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Op-ed by Dr Linda Waverley published in the GlobeAndMail.Com on March 7, 2005.

Tobacco is the second major cause of death in the world. Tobacco consumption is the cause of premature death for nearly five million people every year, one in 10 of all adult deaths worldwide. If current smoking patterns continue, tobacco use will cause some 10 million deaths each year by 2020. But now, a precedent-setting international treaty exists to fight this global tobacco epidemic.

The World Health Organization (WHO) recently enacted its first global treaty to address a health issue. The Framework Convention on Tobacco Control (FCTC), designed to reduce the devastating health and economic impacts of tobacco use throughout the world, became part of international law on February 27, a historic day for global public health. Its provisions are now legally binding for more than 40 countries, including Canada.

This treaty reflects the need for an integrated approach to tobacco control, with the ultimate aim of creating a global social environment that supports non-smoking as the norm. No one measure can create this shift; tobacco-control strategies must tackle the problem on many fronts.

Among other measures, the treaty sets international standards on tobacco price and tax increases, tobacco advertising and sponsorship, product labelling, illicit trade, and second-hand smoke. It also calls for mass communication of the health consequences of tobacco use and international co-operation to give governments greater access to research into socially and culturally appropriate tobacco-control programs.

In Canada, as in other developed countries, significant progress has been made in curbing tobacco use. But smoking continues to be more prevalent among the poor and the less-educated. Our youth continue to experiment with tobacco at rates that defy our best public-health efforts, and women's use of tobacco is still high in certain age groups. Smoking rates among indigenous people are similar to those in developing countries.

But the battle against tobacco is just beginning in other parts of the world, with multinational tobacco companies aggressively seeking new markets. In China, the smoking rate among adult men is already about 65 per cent. Smoking is almost a social necessity — offering a cigarette is a common part of any greeting between men.

While traditional prohibitions on smoking have kept women's rates low, in part a legacy of the Cultural Revolution when puffing tobacco was seen as the morally degenerate habit of Western women, smoking rates among Chinese women have risen from 1 per cent a decade ago to 5 per cent today.

Multinational tobacco companies, meanwhile, have returned to China in full force with the promise of new factories and aggressive marketing tactics that equate female emancipation with tobacco use. It's only a matter of time before smoking among women in China takes hold.

We have learned much about what works in tobacco control, and the treaty reflects this. We've seen that, when civil society, policy-makers, and researchers work together, it's possible to move mountains.

Thailand, for example, has had uncommon success in resisting the plans of the multinational tobacco conglomerates, having won the right to impose some of the world's strictest tobacco controls at a 1990 hearing of the General Agreement on Tariffs and Trade. In Canada, tobacco-control advocates have raised advocacy to an art form, effectively demanding and supporting precedent-setting tobacco-control legislation.

To be most effective, however, tobacco control must be global in its scope. Advertising bans in one country won't work if images are being broadcast by satellite across borders. Attempts to control tobacco smuggling will be limited without a regional approach. The treaty addresses issues that have cross-border implications in a co-ordinated and standardized way.

We must remember that, in Canada, we have seen dramatic shifts in the way tobacco is used and viewed. We have smoke-free workplaces; strong warnings on tobacco products; prohibitions on the sale of tobacco to minors. We still need to do more, but the extent to which tobacco is seen as a cultural norm in our society has fundamentally changed over the past 45 years.

Countries in the South are struggling to control communicable diseases such as AIDS and malaria. They are now facing an increasing burden of disease from non-communicable diseases, such as cardiovascular disease, Type 2 diabetes, and cancer — diseases for which tobacco is a major risk factor.

The countries of the South should not be the next victims of the multinational tobacco companies. The WHO tobacco treaty represents an important way to move forward with a global approach to tobacco control.

Linda Waverley is Executive Director of Research for International Tobacco Control (RITC) with Canada's International Development Research Centre (IDRC).

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