FCTC for All

“Tobacco control” means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke [1]

Fifteen years ago, the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) came into force, the first global compact to systematically address the burden of tobacco related health problems. There were 168 initial signatories to the FCTC and by 2020 the number of parties to the convention grew to 182.

The objective of the special issue in Drugs and Alcohol Today [2] and of this “15 Years Conference” organised in its wake is to take stock of the current global tobacco control landscape, highlight the challenges in the development and delivery of effective harm reduction tools globally, and discuss the opportunities to accelerate the decline of risky tobacco use globally- without leaving anyone behind.

While cigarette consumption has for several years now been falling precipitously in high income countries as for instance UK, Canada or Scandinavia, a very different picture is seen elsewhere. The global burden of tobacco related disease and avoidable mortalities is not declining at the speed at which it was hoped. It is becoming increasingly evident that tobacco consumption prevalence is moving along very different trajectories in different regions and communities: it has shifted substantially onto less privileged and more vulnerable groups. Today an estimated 80% of the world’s users of risky-tobacco (products such as cigarettes, bidis, kreteks, gutkha, zarda, khaini, etc) live in the Global South or Low and Middle Income Countries (LMICs).

Yet even here there are considerable variations. Groups that are already suffering from cultural stigmatization, economic marginalisation and political vulnerability carry a particularly heavy burden. These include ethnic minorities and particularly indigenous populations, sexual minorities and people with mental health conditions. In all cases, they have been largely overlooked by tobacco control interventions.

Disadvantaged communities have once again been neglected in a public health campaign of global proportions. This is not simply due to the intersection of different discriminatory practices, but also a clear shift in the tenor of debate and the objectives of the campaign. Tobacco control campaigns have shifted away from the health focus where the goals were clearly:

  • Reducing chronic tobacco related diseases
  • Lowering the number of avoidable tobacco related deaths

Sadly, the main objective today has become the elimination of any form of tobacco or even nicotine consumption regardless of risk or harm. The prohibition of tobacco has become an end in itself, divorced from a policy of health promotion and at the cost of social welfare. For tobacco prohibitionists, the FCTC and it's associated policies are no longer centred on the human being. It has become ideological, which explains how some of the most effective health promotion strategies from the original FCTC script, such as harm reduction, are being left out.

The purpose of the Special Issue and this “15 Years Conference” is to help consumers, policymakers, regulators and health professionals to re-focus on the erstwhile rationale for tobacco control. In theory, consumers today have an increasing number of options for quitting risky-tobacco. The challenge for policymakers and regulators lies in making them available, affordable and accessible. Healthcare practitioners need to have confidence in these delivery systems, based on independent and credible scientific evidence. And for all these stakeholder groups: the key step is to put health first.

Dr Sudhanshu Patwardhan Guest Editor, Special Issue of Drugs and Alcohol Today and '15 Years' Conference Organising Team September 21, 2020

  1. Article 1, Page 3. FCTC Final Text. https://www.who.int/tobacco/framework/fctc_en.pdf?ua=1 (accessed September 7, 2020)
  2. Drugs and Alcohol Today, Emerald Publishers: Upcoming Print Issue. Vol 20, Issue 3: https://www.emerald.com/insight/publication/issn/1745-9265/vol/20/iss/3 (accessed September 22, 2020)