Introduction
According to the Lancet report of 2000, tobacco usages result in millions of deaths worldwide. This has provoked reactions from the WHO in regulating any tobacco-related activity. Consequently, the WHO has created a body mandated to control any tobacco-related activity globally. FCTC approaches tobacco control from new perspectives where Parties share tobacco-related information from monitoring and surveillance globally to combat tobacco-related deaths. This paper seeks to highlight the effectiveness of FCTC activities in a few countries concerning controlling tobacco usage.
Literature review
The WHO Framework Convention on Tobacco Control (WHO FCTC) operates under the World Health Organisation’s auspices. It tries to reaffirm people’s right to the highest quality of health using evidence. It approaches issues of using addictive drugs from a different perspective as opposed to earlier approaches. It emphasizes the issue of demand reduction and reducing supplies. It came as a result of the global effect of tobacco on humanity. The tobacco epidemic increased due to cross-border trades, direct foreign investments, global marketing, promotion and sponsorship, global advertisement, movements of populations, and the spread of illicit tobacco.
Since its establishment, FCTC has strived to focus on maximizing the global agenda on tobacco control using different means. Such efforts have proved effective in Canada and the US. These are coordinated, collaborative, and cooperative for maximizing efforts and reducing duplication. These cover research centers and policymakers for sharing of information.
The Lancet notes that tobacco consumption results in almost five million deaths every year in the world. It estimates that the figure will rise to 10 million by the year 2020 of which majorities will be from low and middle-income countries. This calls for an alteration of this trend and actions to prevent tobacco-related deaths (Lancet, 2000).
FCTC has some components that guide its operations across the world. The most common is the health warning on packages of cigarettes. This provides useful information about the harmful consequences of tobacco consumption. This strategy is effective as FCTC surveys show that a majority of smokers get information from packages. Health warnings on packages work more than any other form of media reach. It shows that smokers who use 20 sticks per day get at least 7300 warning messages every year. Warnings on packages also reach non-smoking populations such as children and youths. Warning labels are mainly effective in three ways. Labeling offers information and education to both smokers and non-smokers regarding the harmful effects of tobacco use. The information encourages smokers to stop and non-smokers to avoid smoking, and it also offers information that increases efficacy for quitting.
Likewise, the FCTC component of a smoke-free environment is also effective as an approach in controlling the harmful effects of tobacco. Smokers reduce, quit, or reduce initiation depending on the areas they are. These laws are effective due to the support and compliance they receive both from private and public institutions as well as individuals. These laws promote that smoking is socially not suitable for every person.
Progress made so far indicates that there are possibilities of achieving smoke-free environments because of global interest to create smoke-free zones. Both developed and developing countries have adopted the policy and implemented it successfully. These countries include the US, Ireland, Canada, Bermuda, and Kenya among others. This law mainly operates in indoor environments, such as offices, pubs, and public transport systems. Others countries have started borrowing from the successful implementation of smoke-free environment laws.
Overview of the FCTC: its aims, history, outcomes, and monitoring
The FCTC aims 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 to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke” (WHO, 2005).
The WHO FCTC has its adoption in May 2003. Since then, it has strived in the provision of support to countries in signatures, ratification, and implementation of its strategies. The WHO reports show that pilot studies have proved useful in the treaty ratification and implementation. It has provided useful information on the provision of a national tobacco control mechanism. Some of its successful implementations include establishments of Smoking Zones in Kenya, tobacco cells of India, China’s free cities of tobacco advertisement, and Ukraine’s national action plan. Countries are also continuing to sign and ratify the treaty. It has also provided the basis for improving the national capacity for controlling tobacco consumption.
The FCTC approach to tobacco control takes a multisectoral approach. Consequently, it has provided a new basis for regulating tobacco consumption. It has both national and international parameters for regulating tobacco usage through setting minimum requirements in its approaches. The transnational approach provides a basis for cooperation among countries in controlling tobacco usage (Gilmore, 2012).
