Public Health Perspective on Tobacco Control Essay

Literature review

WHO Framework Convention on Tobacco Control

The position of the global community in sustaining availability and accessibility of management of tobacco addiction is critical (Wilson, 2002, pp. 14-15). The international community can contribute to the development of the national policy guidelines for the mentioned issue by offering a forum for exchanging and disseminating information, preparing guidelines and appraisals on appropriate activities, raising funds and developing cooperation with academic and research organizations in the location of smoking cessation. Consequently, various organizations, social groups and universities can contribute significantly in tobacco control efforts through sustenance of environmental reforms that favour non smoking as a social standard or through direct approach to smoking cessation.

In this respect, the copy of the final draft the WHO Framework Convention on Tobacco Control underscores in the Preamble “the special contribution of nongovernmental organizations and other members of civil society not affiliated with the tobacco industry … to tobacco control efforts nationally and internationally and the vital importance of their participation in national and international tobacco control efforts” (Document A56/8 – Annex – Preamble, paragraph 17).

Focusing on smoking cessation and management of tobacco addiction, the copy of the final version of the WHO Framework Convention on Tobacco Control identifies the Preamble that “cigarettes and some other products containing tobacco are highly engineered to create and maintain dependence, and that many of the compounds they contain and the smoke they produce are pharmacologically active, toxic, mutagenic and carcinogenic, and that tobacco dependence is separately classified as a disorder in major international classifications of diseases”.

The draft outlines the arrangement by the WHO to establish and spread appropriate, extensive and incorporated guidelines depended on research findings and best practices, considering national status and priorities, as well as take significant initiatives to support cessation of tobacco consumption and sufficient treatment for tobacco addiction (Document A56/8 – Annex – Article 14(1)).

WHO Tobacco Free Initiative

An important stage of the task on the WHO Framework Convention on Tobacco Control (WHO FCTC) is scheduled to start after its approval by the WHO Member States. Member States require support to confirm and subsequently implement the treaty of concern. To allow the WHO Tobacco Free Initiative (TFI) to respond to appeals for technical support in regard of legal, policy, scientific and reasonable measures following the implementation of the WHO FCTC, it is presently engaged in creating diverse guidelines for nations.

These guidelines meet the local needs of the respective countries, which are implementing tobacco-control initiatives (Policy Recommendations for Smoking Cessation and Treatment of Tobacco Dependence, n.d., pp. 55-61).

Other approaches adopted by WHO Tobacco Free Initiative to accomplish this mission include:

1. a forum with health professionals groups on the way forward in executing the policy recommendations for management of tobacco addiction and smoking cessation;
2. pilot study of the Policy Recommendations for Smoking Cessation and Treatment of Tobacco Dependence;
3. integration of such Policy Recommendations in area training workshops structured to develop national capacity;
4. collection and spread of useful practices;
5. compilation of useful manuals and background resources for health specialist and;
6. endorsement of the incorporation of tobacco control practices, counting smoking cessation and treatment of tobacco addiction approaches in other WHO technical plans (Policy Recommendations for Smoking Cessation and Treatment of Tobacco Dependence, n.d., pp. 55-61).

Overview of FCTC

According to the WHO (2011), an international mechanism for tobacco control was conceived in May 1995 during the World Health Assembly. This was followed by the adoption of the resolution WHA49.17 by the 49^th World Health Assembly in the following year. This resolution required the Director-General to kick off the establishment of WHO FCTC. This vision saw the launching of the first WHO treaty-making venture. Nevertheless, practical negotiations began in 1999, a year following the prioritizing of worldwide tobacco control for WHO by the WHO Director-General, Brundtland.

The FCTC is the veteran world’s global public health treaty. It highlights lawful binding values and objectives that countries or institutions like the European Community (EC), who sanctioned and subsequently accepted to execute the Treaty. Its aims encompass protection of the present and upcoming generation from overwhelming health, environmental, social and economic effects of tobacco usage, and susceptibility to tobacco smoke.

Articles of the FCTC

Article 8: protection from exposure to tobacco smoke

This article concerns the mission of the FCTC of protecting the current and the upcoming generation from the devastating economic, social, environmental and health implications of tobacco consumption as well as exposure tobacco smoke. The article emphasizes the risks of “second-hand tobacco smoke” (SHS) and the susceptibility of the unaware public. The article reports that approximately 79,000 European adults’ deaths are related to SHS, while 7.5 million labourers in Europe are subjected to second-hand smoke at workplace (Article 8, 2008, April, Issue Two).

Article 8 is too brief and broad such that the member organizations required further guidelines to help in implementing their mandates. However, these guidelines are consistent with scientific evidence and recognize the prominent elements of legislation required to successfully safeguard the public from exposure to SHS. However, it not only describes the way the guidelines were developed by the affiliate countries, but also its key elements. These elements include; smoke-free environments, legislation, people, planning and resources, civil society, enforcement and monitoring, and new scientific findings. Finally, it describes the operations of FCTC member nations.

