2                           our news        tell a friend   links       customers say   CHEAP CIGARETTES                             L&M Super Lights Box Price $ 10.40                       cart

Sponsorship bans In France and Britain, cigarette names cannot be displayed – even during Formula 1 races.

Some examples of violations of advertisement/promotion bans Brand sharing Point of sale boards Promotion among youth Product placement in films/ TV In pack promotions

Ban on Sale of tobacco products to minors

Level of enforcement of ban on tobacco sales to minors Countries High Hungary Norway Fiji Moderate Canada Sri Lanka Australia Japan Low/Non Ghana Mexico Uruguay Pakistan Bangladesh India Thailand

Packaging and Labeling

Packaging and Labeling Prominent Pictorial warnings 60% Australia (30% of front; 90% of back) 60% New Zealand (30% of front; 90% of back) 56% Belgium (48% of front, 63% of back, including border) 56% Switzerland (48% of front, 63% of back, including border) 52% Finland (45% of front and 58% of back, including border) 50% Canada (50% of front and back) 50% Singapore (50% of front and back) 50% Thailand (50% of front and back) 50% Uruguay (50% of front and back) Tobacco Free Initiative

Packaging and Labeling …….contd. 50% India (50% of front and back) 50% Chile (50% of front and back) 50% Brazil (100% of either front or back) 50% Venezuela (100% of either front or back) 48% unilingual EC countries (e.g. UK) that have properly implemented the Directive (43% of front, 53% of back, including border) 48% Norway (43% of front, 53% of back, including border) 48% Iceland (43% of front, 53% of back, including border) Tobacco Free Initiative

Pictorial Warning in Australia Tobacco Free Initiative

Proposed pictorial health warnings on tobacco product packs in India For Smoking Forms of tobacco packs (a) Smoking causes cancer (b) Your smoking kills babies

For chewing/smokeless forms of tobacco packages (c) Tobacco causes painful death (d) Tobacco causes Mouth Cancer Specified health warnings on tobacco packs will be implemented w.e.f. 17th March 2008.

Impact of pictorial warnings Country Percentage of people those felt that it ‘very often’ stopped them from smoking a cigarette Thailand 36% Malaysia 28% Canada 19% USA 14% Australia 12% UK 9%

Health Warnings - FCTC compliance Time bound FCTC obligation: to comply within three years of ratification.

Violations observed in India Sale to/by minors Point of sale boards Film Billboards Smoking at public places

Action to be taken at state level Notify authorized officers for the effective implementation of the various provisions of the Act in the State/UT. Establish dedicated State Tobacco Control Cells. Give wider publicity in print and electronic media for the provisions of the Act.

Action to be taken at state level Display Act and Rules on the official web-site. Develop effective mechanisms for enforcement and monitoring of the provisions of the Act by: Setting up a reporting mechanism for general public/civil society and taking immediate action on violations reported; conducting regular raids in public places to prevent smoking in public places; ensuring that the “No sale to minors” , “No smoking in public places” and “No sale around educational institutions” boards are duly installed; ensuring removal/confiscation of hoardings and other material which amount to advertisement of tobacco products etc,.

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