WHO Do You Support?

By the end of this century, more than one billion people will have died in a pandemic of immeasurable scale and wide-reaching consequences. The disease is non-infectious, easily preventable, and widely prevalent in both the developed and developing world. The diagnosis? Tobacco.

According to the Center for Disease Control, tobacco use is responsible for over 443,000 annual deaths in the United States and is recognized as the single most preventable cause of premature deaths in our country. The global burden of disease from tobacco is even more staggering—an estimated five million annual deaths according to the World Health Organization. In an effort to counteract this tremendous loss of human life and productivity, in 2003 the WHO adopted the Framework Convention on Tobacco Control, a treaty designed to strengthen tobacco regulations and increase awareness of the dangers of tobacco’s negative health effects worldwide. As one of the most quickly and widely ratified treaties in UN history and one of the first global attempts to address a chronic, non-communicable disease, the FCTC represents a landmark development in international health.

Despite the progress made in international tobacco control, the United States has yet to ratify the FCTC after its signing in 2004. In 2005, as a member of the Senate, President Obama helped draft a letter urging Former President George W. Bush to send the treaty to the Senate for ratification. Now, six years later, the FCTC has still not been passed to the Senate. As a major base for tobacco production and manufacturing and an influential world power, the United States has a responsibility to ratify the framework and take a more active role in both domestic and international tobacco control.

Tobacco use in the United States remains a critical issue. According to the American Heart Association, 23 percent of American men and 18 percent of American women over the age of 18 smoke. In addition, 28 percent of Americans are exposed to secondhand smoke, which causes an estimated 3,000 lung cancer and 46,000 heart disease deaths each year. Despite the significant health impact that tobacco use has on both smokers and non-smokers, U.S. tobacco legislation remains weak and insubstantial compared to the widely accepted FCTC policy. Federal healthcare programs do not cover smoking cessation programs, and only twenty-five states do not have laws banning smoking in public places.

However, while tobacco use is still a major health care issue, there is at least the reassurance that domestic smoking rates are on the decline. Unfortunately, the scale of tobacco usage globally is threatening to become an epidemic of much larger proportions than any seen in the United States. By 2030, tobacco use is expected to be the leading cause of death in the world, killing an estimated 8 million people a year, with 80 percent of deaths occurring in low and middle-income countries.

With tobacco use on the decline in the United States and most other developed countries, tobacco companies have redoubled their efforts in the developing world. According to the WHO, tobacco use in the developing world is rising by about 3.4 percent per year. In East Asia and the Pacific, the region of the world with the highest proportion of smokers, nearly two-thirds of all adult men smoke. For low-income nations, tobacco use is often a double evil- creating negative consequences for both the health and economic situation. Spending on tobacco products accounts for about 10 percent of the average smoker’s household income in Egypt, 17 percent in the Minhang district of China, and almost 20 percent in the Philippines–without even factoring in future medical costs and loss of productivity.

Legislation included within the Framework Convention on Tobacco Control focuses on several key issues, including raising greater awareness of smoking’s consequences, regulating tobacco advertising, and discouraging future tobacco use. While the United States has included some of these policies within the 2009 Family Smoking Prevention and Tobacco Control Act, there are others that it has failed to address. These policies include creating comprehensive education programs on the consequences of tobacco use (including its “addictive characteristics” and the side-effects of “exposure to tobacco smoke”), providing affordable and accessible tobacco cessation programs, mandating stronger warning labels on cigarette cartons, and implementing tax policy deliberately designed to reduce tobacco consumption.

172 countries have already signed and ratified the Framework Convention on Tobacco Control, and the United States’ failure to do so is disconcerting. The future impact of the tobacco epidemic is incalculable in the scale of its consequences. The United States, as a world leader, has a obligation to do its part in averting this crisis, and it is President Obama’s responsibility to give momentum to this initiative by pushing for the FCTC’s ratification. While it is too late for America to set a precedent, there is still time to take action and inspire change.

Nataliya Nedzhvetskaya ’13 is a Social Studies concentrator in Quincy House.  Jenay A. Powell ’13 is a History of Science concentrator in Quincy House.  They are both members of the Harvard Undergraduate Global Health Forum.