There is concrete evidence that the rigorous smoking bans yielded favourable effects on public health. For instance, with respect to Ireland, a 2007 survey found that a comprehensive workplace smoking ban leads to a considerable decline in air pollution in bars and an enhancement in respiratory health in bar employees. In Scotland, a survey of hospitals revealed a 17% decline in heart attack cases within the first year with the corresponding implementation of the smoking ban. Similarly, in the United States, a 2006 findings on The Health and Economic Impact of New York’s Clean Indoor act indicate that the “the law has not had an adverse financial impact on bars and restaurants.

Article 14: Demand reduction measures concerning tobacco dependence and cessation

This essentially concerns the steps that are adopted to lower the rate of tobacco addiction. This means that the member nations are imposed by this article to implement policies and measure that will accomplish a decline in tobacco dependence, while improving cessation.

Henri-Christine, (2008, p. 3), suggests that strategy for implementation of this article is dependent and entail the following steps:

1. A serious review of all findings including population centered research and survey on the cost benefits of various treatment plans and modalities;
2. A special revision of agenda that successfully handle the demands of developing country Parties as well as Parties which have economies in change;
3. An examination of experiences gained from treatment schedule that have been successful in managing other public health concerns;
4. A decisive review of the way socio-economic condition, age, gender, ethnicity, education and other elements impact tobacco addiction and treatment;
5. A guideline to involve all healthcare sectors and providers;
6. A sketch of important program parts which are forceful and cost-effective, particularly for building country Parties and Parties that have economies in change;
7. Steps to assess outcomes and successes that would sustain programs improvement; and
8. Detecting gaps in awareness and encouragement of study and dissemination of information as per Article 20.

Components of the FCTC

Based on the second forum of the working group on the WHO FCTC (2000, p. 1), the suggested components include; advertising and sponsorship, the eradication of tobacco smuggling, and management of tobacco dependence. Also under Article 15.1 of the FCTC, besides the elimination of illegal trade on tobacco commodities, such as smuggling, and illegal manufacturing and counterfeiting; other components of FCTC include the establishment and execution of relevant national legislation, and sub-regional, regional and international agreement.

FCTC implementation in South Africa

South Africa has implemented Article 13 of FCTC, which concerns tobacco advertising, promotion and sponsorship. This is accomplished through the monitoring by the Conference of the Party on the measure undertaken by the working group. Thus, the South African delegation is focused on the eradication of cross-border advertising, funding and promotion, as well as recommends options for additional work in this field to the Conference of the Parties (FCTC, 2010).

FCTC in Scotland, Ireland and the US

Currently, based on McGrady (2009, p. 5) there are three areas on which the U.S. is highly positioned to contribute greatly to worldwide tobacco control. These areas include; surveillance and monitoring of tobacco control, tobacco product regulation, and illicit trade in tobacco commodities.

The state of California was the first region to implement the indoor smoking ban legislation in 1995. This was subsequently adopted across the US. Eventually this law was implemented by other nations beyond the US borders. Ireland was among the first European nations to enact the laws on indoor smoking ban, in 2004. Scotland implemented this law in 2006 (Tobacco Control Office Department of Health, 2010).

In Ireland the FCTC is implemented through the Office of Tobacco Control. This body facilitates the objective the FCTC through dealings with the government and other relevant organizations on matters of tobacco smoking (Public Health Tobacco Act, 2002). Scotland on the other hand, achieves the FCTC guidelines through the Scottish Ministries under the Smoking, Health and Social care Act 2005 (1) besides other jurisdiction pass regulations pertaining tobacco control (Scottish Statutory Instruments, 2006 No. 90).

Article 15: Illicit Trade in Tobacco Products

Under the Article 15.1 of the FCTC, Parties regard that the eradication of all types of illicit business in tobacco commodities, such as smuggling, unlawful manufacturing and counterfeiting. They also regard institution and execution of relevant national legislation, apart from the sub-regional, regional and international treaties to be critical elements of tobacco control (Hammond, & Assunta, 2000.).

This group highlights the requirements of Article 15 for the Parties to the FCTC in their efforts to address illicit tobacco dealings. These recommendations can be applied in Ghana by various ways based on the Framework Convention Alliance). Owusu-Dabo et al. (2010, p. 1) assert that questions have been raised about the implementation of the various FCTC Articles, whether it will pose no challenge to the Party states. Ghana was the 39^th country to ratify the FCTC.

First step includes monitoring, documenting and controlling tobacco products dealings and limiting the flow of products and their legal positions. This also includes monitoring and analyzing cross-border trade, counting the illicit trade. Further, it also involves monitoring, documenting and controlling the warehousing and distribution of tax suspended commodities (WHO FCTC, 2007).

Second measure includes ensuring that all tobacco commodities packages have trade mark to enable the Parties to determine the manufacturers identity, and to show the intended destination of the product or to establish its sale warrant status in respect to the local market. Third way is by enacting or reinforcing laws against illegal trade encompassing counterfeits and contraband cigarettes, with relevant penalties and resolutions.

