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Geoffrey Fong
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MS 09 - Global Perspectives in Eliminating the Major Cause of Lung Cancer (ID 531)
- Event: WCLC 2017
- Type: Mini Symposium
- Track: Epidemiology/Primary Prevention/Tobacco Control and Cessation
- Presentations: 1
- Moderators:Carolyn Dresler, William Kenneth Evans
- Coordinates: 10/16/2017, 15:45 - 17:30, Room 315
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MS 09.02 - FCTC Implementation around the World (ID 7683)
16:00 - 16:15 | Presenting Author(s): Geoffrey Fong
- Abstract
- Presentation
Abstract:
Tobacco use has been recognized by the World Health Organization as the number one preventable cause of premature death and disability. In the 21st Century, hundreds of millions of people will die because of tobacco use, with 70% of the toll occurring in low and middle-income countries. To magnify the horror of these projections, the tobacco epidemic, unlike other threats to global health, is a direct result of the activities of the most profitable industry in history. In recognition of this current and future epidemic, countries of the world negotiated and adopted in 2003 the WHO Framework Convention on Tobacco Control, the first-ever treaty of the WHO. The WHO FCTC has been ratified by 180 countries and the European Union, is an example of the promise of international health governance and highlights the central role of scientific evidence in tackling the global tobacco epidemic. A decision adopted by the FCTC Conference of the Parties at its 6th Session (Moscow, Nov 2014) called for an independent expert group to conduct an impact assessment of the treaty in its first decade. The expert group used three sources of evidence. The first source was a global evidence review of the scientific research on the impact of the FCTC across 17 of its articles; this review was conducted by the ITC Project. The second source was two reports prepared by global experts, of which one was prepared by the MacCabe Centre for Law and Cancer that reviewed the impact of the FCTC in legislative action taken by governments in tobacco control and in the use of the FCTC by governments in defense of legal challenges, and the second was prepared by Dr. Stella Bialous on the actions of the tobacco industry to weaken the FCTC. The third source was from evidence gathered by the expert group on country missions to 12 FCTC Parties, two from each of the six WHO Regions, and 3 from each of the four World Bank income levels. The main findings of the Impact Assessment Expert Group were the following: • FCTC has played an instrumental role as catalyst and framework for action— foundation for legislation and in defense against legal challenges. • FCTC has promoted tobacco control action in countries where little had been done, and has helped to strengthen action in countries where it was in place before ratification. • FCTC has broadened tobacco control across government and administration. And it has had impact on a range of international and global institutions and agendas. • FCTC has strengthened the role of civil society in tobacco control • FCTC has contributed to reductions in prevalence among Parties that have implemented FCTC policies at high levels, thus contributing to reductions in tobacco-related mortality and morbidity. • Tobacco industry continues to be the greatest threat to the implementation of the WHO FCTC. The expert group also cited the findings of a seminal study conducted by Gravely et al. on the impact of the FCTC on reductions in smoking prevalence. In an analysis of 126 countries, Gravely et al., found that over the first decade of the treaty, those countries that had implemented a greater number of key demand-reduction FCTC policies at the highest level (i.e., implementing those policies at sufficient strength to meet the standards of the FCTC Guidelines adopted for each of those policy domains: tax (Article 6), smoke-free (Article 8), labelling/warnings (Article 11), banning tobacco advertising, promotion, and sponsorship (Article 13), and cessation (Article 14)) experienced substantially greater decreases in smoking prevalence. On average, each additional policy implemented at the highest level was associated with a decrease in smoking prevalence of 1.57 percentage points (equivalent to a relative decrease of 7.09%). The Gravely et al. article, published in Lancet Public Health, demonstrates the power and potential of the FCTC to achieve its ultimate objectives. However, the article also presented findings on the current gap between the potential and the reality: that there have been very slow progress in the implementation of just these high-priority policies, consistent with the ITC Project’s global evidence review of the rate of implementation as well as the WHO’s assessment, which showed that by 2014, only 18% of the world’s population were living in countries with comprehensive smoke-free policies, and only 20% of the world’s population were living in countries with large pictorial warnings on tobacco product packaging. Why has implementation of the FCTC been so slow and in many cases at levels below the standards set by the FCTC Guidelines? All of the evidence gathered by the Expert Group points to one cause: the tobacco industry. Through their political influence, both explicit and covert, the tobacco industry has been quite effective in defeating efforts in many countries to implement the FCTC in accordance with their obligations under the treaty. It is necessary for all parties to engage in strong and vigilant implementation of Article 5.3, which forbids industry involvement in the process of formulating tobacco control policies, to advance the treaty and to more fully achieve its demonstrated potential to combat the global tobacco epidemic. The conclusions and take-home messages are: 1. FCTC Impact Assessment has demonstrated that the FCTC has great potential in reducing the number one preventable cause of death and cancer (esp. lung cancer) 2. BUT: FCTC implementation has been slow and in many cases is not at levels called for by the FCTC Article Guidelines. 3. Number of deaths and DALYs attributable to tobacco has increased since 1990. 4. Must SIGNIFICANTLY accelerate and strengthen FCTC implementation, especially in fully implementing Article 5.3. 5. Must expand implementation to other Articles (e.g., illicit trade, alternative livelihoods) 6. Research on evaluating FCTC implementation is essential for fighting industry attempts to weaken and slow the treaty.
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