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Dr Adriana Blanco Marquizo became the new Head of the Secretariat of the WHO Framework Convention on Tobacco Control (WHO FCTC) on 1 March 2020. Before joining the Convention Secretariat, Dr Blanco Marquizo worked as Chief of the Risk Factors and Nutrition Unit in the Department of Noncommunicable Diseases and Mental Health at the Pan American Health Organization. She actively participated in tobacco control activities in her home country, Uruguay, which contributed to Uruguay becoming the first smoke-free country in the WHO Region of the Americas.
Could you describe your vision of how to accelerate implementation of the WHO FCTC, globally and within the WHO European Region?
In general, we will need to focus on the priority areas indicated by the Global Strategy to Accelerate Tobacco Control: Advancing Sustainable Development through the Implementation of the WHO FCTC 2019–20251 points to, which includes accelerating action, building alliances and partnerships, and protecting the integrity and building on the achievements of the Convention. We will also need to raise the profile of the Protocol to Eliminate Illicit Trade in Tobacco Products among Parties to the Convention in order to have more Parties and then strengthen implementation. Last but not least, we will need to raise awareness about the greatest obstacle to ending the tobacco epidemic: the tobacco industry.
The WHO European Region has the highest prevalence of tobacco smoking among adults (28%), in comparison with
1 See: https:// www .who .int/ fctc/ cop/ g -s -2025/ en/ .
the other WHO regions, including one of the highest smoking prevalence rates among women (19%). In addition to causing illness and death, tobacco remains a key driver of health inequities. Still, the European Region and its 53 Member States have witnessed some of the greatest gains in the fight against tobacco. For instance, 51 of the countries in the European Region (96%) have ratified the WHO FCTC. Only two – Monaco and Switzerland – have not. Also, large graphic health warnings on tobacco products are now in place in 32, or 60%, of the Region’s countries. Region-wide, tobacco taxes are at 75% or more of the retail price of a packet of cigarettes in 25 countries (47%). We also need to underscore how important the issue of enforcement is to the WHO European Region Globally, WHO also projects that the number of males using tobacco is on the decline for the first time ever, indicating that there has been a powerful shift in the global tobacco epidemic.
Still, despite this gain, most governments are not on track to meet the global target of cutting tobacco use by 30% by 2025 and will only achieve a 23% reduction. Only 32 countries
PANORAMA PEOPLE
Interview with
Dr Adriana Blanco Marquizo
By Jonathan Ewing
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worldwide, of which six are from the WHO European Region, are currently on track to reach the 30% target.
Still, the progress that has been made shows that it’s possible for countries to turn the tide if they accelerate implementation of the WHO FCTC, since the current trends mentioned above suggest that tobacco use is not decreasing as quickly as it should to meet the 2025 target.
Full implementation of the WHO FCTC and other relevant tobacco control measures in the Region, through the Roadmap of Actions,2 will help us all to achieve the set targets and ensure that no country is left behind.
How can novel and emerging tobacco products, often advanced by the tobacco industry itself, potentially pose regulatory challenges for the comprehensive application of the WHO FCTC? What approaches do you believe should be taken in relation to such products?
There has not been enough independent scientific research on so-called novel and emerging tobacco products to fully understand their relative danger. So that means that we must focus on product regulation areas such as their classification and decreasing the attractiveness of these emerging tobacco products. We need to do this because these products are creating another layer of interference by the tobacco industry and related industries.
What is particularly disturbing is the tobacco – or should we better say nicotine – industries’ systematic, aggressive and sustained marketing tactics to attract a new generation of tobacco users, including through the introduction of novel products, flavours and other attractive features. So for the moment the Secretariat of the WHO FCTC is calling for all concerned to remain vigilant as regards these emerging products and to follow the decisions made by the Conference of the Parties (COP) – which oversees the functioning of the treaty – with regard to those items.