However, the FCTC may not achieve its objectives if there is no rapid and sustained reduction regarding tobacco usage. Many countries require strong legislation that will legally help the implement control tobacco at the national level. Likewise, they also need legislation that will ensure that both manufacturers and consumers of tobacco comply with the laws (Raw, 2011).
The FCTC has monitoring strategies of its objectives in every country. It requires countries to “regularly collect national data on the magnitude, patterns, determinants and consequences of tobacco use and exposure” (FCTC, 2010). Through monitoring, the FCTC wants to enhance the availability and provision of information related to tobacco activities. Thus, it works with Parties in the adoption of the standard and scientific methods of evidence-based in their surveys. FCTC also seeks to build the capacity of members to improve their survey activities, implementation, and dissemination of findings as well as create, store and use data for tobacco monitoring policies. This also reflects outcomes of tobacco exposure and usage (Warner, 2012).
Global Case study
Describe and evaluate the degree of implementation of the two articles and the evidence of their effectiveness in three countries
Article 13: Tobacco advertising, promotion, and sponsorship
This article calls for a “comprehensive ban on advertising, promotion, and sponsorship” and requires Parties that do not have legislative obstacles to banning every type of promotion and advertising of tobacco (WHO, 2005). In situations where there are legal impediments, the FCTC requires Parties to control or ban print media, radio, Internet, television, other forms of media. Bans and restrictions also affect the sponsorship of both local and international events. Public officials agree that advertisement and promotional bans directly contribute to a reduction in tobacco usage.
Article 8: Protection from exposure to tobacco smoke
This FCTC article needs countries to the agreement to implement and enforce restrictions and bans on public smoking. There are provisions for parties to implement bans on public smoking. The provisions require complete restrictions and bans in all indoor public places. It does not cater for any exceptions based on the nature and occupancy of any place such as pubs, nightclubs, and casinos. For smokers at homes and other private places, the FCTC article offers guidelines and recommendations on the harmful effects of second-hand smoking.
Implementation in China, Ireland, and Uruguay
In China, the ban has been there since 1996. However, tobacco manufacturers have found other means of promoting their brands such as sponsoring events or using companies’ logos without making any reference to cigarettes on advertisement media. In 2011, China announced that it will fully implement the FCTC provision on smoking advertisement and promotions (Ma, 2004).
Most Chinese tobacco promotional and advertisement strategies are illegal and attract fines. China also expects to ban Internet promotions of cigarettes. However, legal constraints are affecting the implementation of advertisement and promotion strategies in China. Some Chinese firms argue that they use scientific and technological developments to reduce the harmful contents of cigarettes. However, we all know that there are no known methods of making smoking a healthy habit (Yang, 1999).
Since 2005, Ireland has been one of the most FCTC compliant in the world. On Tobacco Advertising, Promotion and Sponsorship, Ireland law has a comprehensive ban with only limited exceptions on point of sale for tobacco shops only. Ireland has banned all forms of publicity and sponsorship that promote tobacco. The country only allows financial support from tobacco dealers (Fong, 2006).
Uruguay has performed well about the FCTC provisions. However, just like China, the country is grappling with the challenges of illegal advertisement, particularly at the points of sale (POS).
Uruguay law allows for tobacco advertisement at the POS, but the advertisement must be within the POS and contain the same health warning of the same size and visibility. Recent studies show that violation of the law outside the POS is growing.
Ireland gives strong evidence of the positive health outcomes of smoke-free environments. Following the country’s implementation of the smoke-free law in 2004, ambient air nicotine concentrations decreased by 83%, and people exposed to second-hand smoke reduced from 30 hours per week to zero (Hyland, 2008).
In 2006, Uruguay provided 100% smoke-free by enacting a ban on smoking in all public spaces and workplaces, including bars, restaurants, and casinos. The ban won massive public support, including almost two-thirds of smokers.
