1. THE FRAMEWORK CONVENTION ON TOBACCO CONTROL (FCTC)
Zanele Mthembu
Director: Health Promotion
National Department of Health
February 2005

2. Introduction Tobacco is a leading preventable cause of death worldwide
It kills 4,9 million people annually. This is predicted to rise to 10 million per year by 2030
70% of future deaths will be in the developing world
Tobacco use causes over 40 preventable diseases
A smoker with TB is 30% to 50% more likely to die than a non- smoker with TB

3. Introduction cont.
In South Africa, tobacco related diseases kill about people a year. This is more than the deaths caused by motorcar accidents (about annually).
About 60% of all admissions to Groote Schuur Hospital are from tobacco related illnesses
The WHO has called this a “global public health emergency” and initiated a global response to the crises.

4. Economics of Tobacco use
Reducing smoking will reduce poverty and produce huge economic savings.
Tobacco is responsible for higher medical costs, increased absenteeism from work, lower industrial productivity, and loss of earnings for ill workers
These costs are not offset by the excise taxes paid on tobacco products.

5. The cost of smoking
Smokers of more than 20 cigarettes a day have twice as much time off work due to illness as do non‑smokers.  
40% of heavy smokers die before reaching retirement age compared with 15% of non‑smokers.
Absenteeism is 35% to 45% higher among smokers than non- smokers.
In 1998, over 2.5 million work days were lost in South Africa due to sickness absence from chronic bronchitis, emphysema, and asthma

6. The cost of smoking Cont.
Loss of productive years of life through death from CVD – deaths a year of which 40% are in the economically active work force. R2,4 billion per year in loss productivity.
Loss of productivity through disability from CVD every year: At least of whom 40% were economically active – about R2,4 billion per year
The cost of maintaining the survivors (Health Care Cost and Disability Grants). About R2 billion per year.
In 1994, the MRC estimated that for every R1 received by Government from tobacco taxes, it cost the economy R2 to treat smoking related illnesses and from lost productivity.

7. The FCTC...
The first international public health treaty negotiated by Member States of the World Health Organization
Objective: to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke ...
Timeline: 1999 – 2003
FCTC suggest various courses of action that would enable countries to develop effective tobacco control measures. Recognises that legal and cultural environments varies across nations.
The FCTC specifically recognizes that tobacco control in developing countries and in countries with economies in transition will require sufficient financial and technical resources, and it obliges the Conference of the Parties to seek ways to assist developing countries to meet and exceed their obligations in terms of the Convention.
FCTC is a landmark event in public health policymaking. It is the first time WHO has exercised the treaty making authority in its constitution
The purpose of the treaty is basically to reduce the morbidity and mortality caused by tobacco use through the promotion of global restrictions on the development, marketing, and sales of tobacco products. Nearly all of WHO’s 192 member nations are participating in the negotiations.
Full objective reads, “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for tobacco control measures to be implemented by the Parties at the national, regional and international levels in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke
As far as treaties go. the FCTC was on a very quick schedule -- the formal process began in 1999, and the draft treaty was completed on March 1, 2003.

8. May 21, 2003: The Final Treaty
171 member states of WHO approved final text on March 1, The text was adopted by the World Health Assembly on 21st May 2003.
Treaty will go into force on the 28th February 2005 as more than 40 countries have ratified it. (57 countries of which 8 are from Africa)
Provides a roadmap that could lead to comprehensive tobacco control programs and strategies at the international, regional, national and local levels.

9. FCTC: Process of Enactment
Agreement
Adoption
Signature
Ratification
Entry into Force – 28 February 2005
Conference of Parties

10. South Africa and the FCTC
South Africa Hosted the first ground breaking inter-sessional AFRO meeting in March 2001 which brought AFRO Unity
Represented AFRO at the Bureau
Elected as 1 of 6 Vice Chairpersons of Inter-governmental Negotiating Body with Australia, India, Iran, Turkey and the USA
Chaired the second session of the Inter-governmental Working Group of the FCTC( 31 Jan to 04 February 2005)

11. South Africa and the FCTC cont.
We signed the treaty on Youth Day,
16 June 2003
undertook to strive in good faith to ratify the Convention and show political commitment not to undermine the objectives set out in it.

