1.  2007 Johns Hopkins Bloomberg School of Public Health WHO FCTC: Text, Commitments, and Timelines Gemma Vestal, JD, MPH, MBA, BSN Tobacco-Free Initiative, World Health Organization

2.  2007 Johns Hopkins Bloomberg School of Public Health 2 Learning Objectives Specifically identify relevant articles that are due for implementation Commitments of parties in upholding the Framework Convention on Tobacco Control (FCTC) Timelines of the FCTC

3.  2007 Johns Hopkins Bloomberg School of Public Health 3 Terminology The WHO FCTC is the World Health Organization’s Framework Convention on Tobacco Control  It is also known as the “FCTC,” “Treaty,” “Framework Convention,” or the “Convention” Parties (currently 147): countries bound to follow the provisions of the Treaty Member states (currently 193): countries that are members of the World Health Organization  Forty-seven member states are not current contracting parties to the Treaty

4.  2007 Johns Hopkins Bloomberg School of Public Health 4 Source: World Health Organization. (2005). Understanding the WHO FCTC The obligation on parties to implement the Treaty in good faith The WHO FCTC sets a floor, not a ceiling  “… Parties are encouraged to implement measures beyond those required by this Convention and its protocols …” — FCTC Article 2 “Effective” means evidence based  “… effective legislative, executive, administrative or other measures should be contemplated …” — FCTC Article 4 “In accordance with national law"

5.  2007 Johns Hopkins Bloomberg School of Public Health 5 Source: World Health Organization. (2005); Image Source: World Health Organization. (2005). The Text: An Evidence-Based Tool to Save Lives Overall objective of the FCTC:  “To protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke … to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke.” — FCTC Article 3

6.  2007 Johns Hopkins Bloomberg School of Public Health 6 General Obligations Article 5: establishes the basic obligations of parties under the Convention to advance tobacco control efforts through national action and international obligations Article 5.3: requires parties to undertake measures to protect tobacco control policies from the interests of the tobacco industry, including the adoption of new legislation when necessary

7.  2007 Johns Hopkins Bloomberg School of Public Health 7 Uniqueness of the WHO FCTC Includes provisions related to questions of the liability of contracting parties Includes provisions related to the potential saboteurs of its implementation, the tobacco companies Addresses tobacco control from both the supply-side and demand- side perspectives Reflects measures that have proven effective in reducing tobacco consumption—an evidence-based treaty

8.  2007 Johns Hopkins Bloomberg School of Public Health 8 An Evidence-Based Strategy Reduces demand:  Articles 6–14 Reduces supply:  Articles 15–17

9.  2007 Johns Hopkins Bloomberg School of Public Health Section A Demand Reduction: Articles 6–14

10.  2007 Johns Hopkins Bloomberg School of Public Health 10 Article 6: Price and Tax Measures to Reduce Demand Tobacco price and tax increases Specifically, youths are price sensitive, price inelastic  Price and tax increases are effective means of decreasing tobacco consumption among youths

11.  2007 Johns Hopkins Bloomberg School of Public Health 11 Article 8: Protection from Exposure to Tobacco Smoke According to WHO, secondhand smoke (SHS) is a carcinogen for which there is no “safe” level of exposure No “safe” level is achieved via ventilation and/or separate non- smoking areas as an alternative to smoke-free environments Good faith implementation of this article requires parties to implement smoke-free policies in public places, workplaces, and public transport in areas under national jurisdiction and to actively promote smoking bans at other jurisdictions

12.  2007 Johns Hopkins Bloomberg School of Public Health 12 Article 9: Regulation of Tobacco Products The Conference of the Parties (COP)  The highest governing body of the WHO FCTC  Comprised of the parties present and voting during a session  COP1, held in February 2006, was charged under Article 9 with developing guidelines for testing, measuring, and regulating the contents and emissions of tobacco products COP1 mandated the Convention Secretariat/Tobacco Free Initiative (TFI) to convene a working group to develop the guidelines The working group presented a progress report to COP2 in June/July 2007

13.  2007 Johns Hopkins Bloomberg School of Public Health 13 Article 9: Regulation of Tobacco Products The work on these guidelines will most likely continue until COP4, most likely in October 2010 The tobacco industry has the ironic privilege of selling tobacco products, which kill half their consumers With this non-deserved privilege should come the burden of responsibility  The burden of the testing and measuring of the contents and emissions of tobacco products should lie on the industry This is a complex area and it is strongly recommended that the ongoing work by the WHO Study Group on Tobacco Product Regulation (TobReg) and other public health practitioners be fed into the process of guidelines development

