Global Tobacco Control:

WHO Framework Convention on

Tobacco Control (FCTC)

Ghazi Zaatari, MD Professor & Chair

Department of Pathology & Laboratory Medicine

American University of Beirut

Chair, Study Group on Tobacco Product Regulation

World Health Organization (WHO)

Tobacco Regulation:

The Problem

1. The increased global epidemic of tobacco

use

2. The alarming rise in health hazards of

tobacco use (harm)

3. The lack of trust in the tobacco industry

and its unwillingness in regulating its

products

63% of all deaths are caused by NCDs,

for which tobacco use is one of the

greatest risk factors

> 600 000 people die each year from exposure

to second-hand smoke

6 million Nearly 6 million people killed by

tobacco each year.

1 billion deaths by end of 21st century if the

pattern persists

The Tobacco Epidemic - Today

63% of all deaths are caused by NCDs,

for which tobacco use is one of the

greatest risk factors

> 600 000 people die each year from exposure

to second-hand smoke

6 million Nearly 6 million people killed by

tobacco each year.

1 billion deaths by end of 21st century if the

pattern persists

The Tobacco Epidemic -

Tomorrow

Tobacco Contents & Emissions

• At least 4800 chemicals have been

identified in particulate and gas phases of

smoke

• Many proven to be toxicants and

carcinogenic

= tobacco smoke + charcoal products (+ foil) – “filtering effect”

hose

mouthpiece

body

bowl

head

coal

tobacco

water

Narghile waterpipe smoke

Differences with

cigarette

tobacco burn not self-sustaining

charcoal needed

“molasses” flavorings

order of magnitude higher flow

rates/puff volumes

long flow path with

bubbler/humidifier (produces

cool “smooth” smoke)

Photo credit: internet, source

unknown

Single narghile use session Single cigarette

STUDY 1

(2003)

STUDY 2

(2005)

Tobacco type ma’assel ma’assel

Number of puffs 100 171

Puff volume, ml 300 530

Tobacco paste consumed, g 3.0 4.7

Charcoal consumed, g 5.2

“Tar”, mg 242 802 29

Nicotine, mg 2.25 2.96 2.39

CO, mg 145 22.5

PAH

Phenanthrene, ng 748 200-400*

Fluoranthene, ng 221 9 - 99***

Chrysene, ng 112 4 - 41***

Heavy metals

Arsenic, ng 165 40-120*

Beryllium, ng 65 300*

Nickel, ng 990 0-600*

Cobalt, ng 70 0.13-0.2*

Chromium, ng 1340 4-70*

Lead, ng 6870 34-85*

Waterpipe vs. Cigarette Toxicant yields

* Reported ranges for commercial cigarettes, Jenkins et al., 2000

**arithmetic mean for 1294 domestic cigarette brands tested by FTC for 1998 (FTC, 2000).

***LGC, 2002.

Carcinomas desarrollados en la oreja de conejo con

alquitran de tabaco, a los 9 meses, Serie II

Oral Cavity Lung

Bladder Larynx

Air Monitoring in Lebanese Restaurants

G. Saade, Harvard School of Public Health

Nicotine Addiction

April 14, 1994 – The “7 CEOs” of Big Tobacco

testified that “Nicotine is not addictive”

Tobacco Industry Influencing

ISO TC 126

“There are two international organizations

controlled by the industry: CORESTA and

ISO… CORESTA is 100% controlled by the

industry… ISO Technical Committee 126 is

made of approximately 80% industry… The

best way to work with these two organizations

is to do all the technical work within CORESTA

and then have it endorsed by ISO.”

Memorandum to MC Bourlas

March 19, 1990, Philip Morris

WHO Framework Convention on Tobacco

Control (FCTC)

Adopted on May 21, 2003 at the 56th World

Health Assembly and entered into force on 27

February 2005; so far 176 parties to WHO

FCTC

Preventing initiation

and uptake

Comprehensive Tobacco Control

Measures

Protecting

from second-

hand smoke

Promoting

cessation

Regulating

products

FCTC- 38 Articles

• Objective, guiding principles and general

obligations

• Measures relating to the reduction of demand

for tobacco

• Measures relating to the reduction of demand

for tobacco

FCTC • Protection of the environment

• Questions related to liability

• Scientific and technical cooperation and

communication of information

• Institutional arrangements and financial

resources

FCTC

• Settlement of disputes

• Development of the convention

Measures relating to the reduction of

demand for tobacco

• Article 8- Protection from exposure to

tobacco smoke

• Article 9- Regulation of the contents of

tobacco products

• Article 10- Regulation of tobacco

product disclosures

Measures relating to the reduction of

demand for tobacco

• Article 11- Packaging and labeling of

tobacco products

• Article 12- Education, communication,

training and public awareness

• Article 13- Tobacco advertising,

promotion and sponsorship

Measures relating to the reduction of the

supply of tobacco & Protection of environment

• Article 15- Illicit trade in tobacco

products

• Article 16- Sales to and by minors

• Article 18- Protection of the

environment and the health of persons

FCTC - Article 5.3

• 1. Each Party shall develop, implement, periodically update and review

comprehensive multisectoral national tobacco control strategies,

plans and programmes in accordance with this Convention and the

protocols to which it is a Party.

• 3. In setting and implementing their public health policies with respect

to tobacco control, Parties shall act to protect these policies from

commercial and other vested interests of the tobacco industry in

accordance with national law.

Tobacco advertising, promotion and sponsorship

CHABABLIK: Arabic for Youth

CHABABLIK: Arabic for Youth

"The success of the FCTC as a

tool for public health will depend

on the energy and political

commitment that countries

devote to implementing it in the

next few years. The result will be

global public health gains for all.

The challenge we face is for the

treaty to make a difference

where it really matters - in

countries." Dr. J. W. LEE

Director General

2003

POLITICAL WILL

Ministry of Health

Ministry of Finance Ministry of Justice

Ministry of Education

Ministry of Agriculture

PUBLIC AWARENESS NGOs Media

Health Professionals

Trade unions

INTERNATIONAL SUPPORT

WLF

Bloomberg Philanthropies

CDC

Donor countries

Gates foundation

INTERGOVERNMENTAL WORK

WHO Head quarter (TFI)

WHO Country offices

WHO Regional Office

UN task force

SCIENTIFIC EVIDENCE

JHBSPH

Researchers

IARC

WHO Collaborating Centres

WHO Framework Convention

on Tobacco Control

Working together

to curb the

tobacco epidemic