Your Excellency, President Vazquez, Former President Fischer, distinguished delegates and friends.
In the time it takes me to deliver this short address approximately 166 individuals around the world will have died from a totally avoidable and man-made epidemic. Annually, 6 million people die from tobacco related diseases. More than 5 million of those deaths are the result of direct tobacco use while over 600,000 are non-smokers who die from being exposed to second-hand smoke.
At such a distinguished gathering, I need not remind you of the devastating impact tobacco consumption has on your patients, their families and the wider community. I have seen with my own eyes individuals affected by this disease during my time as lung disease specialist working as a medical doctor at a cancer care hospital. While science has progressed and treatments improved since my time in clinical care, you can appreciate that the ability to help lung cancer patients and their families is still limited, even within the most developed health care systems.
At government level, it goes beyond each personal tragedy, dealing as it must with the consequences of growing costs to health service budgets. This is a colossal burden and yet we continue to hear that all this suffering and all these costs are a matter of personal choice and that we should avoid a ‘nanny state’ mentality, getting in the way of an adult’s right to choose.
Bottom line, so we are told - people have the freedom to choose. No one is responsible for the suffering and the tobacco industry is a legal industry, merely supplying a demand that is already there.
In recognising the important contributions so many of you are making in research and treatment of lung cancer, we neglect at our peril the considerable efforts being made elsewhere by representatives of the tobacco industry. Right now, they employ strategies to sell even more of their regular products around the world while introducing in the market new products such as water pipes and electronic nicotine delivery systems.
The continuing strides in treating lung cancer must unfortunately be put against the matching strides the tobacco industry is making in selling its noxious products to a new generation of consumers, cynically targeting mass markets both in high income and in low- and middle- income countries; the latest, places that can least afford the cost of treating victims of tobacco or are least able to bear the burden of so many productive wage earners dying early or being taken out of the labour market because of disabilities.
So, set against this multi-million dollar transnational industry which is as robust and ruthless as ever, what meaningfully active prevention is available to us?
I am here to tell you, that the WHO Framework Convention on Tobacco Control is a powerful evidence-based tool in tackling the tobacco epidemic head on and is already showing impact. This global public health treaty is the 21st century international law that can save lives.
And by its legally binding nature, parties to this treaty protect public health by domesticating a number of measures that reduce, from one end the demand and from the other, the supply of tobacco products.
The Convention provides provisions to protect individuals from exposure to tobacco smoke and helps Parties to ban tobacco advertising, promotion and sponsorship including cross border advertising and transnational entertainment services. Its provisions also commit Parties to offer tobacco cessation services to consumers and promotes bans on sales to and by minors. And considering those farmers and communities locked into tobacco production, it promotes alternatives to tobacco growing and supports alternative sustainable livelihoods, while at the same time protecting the environment. There is a growing role in support of gender specific aspects of tobacco control and protecting the most vulnerable in our communities who can be most susceptible to the tobacco epidemic.
In the areas of civil liability the Convention helps Parties implement measures that compensate the health care costs for victims of tobacco use. The Convention truly does provide a framework of cross sectoral actions that enable tobacco control measures for Parties in every region of the world.
Furthermore, the Convention makes plain, we cannot work with or permit the tobacco industry to play any part in public health matters. The industry’s past history reveals it to be a duplicitous partner that cannot be trusted, despite all its protestations, it is not fit to offer one crumb of advice to those of us who fight against the epidemic it has so effectively and cruelly engineered around the world.
Like any international treaty, the WHO FCTC has its own Secretariat, based in Geneva and hosted by the World Health Organization and we aim to serve all the Parties to the Convention and assist them in their implementation initiatives.
The Convention has now 180 Parties, covering 90 per cent of the world’s population.
Countries become Parties to the treaty because they see it can make a difference. For almost twelve years since the Convention entered into force we have seen remarkable developments in global tobacco control. Eighty percent of countries have introduced or strengthened existing tobacco control legislation since becoming Parties.
Since the advent of the Convention, the cost of a packet of cigarettes has, on average, increased by 150% in those countries which are Parties. Increasing the price of tobacco is the best way to inhibit initiation, particularly for young people, and it helps persuade many others to give up the addiction.
A picture is worth a thousand words, and this idiom has never been so true as when applied to tobacco control. Since the start of the Convention many Parties have introduced regulations requiring the use of graphic health warnings reaching up to 90% of the packet. With large warnings potential consumers cannot escape the stark reality of the risks they face. The introduction of plain packaging regulations takes this idea further still. It removes the final branding and promotional opportunity tobacco companies have to tempt potential customers to their product.
