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Global Tobacco Control:
WHO Framework Convention on
Tobacco Control (FCTC)
Ghazi Zaatari, MD Professor & Chair
Department of Pathology & Laboratory Medicine
American University of Beirut
Chair, Study Group on Tobacco Product Regulation
World Health Organization (WHO)
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Tobacco Regulation:
The Problem
1. The increased global epidemic of tobacco
use
2. The alarming rise in health hazards of
tobacco use (harm)
3. The lack of trust in the tobacco industry
and its unwillingness in regulating its
products
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63% of all deaths are caused by NCDs,
for which tobacco use is one of the
greatest risk factors
> 600 000 people die each year from exposure
to second-hand smoke
6 million Nearly 6 million people killed by
tobacco each year.
1 billion deaths by end of 21st century if the
pattern persists
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The Tobacco Epidemic - Today
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63% of all deaths are caused by NCDs,
for which tobacco use is one of the
greatest risk factors
> 600 000 people die each year from exposure
to second-hand smoke
6 million Nearly 6 million people killed by
tobacco each year.
1 billion deaths by end of 21st century if the
pattern persists
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The Tobacco Epidemic -
Tomorrow
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Tobacco Contents & Emissions
• At least 4800 chemicals have been
identified in particulate and gas phases of
smoke
• Many proven to be toxicants and
carcinogenic
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= tobacco smoke + charcoal products (+ foil) – “filtering effect”
hose
mouthpiece
body
bowl
head
coal
tobacco
water
Narghile waterpipe smoke
Differences with
cigarette
tobacco burn not self-sustaining
charcoal needed
“molasses” flavorings
order of magnitude higher flow
rates/puff volumes
long flow path with
bubbler/humidifier (produces
cool “smooth” smoke)
Photo credit: internet, source
unknown
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Single narghile use session Single cigarette
STUDY 1
(2003)
STUDY 2
(2005)
Tobacco type ma’assel ma’assel
Number of puffs 100 171
Puff volume, ml 300 530
Tobacco paste consumed, g 3.0 4.7
Charcoal consumed, g 5.2
“Tar”, mg 242 802 29
Nicotine, mg 2.25 2.96 2.39
CO, mg 145 22.5
PAH
Phenanthrene, ng 748 200-400*
Fluoranthene, ng 221 9 - 99***
Chrysene, ng 112 4 - 41***
Heavy metals
Arsenic, ng 165 40-120*
Beryllium, ng 65 300*
Nickel, ng 990 0-600*
Cobalt, ng 70 0.13-0.2*
Chromium, ng 1340 4-70*
Lead, ng 6870 34-85*
Waterpipe vs. Cigarette Toxicant yields
* Reported ranges for commercial cigarettes, Jenkins et al., 2000
**arithmetic mean for 1294 domestic cigarette brands tested by FTC for 1998 (FTC, 2000).
***LGC, 2002.
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Carcinomas desarrollados en la oreja de conejo con
alquitran de tabaco, a los 9 meses, Serie II
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Oral Cavity Lung
Bladder Larynx
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Air Monitoring in Lebanese Restaurants
G. Saade, Harvard School of Public Health
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Nicotine Addiction
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April 14, 1994 – The “7 CEOs” of Big Tobacco
testified that “Nicotine is not addictive”
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Tobacco Industry Influencing
ISO TC 126
“There are two international organizations
controlled by the industry: CORESTA and
ISO… CORESTA is 100% controlled by the
industry… ISO Technical Committee 126 is
made of approximately 80% industry… The
best way to work with these two organizations
is to do all the technical work within CORESTA
and then have it endorsed by ISO.”
Memorandum to MC Bourlas
March 19, 1990, Philip Morris
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WHO Framework Convention on Tobacco
Control (FCTC)
Adopted on May 21, 2003 at the 56th World
Health Assembly and entered into force on 27
February 2005; so far 176 parties to WHO
FCTC
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Preventing initiation
and uptake
Comprehensive Tobacco Control
Measures
Protecting
from second-
hand smoke
Promoting
cessation
Regulating
products
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FCTC- 38 Articles
• Objective, guiding principles and general
obligations
• Measures relating to the reduction of demand
for tobacco
• Measures relating to the reduction of demand
for tobacco
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FCTC • Protection of the environment
• Questions related to liability
• Scientific and technical cooperation and
communication of information
• Institutional arrangements and financial
resources
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FCTC
• Settlement of disputes
• Development of the convention
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Measures relating to the reduction of
demand for tobacco
• Article 8- Protection from exposure to
tobacco smoke
• Article 9- Regulation of the contents of
tobacco products
• Article 10- Regulation of tobacco
product disclosures
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Measures relating to the reduction of
demand for tobacco
• Article 11- Packaging and labeling of
tobacco products
• Article 12- Education, communication,
training and public awareness
• Article 13- Tobacco advertising,
promotion and sponsorship
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Measures relating to the reduction of the
supply of tobacco & Protection of environment
• Article 15- Illicit trade in tobacco
products
• Article 16- Sales to and by minors
• Article 18- Protection of the
environment and the health of persons
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FCTC - Article 5.3
• 1. Each Party shall develop, implement, periodically update and review
comprehensive multisectoral national tobacco control strategies,
plans and programmes in accordance with this Convention and the
protocols to which it is a Party.
• 3. In setting and implementing their public health policies with respect
to tobacco control, Parties shall act to protect these policies from
commercial and other vested interests of the tobacco industry in
accordance with national law.
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Tobacco advertising, promotion and sponsorship
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CHABABLIK: Arabic for Youth
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CHABABLIK: Arabic for Youth
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"The success of the FCTC as a
tool for public health will depend
on the energy and political
commitment that countries
devote to implementing it in the
next few years. The result will be
global public health gains for all.
The challenge we face is for the
treaty to make a difference
where it really matters - in
countries." Dr. J. W. LEE
Director General
2003
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POLITICAL WILL
Ministry of Health
Ministry of Finance Ministry of Justice
Ministry of Education
Ministry of Agriculture
PUBLIC AWARENESS NGOs Media
Health Professionals
Trade unions
INTERNATIONAL SUPPORT
WLF
Bloomberg Philanthropies
CDC
Donor countries
Gates foundation
INTERGOVERNMENTAL WORK
WHO Head quarter (TFI)
WHO Country offices
WHO Regional Office
UN task force
SCIENTIFIC EVIDENCE
JHBSPH
Researchers
IARC
WHO Collaborating Centres
WHO Framework Convention
on Tobacco Control
Working together
to curb the
tobacco epidemic