From Tobacco Info No. 4 - February 2011
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Contents of tobacco products, cessation and economics

WHO Framework Convention on Tobacco Control gains in precision and strength

By Pierre Croteau

In Punta del Este, Uruguay, the fourth Conference of the Parties (COP-4) to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) ended on November 20 with notable achievements for public health.

Delegates from the European Union and 133 countries endorsed guidelines for the implementation of many articles of the FCTC, a treaty currently ratified by 172 Parties.

COP-4 saw the adoption of a declaration to support Parties being attacked by tobacco companies who are using trade and investment agreements to challenge their implementation of the FCTC and its guidelines. The declaration was of particular importance to the host country, Uruguay, whose labelling and packaging requirements are under legal attack by the world’s leading cigarette supplier, Philip Morris International. In Uruguay, following a recent law, pictorial health warnings are required to cover 80% of the front and back of cigarette packages.  Since 2006, Uruguayan smokers have seen four different waves of pictorial health warnings (See footnote 1).

Contents and disclosures

Article 9 of the FCTC deals with the regulation of the contents of tobacco products and Article 10 concerns disclosures of information related to product contents and emissions. Among the directives approved under these two articles is one that recommends that Parties “restrict ingredients that may be used to increase palatability in tobacco products.”  The objective of the guidelines is clear and straightforward: “There is no justification for permitting the use of ingredients, such as flavouring agents, which help make tobacco products attractive.” It is this rationale that Parties are to use in formulating their own policies with respect to sweeteners, ingredients with colouring properties and ingredients such as vitamins that are aimed at creating the impression that products have health benefits.  It is worth mentioning that in many countries, some brands of cigarettes are fancifully coloured and designed.

The recommended restrictions on ingredients approved by the delegates in Punta del Este target not only cigarettes but all tobacco products, including bidis, hookah blends, smokeless tobacco products, etc.  No exception was made for menthol either, the flavouring agent that is most frequently added to cigarettes on the North American market.

Moreover, in the spirit of previous guidelines about packaging and labelling, an additional directive reads: “parties should consider imposing a ban on the sale of tobacco products whose packaging suggests the presence of an ingredient that has been prohibited.”

Tobacco dependence and cessation

The approved guidelines for the implementation of Article 14 of the Convention “encourage Parties to strengthen or create a sustainable infrastructure which motivates attempts to quit, ensures wide access to support for tobacco users who wish to quit and provides sustainable resources to ensure that such support is available.” The directives specify as underlying considerations: “tobacco cessation and tobacco dependence treatment strategies should be based on the best available evidence of effectiveness” and “tobacco dependence treatment should be widely available, accessible and affordable, and should include education on the range of cessation options available.”

Guidelines related to Article 14 also prescribe that “all health-care workers should be trained to record tobacco use, give brief advice, encourage a quit attempt and refer tobacco users to specialized tobacco dependence treatment services where appropriate.” In addition, the text recommends the Parties “address tobacco use by health-care workers” because “they are role models and by using tobacco they undermine public health messages about its effects on health.”  Such a message might sound obvious, but is worth delivering.

According to data published in the 2009 issue of The Tobacco Atlas, 6% of student health professionals smoke in China, between 11% and 21% in countries such as India, Brazil or Canada, between 31% and 41% in Turkey, Poland or Spain and more than 51% in Italy or Germany (See footnote 2).

Among actions to establish population-level approaches, mass communication is key. “Mass communication and education programs are essential for encouraging tobacco cessation,” claim the endorsed directives. “These programs can include both unpaid and paid media placements.” A guideline adopted in 2008 by COP-3 for Article 11 states: “Well designed health warnings and messages on tobacco product packages have been shown to be a cost-effective means to increase public awareness of the health effects of tobacco use and to be effective in reducing tobacco consumption.”

Taxes and jobs

The delegates at COP-4 agreed to create a working group to draft guidelines on Article 6 of the FCTC, which deals with price and tax measures to reduce tobacco consumption.

On that matter, the technical report released in August by WHO’s Tobacco Free Initiative is rather encouraging.  Recent studies indicate that in China, a 10% increase in cigarette price would reduce cigarette consumption by 5 to 6.4%.  In India, the same 10% would reduce the consumption by 1.8 to 3.4% for standard cigarette, and by 8.6 to 9.2% for bidis, a small hand-rolled cigarette popular among Indians. Even in high-income countries, a 10% hike in the price is likely in most cases to reduce the consumption by around 4%.  “The taxes and prices affect both the prevalence of tobacco use and the amount of tobacco consumed by users,” says the report.

The report also reaches important conclusions about the impact of tobacco tax increases on employment, a concern held by policy makers in countries around the world who fear they have to choose health over jobs. “In most countries, tobacco tax increases would be likely to have either no net impact on employment or, more likely, would lead to a small increase in the number of jobs. Higher tobacco product taxes reduce tobacco consumption, and hence spending on tobacco products would be replaced by spending on other goods and services. Any reductions in tobacco-dependent employment, following tobacco tax increases, would therefore be offset by increases in employment in other sectors.”

The delegates at COP-4 extended the mandate of the working group on economically sustainable alternatives to tobacco growing.  They also approved a fifth and final intergovernmental negotiating session on the Protocol on Illicit Trade in Tobacco Products, which will be held in early 2012 because of budgetary shortfalls in 2011.

Some Canadian perspectives

All the work, all the meetings and all the measures to be implemented cost money, right now, and many countries involved in the FCTC have small budgets.

Melodie Tilson, Director of Policy for the Non-Smokers’ Rights Association and a Canadian observer at COP-4, believes that Canadians have a rich experience in the implementation of effective tobacco control policies and it is imperative that relatively rich governments provide funding to expedite this knowledge to developing countries, and in so doing, expedite a decline in tobacco caused illnesses and deaths in those countries.

Rob Cunningham, Senior Policy Advisor for the Canadian Cancer Society and also an observer in Punta del Este, says that the innovative way the Canadian government addressed the challenge of flavoured products, with The Cracking Down on Tobacco Marketing Aimed at Youth Act, has been useful for many countries that have legislated since 2009.  On the other hand, public health in Canada would benefit if our legislation and regulation complied more fully with the FCTC guidelines, notably those adopted at COP-3 concerning packaging and labelling and tobacco promotion.

Footnote 1: On November 15, 44 countries reported the requirement of health warnings in the form of — or including — pictures or pictograms.

Footnote 2: However, among Canadian physicians specifically, the prevalence of smoking may be as low as 3%, as shown by Dr. Atul Kapur during a presentation at the 6th National Conference on Tobacco or Health, in Montreal in 2009.