The World’s First Global Health Treaty Turns 10 – and the US is Still Absent

By Derek Yach and Heather Wipfli

By Derek Yach and Heather Wipfli

February 27, 2015 marks a decade since the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) entered into force, marking a watershed moment in global public health. It represented the first treaty negotiated under the auspices of WHO and the first collective response to address the emerging pandemics of noncommunicable diseases (NCDs), i.e. coronary heart disease, diabetes, cancer, and chronic lung disease. Driven by common risk factors – tobacco use, poor diet, physical inactivity and alcohol abuse – NCDs killed 8 million people before their 60th birthday in developing countries in 2013 alone, with significant human and economic consequences globally. NCD epidemics are projected to inflict $21.3 trillion losses in developing countries by 2040—a cost nearly equal to the entire economic output of those countries in 2013. This is not just an issue of concern for developing countries. A recent Council on Foreign Relations (CFR) Task Force on NCDs concluded, “These economic consequences will undercut potential US trade partners and allies and may reduce domestic support for governments of US strategic interest.”

The FCTC represents a key weapon in the NCD battle as tobacco remains the leading cause of preventable death in the world, killing nearly 6 million people in 2013. Annual tobacco-related deaths are projected to reach 8 million by 2030, with approximately 80 percent forecasted in developing countries. With 180 parties, the FCTC is one of the most widely accepted treaties in UN history. Tobacco control policies are stronger on average today than when the FCTC entered into force; approximately 70 percent of parties to the treaty have implemented its binding provisions. Emerging evidence suggests these policies are significantly reducing tobacco use in populations covered. In Uruguay, for example, between 2005 and 2011 implementation of FCTC-related policies decreased tobacco use annually by an estimated 3.3 percent (equivalent to 23% over 6 years). Aggressive FCTC implementation in Turkey has resulted in a 13% relative reduction in smoking between 2008 and 2012. Globally, policy progress achieved between 2007 and 2010 alone is forecasted to result in 7.5 million fewer smoking-related deaths by 2050.

Implementation of the treaty, however, is not consistently applied in all countries or regions and significant challenges to its full implementation remain, including ongoing tobacco industry efforts to undermine its impact, the rise of trade-related disputes, competing interests and funding shortages. New policy innovations are critically needed to sustain gains and respond to the rapidly evolving global tobacco control environment.

US governmental and corporate leadership is urgently needed in this regard. Recent corporate and workplace initiatives in the US need to be globalized — including CVS Pharmacy’s leadership in removing of all tobacco products from their stores and introducing robust smoking cessation programs. US-based life insurers are also shifting to aggressively encourage their smoking members to quit and reap premium rewards. The US Congress has made progress in tobacco control over the past decade, including the passage of the Family Smoking and Prevention Act giving the FDA regulatory authority over tobacco products. Countries worldwide are watching the FDA process closely as they consider regulatory action. Unfortunately, multiple elements of this Act have been challenged by the tobacco industry (e.g. large, graphic health warnings) and progress is slow.

Despite these innovations, there is much more the US can and should do. The Obama Administration has failed to demand a congressional vote on FCTC ratification and the US remains one of very few countries in the world not party to the treaty. Consequently, the US is not directly involved in FCTC implementation or the ongoing evolution of global tobacco control law – a huge missed opportunity to exert leadership in the global fight against NCDs. In regards to Congress, it has also failed to reinstate a larger budget for tobacco control research in developing countries through the National Institutes for Health (NIH).  Such population and implementation research on NCD risk factors, including tobacco control, is urgently needed. Lack of evidence leads to disagreement within the global tobacco control community on best practices, diminishing their collective voice, complicating decision-making, and providing more opportunity for transnational tobacco companies to push their agenda.

While the US CDC has been a key partner in improving the US ability to track the NCD epidemic over the past decade, funding has come from private, philanthropic sources, notably former New York City Mayor Michael Bloomberg’s foundation. Economic austerity and competing priorities have resulted in funding cuts to public health overall, and tobacco control in particular. As emphasized by the CFR Task Force, the US needs to reexamine its global health priorities and spending, ensuring their continued effectiveness in addressing the greatest threats to health and security – including investment in NCD prevention and control.

Global tobacco control represents our greatest low-cost prevention tool for NCDs. The FCTC provides affordable prevention-based solutions to tobacco-related diseases and the US can help countries implement their obligations by taking a leadership role, including funding more research targeting NCD risk factors and ongoing collaboration with private sector and philanthropic partners, so the world can sustain the gains of the last decade and respond to the rapidly evolving tobacco control environment. Above all, ten years after the FCTC entered into force, we must remember that the global fight to prevent tobacco-related death and disease is far from over.


Derek Yach, MBChB, is the executive director of the Vitality Institute, a New York City based research organization that advocates for greater preventive health measures. He is also the chair of the World Economic Forum’s Council on Aging, a past executive director at the World Health Organization, and the former senior vice president of global health and agriculture policy at PepsiCo.  Yach is a member of the advisory boards of the Clinton Global Initiative and the New York Academy of Sciences.

Heather Wipfli, Ph.D., is the associate director for the USC Institute for Global Health and an assistant professor in the Department of Preventative Medicine at the Keck School of Medicine at the University of Southern California.

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