14.  2007 Johns Hopkins Bloomberg School of Public Health 14 Article 10: Regulation of Tobacco Product Disclosures Requires parties to require manufacturers to disclose information derived from their testing and measuring of tobacco contents and emissions Verification of the disclosed results via established sampling methods should not be entrusted to the industry  It should be done by an independent laboratory, by a regional reference center, or by a national government lab The cost of the verification process should be recouped from the manufacturers where possible

15.  2007 Johns Hopkins Bloomberg School of Public Health 15 Article 10: Regulation of Tobacco Product Disclosures To minimize the work involved for any individual country, a standardized system for collecting, reporting, and analyzing the required information should be established A harmonized reporting format should be established to obtain trend information regarding the monitoring of product performance, including contents, additives, design changes, emissions, etc., which can be comparable across countries and over time

16.  2007 Johns Hopkins Bloomberg School of Public Health 16 Images source: Physicians for a Smoke-Free Canada. (2007). Article 11: Packaging, Labeling of Tobacco Products Obligates parties to require government-approved rotating health warnings on tobacco packaging that cover at least 30%—preferably 50%—of the principal display area and may include pictures or pictograms Firm deadline: each party is required within three years of entry into force to adopt and implement the above measures

17.  2007 Johns Hopkins Bloomberg School of Public Health 17 Image source: Trinkets & Trash. (2007). Article 11: Packaging, Labeling of Tobacco Products Ensures that packages and labels are not false, mis- leading, deceptive, or likely to create an erroneous impression about its characteristics, health effects, hazards, or emissions Bans the use of terms such as “mild,” “light,” or “ultra-mild”

18.  2007 Johns Hopkins Bloomberg School of Public Health 18 Articles 9, 10, and 11: Product Regulation Provisions Regulation of tobacco products is encompassed within a set of provisions contained in Articles 9, 10, and 11 of the FCTC  Targeted at the regulation of the manufacture, packaging, labeling, and distribution of tobacco products

19.  2007 Johns Hopkins Bloomberg School of Public Health 19 Articles 9, 10, and 11: Product Regulation Provisions The scientific basis for the principles guiding the implementation of Articles 9 and 10 establishes the rationale for the principles guiding the implementation of Article 11 For this reason, and in order to achieve the synergistic effect of these provisions, all three articles should be treated as a single set of interrelated and mutually reinforcing regulations

20.  2007 Johns Hopkins Bloomberg School of Public Health 20 Article 12: Education, Training, and Awareness Requires parties to:  Promote broad access to comprehensive public awareness programs on the health risks of tobacco  Promote effective training and awareness programs, including those on the strategies of the tobacco industry to market a lethal product

21.  2007 Johns Hopkins Bloomberg School of Public Health 21 Article 13: Advertising, Promotion, and Sponsorship Requires parties to undertake a comprehensive ban on tobacco advertising, promotion, and sponsorship within five years after the Treaty’s coming into force for that country Prohibits all forms of tobacco advertising, promotion, and sponsorship that promote a product by any means that are false, misleading, deceptive, or that create an erroneous impression about its characteristics Prohibit or, in the case of a party that cannot prohibit due to its constitution or constitutional principles, restrict tobacco sponsorship of international events, activities, and/or participation therein

22.  2007 Johns Hopkins Bloomberg School of Public Health 22 Article 13: Advertising, Promotion, and Sponsorship Requires that health or other appropriate warnings or messages accompany all advertising  An expansion of the obligation specified in Article 11 to use health warnings and messages by extending it to all tobacco advertising, promotion, and sponsorship Requires the tobacco industry to disclose expenditures on tobacco advertising, promotion, and sponsorship to relevant government authorities

23.  2007 Johns Hopkins Bloomberg School of Public Health 23 Article 14: Tobacco Dependence and Cessation Helping adults to quit smoking is universally recognized as a cost- effective method of preventing disease However, depending on a party’s economic resources, health care systems, and level of tobacco use, the appropriate means of providing meaningful cessation assistance vary widely Accordingly, Article 14 requires each party to first develop cessation and treatment guidelines that are tailor-made to its circumstances, but that are also evidence based