Beyond Ratification

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The Future for U.S. Engagement on International Tobacco Control

Tobacco use is arguably the greatest threat to global health. Tobacco use and secondhand smoke kill more people annually than HIV/AIDS, tuberculosis, and malaria combined. Unless action is taken, an expanding pandemic of tobacco-related diseases promises to disable and kill hundreds of millions more in coming decades, mostly in low- and middle-income countries. Beyond its effects on morbidity and mortality, tobacco use has dramatic social and economic consequences, consuming health care budgets, robbing families of their primary wage earners, and hindering economic development.

Tobacco use is also one of the most preventable threats to global health. Cost-effective, evidence-based tobacco control programs have succeeded in developed and developing countries alike. The Framework Convention on Tobacco Control (FCTC)—the first treaty developed and adopted pursuant to the authority of the World Health Organization (WHO)—provides a blueprint for these tobacco control programs and a platform for their monitoring and implementation. If adequately resourced and implemented, the strategies prescribed in the FCTC offer the opportu­nity to avert millions of premature deaths in a sustainable manner.

Many arguing for increased U.S. engagement on global tobacco control have focused on the need for the United States to ratify the FCTC. Given the poor near-term prospects for ratification and the lack of momentum behind FCTC implementation, a new approach is warranted. Although the United States should ratify the FCTC, it should not wait to do so before in­creasing its support for low- and middle-income countries’ FCTC implementation. This ap­proach would accomplish the same objective—to meaningfully demonstrate U.S. commitment and leadership—and do more to advance global tobacco control.

Thomas J. Bollyky