The world is now experiencing a domino-effect as more Parties introduce plain packaging legislation. This wave of change is being further encouraged as the tobacco industry loses highly publicised court cases in its desperate attempts to stop these measures.
It is important to hear that tobacco control measures are moving ahead here in Austria. The country has adopted smoke-free legislation due to be enforced in May 2018 and we are sure that the new elected President will move this agenda forward as a priority in public health. Together with the European Union Tobacco Product Directive, Austria is at the threshold of major reforms in tobacco control measures that will protect generations into the future.
Some of the European measures are worth highlighting – for example, the Directive obliges all 27 member states to ban flavourings and additives to cigarettes; to introduce large graphic pictorial health warnings on cigarette packets; and to regulate the sale and production of nicotine delivery systems.
As you are noticing, the Convention has made a powerful contribution to tobacco control policy development and implementation, strengthening existing strategies, and contributing to the denormalisation of smoking and tobacco use.
The role of the Convention, in supporting Parties has helped them with their own efforts, both within their countries and in cooperation across borders to establish measures that are starting to turn tobacco use away from a normal past-time into an abnormal and receding pursuit. So, it can rightly be said, the Convention has made definitive steps in denormalisation of use – a valuable contribution to public health and human rights.
The Convention has helped law-makers and civil servants introduce effective tobacco control measures where there had been none. The Convention’s articles and accompanying guidelines helped Parties draft new legislation and regulations. Elsewhere, it has helped those countries where they already had policies in place before ratification to increase the effectiveness of their policies – strengthening tobacco control measures that fit their own legal traditions.
Parties report that thanks to the Convention it has helped them to engage ministries and sectors of government outside of public health.
Those Parties implementing policies at high levels have generally experienced greater reductions in smoking prevalence. This has contributed to reductions in mortality and morbidity caused by smoking in those countries.
But the Convention is not all about the role of government. The additional and complementary support provided by the non-government sector, as it presses for action and measurable changes have been made with support from academia, civil society and grassroots’ groups.
And while we look to the grassroots to support effective implementation of the Convention, so too must we look internationally.
For now, the Convention has settled into maturity, after Parties engaged with negotiating Protocols and Guidelines.
One significant step forward in the implementation of the treaty was the negotiation and adoption by Parties of the Protocol to Eliminate Illicit Trade in Tobacco Products. To enter into force it requires only 17 more Parties to ratify it. I expect this will happen next year.
The Protocol was developed by the Parties to the Convention in response to the growing illegal trade in tobacco products, often across borders. This trade is a serious threat to public health because it increases access to cheaper tobacco products, fuelling still further the tobacco epidemic and undermining tobacco control policies.
Beyond demand and supply reduction provisions, the treaty has been successful in promoting connection to activities across the UN system and onwards to global priorities.
Parties to the treaty have joined global initiatives to control Non-communicable diseases including the UN Political declaration as tobacco use only is responsible for 1 out of 6 NCD's related deaths. Another important global step was taken in the inclusion of the implementation of the WHO FCTC in the Sustainable Development Goals, to be achieved by 2030.
I would like at this point to stop informing my colleagues on what the treaty and the tobacco epidemic are all about. I would instead ask for us all to consider what we can do personally and professionally to help curb the tobacco epidemic.
Medical practitioners, health workers, and indeed all of us involved with health are in a unique position to help. Evidence from a number of Parties show that cessation services can see significant success rates and are economically sustainable if patients can be asked about their life-style and tobacco use at all entry levels when seeking health advice. It doesn’t matter why a patient meets a nurse, dentist, doctor or specialist. The opportunity to help introduce cessation advice can start at any level.
There are other examples of good cessation best practices but I would encourage you to consider how you and your institution can assist ‘quit tobacco use’ initiatives in your home countries.
Your involvement is also important as a role model, promoting sound tobacco control measures in your country, engaging with your professional associations to advocate for needed regulations, ensuring your premises are tobacco-free.
But successful tobacco control also requires vigilance. We are all called to help keep the industry away from tobacco control initiatives and request researchers and universities and any organization you belong to, not to accept funds from the tobacco industry and their pension funds, to disinvest from the tobacco industry market.
The basis of the WHO FCTC is fundamentally one that protects human rights.
Every country has the duty to strive to provide every citizen with the highest attainable standard of health. This right requires Parties to develop national health strategies and plans of action to curb the epidemic.
Whatever the pressing issue for each country, it leads to one conclusion; the need to regulate the behaviour of an industry that tramples over the most basic human rights – the right to life and the right to health. This right requires each of us to do whatever is in our hands to curb the tobacco epidemic contributing to a healthier future for the next generations. Remember that 166 people could have been saved during the 15 minutes of my speech.
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