Fourthly, integrate proper measures to guarantee destruction or disposition of the confiscated manufacturing equipment and contraband and counterfeit products as per the article 15.4e.

Finally, Ghana should endeavor to ensure compliance of its subjects companies, organizations or the public to the relevant legislation and treaties, collaborate globally, by being involved in helping other Parties in recognizing the point of diversion of commodities into the illegal market. Also this should involve sharing information among consumers, tax and relevant powers. Moreover, it entails fostering cooperation on inspections, proceedings and prosecutions between national bureaus and related local and worldwide intergovernmental organizations.

Surveillance and monitoring of FCTC

Monitoring of the FCTC guidelines encompasses response to the tobacco manufacturers’ efforts to weaken smokefree initiatives (Article 8, 2008, April, Issue Two). The WHO in collaboration with the US Center for Disease Control and Prevention, and the Canadian Public Health Association invented the Global Tobacco Surveillance System (GTSS) to enable FCTC Parties to implement and sustain tobacco control surveillance and monitoring. This system offers a flexible framework that comprises common data elements which allow member countries to incorporate significant characteristic information at their judgment.

Besides, it employs a popular survey process, common field protocols for data collection, and standard data management and processing techniques. Moreover, the GTSS involves data collection via several surveys including; the Global Health Professional Student Survey, the Global Personnel Survey, and the Global Youth Tobacco Survey (Warren 2008).

Warren (2008) further asserts that various countries across the globe can apply both the GYTS data to monitor and assess Tobacco Control Action Plans and articles from WHO FCTC. The GYTS offers pointers for determining success level of various WHO FCTC articles including surveillance and monitoring, children’s access and availability, media and advertising, cessation, school based tobacco control, exposure to SHS, and prevalence.

According to the Institute for Global Tobacco Control (2011), another tool projected for use for surveillance and monitoring is the FCA FCTC Monitor. This tool was recently developed by the Institute for Global Tobacco Control in liaison with the Framework Convention Alliance for Tobacco Control. It is data collection scheme used to monitor the application of the Framework Convention on Tobacco Control (FCTC) treaty.

Further the author affirms that the FCA FCTC Monitor is intended to be a yearly report distributed at the Conference of Parties (COP) to offer a baseline of data to support governments’ actions to attain their mandates as per the treaty promptly. This tool focuses on the prominent requirements of the treaty, such as tobacco sponsorship, advertising and promotion; packaging and labeling of tobacco commodities; exposure to tobacco smoke; and price and tax of tobacco commodities. Furthermore, the FCA FCTC Monitor will examine the influence of non-party players on the execution of the treaty, including the assessment of non-government tobacco control initiatives, media coverage and tobacco trade intervention.

Reference List

Article 8: protection from exposure to tobacco smoke. 2008 April. Spotlight on the Framework Convention on Tobacco Control (FCTC). Web.

Hammond, R. & Assunta, M., 2000. The Framework Convention on Tobacco Control: promising start, uncertain future. Web.

Henri-Christine, R., 2008. Briefing 7: Elaboration of guidelines for implementation of Article 14 (Demand reduction measures concerning tobacco dependence and cessation).Third session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control, Durban, South Africa. Geneva; Switzerland: Framework Convention Alliance.

Institute for Global Tobacco Control, 2011. FCTC Monitoring. Johns Hopkins University. Web.

McGrady, B., 2009. U.S. Engagement in International Tobacco Control – A Report of the CSIS Global Health Policy Center, 2009. Center for Strategic and International Studies. Web.

Owusu-Dabo E. McNeill A. Lewis S. Gilmore A. & Britton J., 2010. Status of implementation of Framework Convention on Tobacco Control (FCTC) in Ghana: a qualitative study. BMC Public Health 2010, 10:1. Web.

Public Health (Tobacco) Act, 2002. Number 6 of 2002. Web.

Policy Recommendations for Smoking Cessation and Treatment of Tobacco Dependence. n.d. Chapter 6: The role of WHO, its partners, and the WHO FCTC provisions. Web.

Scottish Statutory Instruments, 2006. Public health: The prohibition of smoking in certain premises (Scotland) Regulations. Web.

The Health and Economic Impact of New York’s Clean Indoor Air Act, 2006. New York State Department of Health. Web.

Tobacco control office Department of Health, 2010, November. International Trend in Tobacco Control. Web.

World Health Organization. 2011. The history of the WHO Framework Convention on Tobacco Control. WHO.

World Health Organization: Framework Convention on Tobacco Control, 2007. Conference of Party Report, Ghana.

Warren, C.W., 2008. The Global Youth Tobacco Survey (GYTS): linking data to the implementation of the WHO Framework Convention on Tobacco Control. BMC Public Health 2008, 8 (Suppl 1): S1. Web.

Wilson E., 2002. Smoking Cessation in Canada and International Opportunities. Presentation at the WHO meeting on Global Policy for Smoking Cessation hosted by the Ministry of Health of the Russian Federation, Moscow.