Majorities of Chinese in large cities support smoking bans in public places, hospitals, workplaces, bars, restaurants, and schools. However, China has not been strict with the implementation and enforcement of the FCTC provision.
Compare and contrast the FCTC in the three countries you have chosen: Uruguay, Ireland, and China
Uruguay achieved a 100 percent smoke-free environment by the year 2006 in the Latin Americas. The ban covers places such as workplaces, public places, public, transport bars, and restaurants. These are some of the public places in Uruguay where the law does not allow smoking. Uruguay has been having a smoking ban in public places since 1996, but it had not fully implemented it. In the year 2004, Uruguay ratified the FCTC. This development paved the way for the complete implementation of the smoke-free law in 2004.
Just like Uruguay, Ireland also has effective smoke-free environment legislation. The country has been able to maintain its smoke-free environment due to strict implementation of the law and associated fines on people found smoking in non-designated zones. Uruguay also has a 100 percent smoke-free environment.
Among these countries, China is the least effective in implementing its FCTC treaty. The country has not been able to achieve any meaningful regulation of smoking in the public due to laxity in the implementation of the law. This happens even though China prohibits smoking in schools, welfare institutions, and indoor areas with more than three occupants. China allows smoking in designated areas outside public institutions and places.
In regulating tobacco advertising, promotion, and sponsorship, the three countries differ considerably. According to the WHO requirements, countries or cigarette manufacturers must display large health warnings on cigarette packages. In addition, countries must actively ban or restriction any form of media campaigns regarding tobacco advertisement and promotion (WHO, 2011). Uruguay and Ireland have successfully been able to achieve maximum implementation and positive results in regulating cigarette promotion and advertisement due to implement of strict laws. On the other hand, China still suffers from the ineffective implementation of the laws despite their existence (WHO, 2011).
A feasible and effective approach to reducing smoking-related harm in Brazil
Article 9: Regulation of the contents of tobacco products
Most countries regulate the contents and ingredients of tobacco products, and Brazil is one of them. Brazil requires tobacco firms to report all ingredients they have used in manufacturing their brands. However, this provision has a drawback because the FCTC has not developed any acceptable scientific method of assessing the contents of tobacco products (Brazilian National Cancer Institute, 2006).
The WHO claims that cigarettes’ ingredients increase addictiveness and toxicity, but there are no data to prove that all cigarettes have the same harmful effects. However, some of the cigarettes with various ingredients are attractive and palatable to consumers.
In 2010, the European Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) concluded: “there is no evidence that ingredients enhance the addictiveness of tobacco products and found that it is very difficult to identify the significant role of individual additives in promoting the tobacco products’ attractiveness” (DIN, 2004). Thus, a ban on tobacco ingredients will have no impact on effects or in countries where flavored cigarettes are not available.
Surveillance and monitoring of the FCTC
Watching the tobacco industry
WHO FCTC watches new strategies and developments in the tobacco industry to develop new approaches. They know that if smokers use tobacco according to the recommendations of manufacturers, then most of its users will die of tobacco-related deaths. Thus, it monitors the tobacco industry and informs Parties of the developments.
Monitoring consists of surveillance and regulation. Under surveillance, FCTC carries out an ongoing process of monitoring and countering changes in the tobacco industry that may affect public health policies. FCTC also collects reports and keeps a database of activities of the tobacco industry that disregard transnational control of tobacco. Under the regulation, FCTC attempts to control the contents, smoking, advertisement, promotion, and packaging of tobacco products (Jasarevic, 2012).
Conclusion
A global survey across these four countries reveals several challenges in the implementation of the FCTC treaty. The fundamental problem in combating tobacco-related activities in most countries is laxity in the implementation of the law as China demonstrates. At the same time, some countries experience legal challenges concerning the FCTC treaty. Given these scenarios, the FCTC must review its strategies and encourage its Parties to find solutions in enacting the treaty. This is the only way to achieve the results Uruguay and Ireland have achieved, and reduce tobacco-related deaths.
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