Tobacco Harm Reduction and the right to health

16 of the Independent High Level Commission on NCDs. 49 The report references the “common understanding” reached at the UN General Assembly in 2018 that “progress and investment to date is insufficient” to reduce premature death and disability from NCDs by 2030 (SDG 3.4). 50 On tobacco – a leading cause of NCDs – the Commission’s final report offers nothing but demand reduction. To reach the goal of reducing deaths from NCDs among the 30 – 69 age group by one third by 2030 (SDG 3.4.1), the Commission predicts that a massive 50% prevalence reduction in tobacco smoking worldwide is required. But no countries have ever achieved a 50% drop in smoking using mainstream tobacco control measures. It cannot be done – especially as the Commission also notes that MPOWER is currently fully implemented for less than 0.5% of the world’s population. 51 The only other mention of tobacco is in reference to the continued “exclusion of the tobacco industry and non-State actors that work to further the interest of the tobacco industry in line with the WHO Framework Convention on Tobacco Control (FCTC).” 52,53 However, the WHO does not try to exclude countries from participating in FCTC meetings even if their governments own substantial shares in the tobacco industry. The scale of the problem, and the limitations of current tobacco control measures, points to the urgent need for tobacco harm reduction to become part of the solution. Given its leadership and influential role in global health policy, the full benefits of tobacco harm reduction in tackling non-communicable diseases – especially for the 80% of smokers who live in low- and middle-income countries – can only be realised if the WHO overcomes its antipathy towards it. Harm reduction and the WHO Framework Convention on Tobacco Control A close look at the WHO FCTC reveals there are, in fact, three strategies the Convention defines as making up tobacco control: “For the purposes of this Convention, ‘tobacco control’ means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke.” (emphasis added) The Framework Convention on Tobacco Control 2005, Article 1d. 54 49 The Independent Commission (October 2017 - October 2019) was convened to “advise [the Director General] on bold and at the same time practical recommendations on how to transform new opportunities to enable countries to accelerate progress towards SDG target 3.4 on NCDs.” WHO Independent High Level Commission on Non-Communicable Diseases, Terms of Reference (publication date unknown). https://www.who.int/ncds/governance/high-level-commission/NCDs-High-level-Commission-TORs.pdf?ua=1 50 WHO, Independent High Level Commission on Non-Communicable Diseases Final Report (December 2019) https://who.canto.global/b/JG898 (Password 689764) 51 WHO, Independent High Level Commission on Non-Communicable Diseases Final Report (December 2019) https://who.canto.global/b/JG898 (Password 689764) 52 WHO, Independent High Level Commission on Non-Communicable Diseases Final Report (December 2019) https://who.canto.global/b/JG898 (Password 689764) 53 Article 5.3 of the WHO FCTC: 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. WHO (2005) Framework Convention on Tobacco Control. https://www.who.int/tobacco/framework/WHO_FCTC_english.pdf 54 WHO (2005) Framework Convention on Tobacco Control. https://www.who.int/tobacco/framework/WHO_FCTC_ english.pdf Image: Ray Reyes on Unsplash