12. Current Status of the FCTC
Signatories
Ratification
Including:- Kenya, Mauritius, Madagascar, Seychelles, Lesotho, Botswana Fiji, Ghana, Senegal,New Zealand, Bangladesh, India,
Japan, Norway, France, Mexico
Accessions - 2

13. FCTC: Key Provisions: Obligations & Exhortations
The Convention contains sufficient obligations and exhortations to enable states to craft appropriate tobacco control policies to meet their own needs.
The FCTC obliges Parties to adopt and implement effective measures within 3 years after entry into force of the Convention for that party, on a number of demand and supply- side measures;
Advertising:
Comprehensive ban on advertising, promotion and sponsorship
Preambulatory finding
Constitutional carve out
Expansive definition
Cross border advertising and future protocol
Packaging and Labeling
30% with exhortation to 50% of principle display areas
Light and low
Second- hand smoke
Adopt or provide protection from exposure to tobacco smoke
Taxes Sales to and by Minors Illicit Trade in Tobacco Products Trade / health Reservations

14. Key Provisions Measures related to reducing the demand for tobacco:
Price and tax measures
Protection from exposure to environmental tobacco smoke
Regulation and disclosure of contents of tobacco products
Packaging and labeling

15. Key Provisions - cont.
·  Education, communication, training and public awareness
·  Comprehensive ban and restriction on tobacco advertising, promotion and sponsorship
·  Tobacco dependence and cessation measures

16. Key Provisions - cont.
Measures relating to reducing the supply of tobacco
Elimination of the illicit trade of tobacco products
Restriction of sales to and by minors
Support for economically viable alternatives for growers

17. The FCTC and International Trade (Preamble)
Parties to the Convention are “determined to give priority to their right to protect public health”.
To give interpretive guidance only if tobacco control measures based on the FCTC are attacked under other international agreements, including trade agreements.
Encourages governments to prioritize the health of their citizens over commercial interests.
NB: This does not place any obligation on a Party to adapt or alter, existing, or even future trade relations.
FCTC does not affect the right of governments to enter into any bilateral or multilateral agreements.

18. Article 2 Relationship between this Convention and other agreements and legal instruments
In order to protect human health, Parties are encouraged to implement measures beyond those required by this Convention and its protocols.
The provisions of the Convention and its protocols shall in no way affect the right of Parties to enter into bilateral or multilateral agreements, including regional or sub-regional agreements, on issues relevant or additional to the Convention and its protocols, provided that such agreements are compatible with their obligations under the Convention and its protocols.

19. Article 5 General Obligations
Amongst other things and in accordance with each country’s capabilities, this Article advocates the need for the establishment of national coordinating mechanisms / focal points.

20. Article 6 Price and Tax Measures to Reduce the Demand for Tobacco
Parties recognize that price and tax measures are an effective and important means of reducing tobacco consumption [in] the population, in particular young persons.
Without prejudice to the sovereign right of the Parties, the Convention encourages countries to determine and establish their taxation policies.

21. Article 8 Protection from exposure to tobacco smoke
Parties recognize that scientific evidence has unequivocally established that exposure to tobacco smoke causes death, disease and disability.
Each Party shall adopt and implement … effective … measures, providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.

22. Article 9 Regulation of the Contents of Tobacco Products
The Conference of the Parties… shall propose guidelines for testing and measuring the contents and emissions of tobacco products, and for the regulation of these contents and emissions.
Each Party shall, where approved by competent national authorities, adopt and implement..measures for such testing and measuring.

23. Article 10 Regulation of Tobacco Product Disclosures
Each Party shall.. implement… measures requiring manufacturers and importers of tobacco products to disclose to governmental authorities information about the contents and emissions of tobacco products.
Each Party shall.. implement.. measures for public disclosure of information about the toxic constituents of the tobacco products and the emissions that they may produce.

24. Article 11 Packaging and Labeling of Tobacco Products
Countries are encouraged to adopt and implement effective measures (in accordance with national laws) to ensure that misleading words that created an impression that a particular tobacco product is less harmful than the other, are not used. These words may include terms like “low tar”, “ultra-light”, or “mild”.
Each unit packet and package of tobacco products and any outside packaging and labelling of such products also carry health warnings describing the harmful effects of tobacco use, and may include other appropriate messages.

25. Article 12 Education, communication, training and public awareness
Each Party shall promote and strengthen public awareness of tobacco control issues, using all available communication tools, as appropriate.

26. Article 13 Tobacco Advertising, Promotion and Sponsorship
The FCTC encourages countries to undertake a comprehensive ban of all tobacco advertising, promotion and sponsorship in accordance with each countries national laws.
Parties are encouraged to consider the elaboration of a protocol setting out appropriate measures that require international cooperation in dealing with cross-border advertisement.

27. Article 14 Demand reduction measures concerning tobacco dependence and cessation
Each Party shall take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence.