The COP has also recommended that health claims being made about these products should be prohibited until they are scientifically proven. The COP plans to discuss a comprehensive report that is being prepared by the Secretariat and WHO on research and evidence on novel and emerging
2 See: http:// www .euro .who .int/ en/ about -us/ governance/ regional -committee -for -europe/ past -sessions/ 65th -session/ documentation/
working -documents/ eurrc6510 -roadmap -of -actions -to -strengthen -implementation -of -the -who -framework -convention -on -tobacco -control -in -the -european -region -20152025.
products, especially heated tobacco products, and their impact on the health of users and non-users, their addictive potential, and their potential role in initiating and quitting smoking. The COP will then propose potential policy options to achieve the objectives and measures required to help reduce the consumption of traditional and novel and emerging tobacco products.
Tobacco is increasingly recognized as fundamental to the global development agenda, and as incompatible with sustainable development. How do you propose that the Convention Secretariat can facilitate integrating tobacco control into other priorities and advancing the 2030 Agenda for Sustainable Development?
In 2011, the United Nations General Assembly High-level Meeting on the Prevention and Control of Non-communicable Diseases (NCDs) called for the accelerated implementation of the WHO FCTC, and in 2015, at the Third International Conference on Financing for Development in Addis Ababa, Ethiopia, increasing tobacco taxes was endorsed as a key strategy to reduce tobacco consumption and the global burden of NCDs and to help finance sustainable development. Also, in 2015, the WHO FCTC was recognized as a “means of implementation” for Goal 3 of the United Nations 2030 Agenda for Sustainable Development, which broadly calls for ensuring healthy lives and promoting well-being for all at all ages.
In many ways, and as per a report published by the United Nations Development Programme and the Secretariat, the WHO FCTC is an accelerator for sustainable development and it interacts with the 17 Sustainable Development Goals (SDGs) in the 2030 Agenda. Therefore, inclusion of the WHO FCTC within the 2030 Agenda is potentially a very real game-changer.
Following targets 3.a on strengthening the implementation of the WHO FCTC in all countries, as appropriate and 3.4 on reducing premature mortality from NCDs by one third and the promotion of mental health and well-being over the next 10 years, will raise the awareness of tobacco as a key sustainable development issue. This will help national governments and other stakeholders to commit to intensifying and harmonizing tobacco control efforts. That will underline the necessity of mobilizing resources for WHO FCTC implementation, and better align health financing priorities and reduce the epidemiological burden.
Increasing healthy life expectancy through tobacco control policies such as raising taxes on tobacco, would be an important investment in human capital.
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Sustainable development challenges the very existence of tobacco, and many argue that an integral approach to achieving the SDGs should be envisioning “endgame”
strategies for tobacco. While some believe that a tobacco- free era can be accomplished by adopting conventional and incremental measures within the WHO FCTC, others believe it needs to go beyond these, enhancing the measures within the treaty and proposing bold interventions. In your view, how can the “endgame” of tobacco be approached without diverting resources and distracting attention from immediate work regarding implementation of all WHO FCTC provisions?
In order to better protect human health, the WHO FCTC calls, in its Article 2, for Parties to implement measures beyond those required by the Convention and its protocols, explicitly saying that nothing in these instruments shall prevent a Party from imposing stricter requirements that are consistent with international law.
So, some of the endgame strategies for tobacco control include, for example: regulating nicotine levels to make tobacco products non-addictive or less addictive; implementing a kind of licensing procedure for smokers; and setting restrictions based on birth date – all part of an effort to create a tobacco- free generation.
The WHO FCTC offers a package of evidence-based and cost- effective measures, and some of them have been defined as
“best buys” by WHO (very cost-effective and effective measures that can be implemented even in constrained resource environments) that help to reduce tobacco consumption, such as: raising tobacco taxes, implementing 100% smoke- free legislation, requiring pictorial health warnings, and applying a total ban on tobacco advertisement, promotion and sponsorship.
Disclaimer:
The interviewee alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization.n
