FCTC stimulated smoking bans and pictorial warnings but not tax increases or ad bans

The WHO Framework Convention on Tobacco Control (FCTC) committed Parties to, among other things, implement tobacco demand reduction measures including smokefree laws, strong health warning labels and increase tobacco taxes. Previous studies, including some of our work, have generally shown that countries followed treaty ratification by implementing at least some of these policies. Now Heikki Hiilamo and I have published a more sophisticated analysis that also takes into account countries’ policies before they ratified the FCTC.

In our paper, “Global implementation of tobacco demand reduction measures specified in Framework Convention on Tobacco Control,” published in Nicotine and Tobacco Research, we found that, controlling for country income status and state capacity, the laws countries had before ratifying the FCTC, the odds of implementing smokefree laws and pictorial health warning labels increased with time following ratification.

In contrast, for taxes the treaty did not seem to have had a positive effect after taking into account pre-treaty taxes. Instead, a history of higher taxes predicted future policy making. The relatively poor performance on taxes may be because health ministries are usually responsible for other FCTC demand reduction articles, while the tobacco taxes fall under the purview of the finance ministries, which tend to be more sympathetic to business interests, including the tobacco industry.

Time since ratification did not predict implementation of advertising restrictions either.

As the next Conference of the Parties approaches, delegates need to recognize that while the FCTC was followed by implementation of some FCTC-compliant demand reduction policies, there are still many parties that have not implemented the FCTC, particularly increasing taxes and ending tobacco advertising and promotions.

Here is the abstract:

Objectives: The world first global health treaty, WHO Framework Convention on Tobacco Control (FCTC) aims to reduce tobacco product demand by focusing on tobacco taxes, smoking bans, health warning labels and tobacco advertising bans. Previous studies almost unanimously suggest that FCTC has prompted countries to implement more effective tobacco demand reduction policies. By taking into account the pre-FCTC status, country income level and state capacity we studied if ratifying FCTC was associated with tobacco demand reduction measures in 2018/2019.  

Methods: We used logistic regression to assess the association of FCTC ratification with adoption demand reduction measures, accounting for years since ratification, baseline status and other covariates.  

Results: Except for taxes, state of tobacco policy implementation before FCTC ratification did not predict adoption of FCTC policies. Time since FCTC ratification was associated with implementing smoking bans and pictorial HWLs. In contrast, while the tax rate prior to FCTC ratification was positively associated with increased taxes after FCTC ratification, time since FCTC ratification was marginally negatively associated with increases in tobacco taxes.

Conclusions: While the FCTC was followed by implementation of compliant demand reduction policies, there are still many parties that have not implemented the FCTC, particularly increasing taxes and ending tobacco advertising and promotions.

Implications: We assessed changes in tobacco demand reductions measures over 22 years in 193 countries. By using internal tobacco industry documents, we were able establish a baseline before the FCTC negotiations.Unlike previous studies we included four tobacco demand reductions measures: tobacco taxes, smoking bans, health warning labels and tobacco advertising ban, The limitation of the study is that we do not have data to describe if demand reduction measures are actually enforced or what their effect on tobacco consumption is.

The full citation is: Hiilamo H, Glantz S. Global implementation of tobacco demand reduction measures specified in Framework Convention on Tobacco Control. Nicotine Tob Res. 2021 Oct 18:ntab216. doi: 10.1093/ntr/ntab216. Epub ahead of print. PMID: 34661672. It is available for free here.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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