First worldwide public health treaty on the way

CMAJ 1999;160:1426

© 1999 Canadian Medical Association

If the convention is adopted, WHO will ask its 191 member states, including Canada, to sign it by 2003. The move would force signatories to place drastic curbs on the way tobacco is advertised, marketed, taxed and grown. In effect, it would be the first worldwide public health treaty.

This move is a marked departure for WHO. The international organization used to believe that individual countries and health organizations should deal with the issues surrounding tobacco. Now it is convinced that smoking is a global issue that has to be addressed on an international scale.

"WHO cannot remain indifferent," says Dr. Gro Harlem Brundtland, the director general. "We need to free our population — in particular the young — from the tobacco pandemic."

WHO says that at least 3.5 million people died in 1998 as a result of smoking and other forms of tobacco use. By the 2020s, the tobacco-related death toll is expected to reach 10 million annually, with 70% of the deaths occurring in developing countries. "By 2020, the burden of disease attributable to tobacco is expected to outweigh that caused by any single other disease," warned Brundtland.

In July 1998 she established a project, the Tobacco Free Initiative, to coordinate a global strategic response to tobacco as an important public health issue. A Canadian, Dr. Enis Baris of the International Development Research Centre, sits on the initiative's Strategy and Policy Advisory Committee.

The initiative is forming partnerships with a wide range of nongovernmental organizations and others. For example, it is working with UNICEF to prevent children and adolescents from starting to smoke, and with the World Bank to develop more effective uses of excise tax and with academic centres to gather research.

More information is available at www.who.int/toh or www.idrc.ca/tobacco.

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