28. Article 15 Illicit Trade in Tobacco Products
. …the elimination of all forms of illicit trade in tobacco products, including smuggling, illicit manufacturing and counterfeiting… are essential components of tobacco control.
About a third (1/3) of all cigarettes that are exported, disappear en- route and end up in the contraband market.
Worldwide, this amounts to about 355 billion cigarettes.
Therefore the FCTC encourages regional and international cooperation in addressing this problem.
The FCTC encourages countries to adopt measures that will ensure that all unit packets and packages of tobacco products, and any outside packaging of such products, are clearly marked in order to assist countries in determining the origin of tobacco products. The cost to be born by the tobacco industry.
Article 18
Protection of the environment and the health of persons

29. Article 16 Sales to and by minors
Each Party shall … prohibit the sales of tobacco products to persons under the age set by domestic law, national law or eighteen.
Each Party shall prohibit or promote the prohibition of the distribution of free tobacco products to the public and especially minors.
Each Party shall endeavour to prohibit the sale of cigarettes individually or in small packets which increase the affordability of such products to minors

30. Article 17 Provision of support for economically viable alternative activities
Parties shall, in cooperation with each other and with competent international and regional intergovernmental organisations, promote, as appropriate, economically viable alternatives for tobacco workers, growers and, as the case may be, individual sellers.

31. Article 18 Protection of the environment and the health of persons
Parties agree to have due regard to the protection of the environment and the health of persons in relation to the environment in respect of tobacco cultivation and manufacture within their respective territories

32. Article 19 Liability
Countries are encouraged to consider taking legislative action to deal with criminal and civil liability related to the harm caused by the tobacco companies. This issue is raised in the Convention to enable Parties (to the Convention) to take appropriate steps to deal with liability. However, the Convention does not compel any Member State to embark on any action against tobacco companies. This is in line with the currently held policy of the South African government not to participate in litigation in other countries.

33. Article 20 Research, surveillance and exchange of information
The Parties undertake to develop and promote national research and to coordinate research programmes at the regional and international levels in the field of tobacco control

34. Article 21 Reporting and exchange of information
Each Party shall submit to the Conference of the Parties, through the Secretariat, periodic reports on its implementation of this Convention

35. Article 22 Cooperation in the scientific, technical and legal fields and provision of related expertise
The Parties shall cooperate directly or through competent international bodies to strengthen their capacity to fulfill the obligations arising from this Convention, taking into account the needs of developing country Parties and Parties with economies in transition. Such cooperation shall promote the transfer of technical, scientific and legal expertise and technology, as mutually agreed, to establish and strengthen national tobacco control strategies, plans and programmes

36. Part VIII: Institutional arrangements and financial resources
Article 23: Conference of the Parties
Article 24: Secretariat
Article 25: Relations between the Conference of the Parties and intergovernmental organisations
Article 26: Financial resources

37. Part IX: Settlement of Disputes
Article 27: Settlement of disputes

38. Part X Development of the Convention
Article 28: Amendments of this Convention
Article 29: Adoption and amendments of annexes to this Convention

39. Part XI Final Provisions
Article 30: Reservations
Article 31: Withdrawal
Article 33: Protocols
Article 34: Signature
Article 35: Ratification, acceptance, approval, formal confirmation or accession
Article 36: Entry into force
Article 37: Depositary
Article 38: Authentic texts

40. Financial Implications of the FCTC for SA
The FCTC will be integrated within the existing tobacco control initiatives of the Department of Health
The main expense will be the financing of the Conference of the Parties (COP), its subsidiary bodies and the secretariat, estimated at US $ per year
At its first meeting, the COP will determine how it is to be funded.

41. Constitutional Implications
The preamble of the FCTC makes reference to three human rights Conventions: the International Covenant on Economic, Social and Cultural Rights, the Convention on the Elimination of All Forms of Discrimination Against Women and the Convention on the Rights of the Child, as other means of protecting and restoring human rights and dignity.
The FCTC will enhance important values enshrined in our Constitution. In particular, it will promote and protect the Rights to a Safe Environment, the Rights of Children, as well as Health, Gender and Human Rights.
None of the provision of the FCTC is in conflict with any aspects of the South African Constitution. (Confirmed by the State Law Advisors)

42. Implications of Ratifying for SA
Thousands of lives of South Africans will be saved from premature deaths
Thousands of South Africans will be spared ill-health and disability
Millions of South Africans will be spared the unnecessary loss of family members, including those who are economically active.
Savings of billions of Rands related to loss of production,as well as health care costs related to premature death and disability

43. THANK YOU