How Should Global Tobacco Control Efforts Be Prioritized to Protect Children in Resource-Poor Regions?

Abstract

The tobacco industry's aggressive marketing of tobacco products and electronic (e-)cigarettes is well documented. Yet existing restrictions on tobacco and e-cigarette marketing are poorly implemented in most low-and middle-income countries. Ongoing challenges include weak implementation and enforcement of some aspects of the WHO Framework Convention on Tobacco Control and a lack of consensus among health professionals on how to address the tobacco industry's health claims related to e-cigarettes and other novel tobacco products. We argue that, despite these challenges, countries must prioritize the implementation and enforcement of restrictions on tobacco and e-cigarette marketing as these products represent not only a serious public health threat but also a violation of children's rights. Need for Tobacco Regulation The WHO (World Health Organization) Framework Convention on Tobacco Control (FCTC) entered into force in 2005 and, as of July 2019, it had 181 parties. 1 The FCTC lays out a number of demand-and supply-side measures to reduce tobacco use, including restrictions on direct and indirect tobacco marketing. Parties to the FCTC acknowledge that tobacco marketing, which comes in many forms (advertising, events sponsorships, promotions, point of sale displays, attractive packaging, innovative product designs, social media advertising) serves to encourage youth tobacco use. 2 Indeed, the greatest impediment to FCTC implementation has been the tobacco industry, 3 as its political influence and strategies have served to block, delay, or weaken tobacco marketing restrictions, particularly in low-and middle-income countries (LMICs). 4 www.amajournalofethics.org 136 The FCTC has had significant success in promoting tobacco control globally and in reducing the prevalence of tobacco use in several countries. 1,5,6,7 The 2019 WHO Report on the Global Tobacco Epidemic: Offer Help to Quit Tobacco Use estimates that the global prevalence of tobacco use declined from 22.5% in 2007 to 19.2% in 2017, with middle-income countries experiencing a lower rate of decline than high-and low-income countries. 1 Data from the 2019 report also indicate that tobacco use among youth remains high and that electronic (e-)cigarette use among youth has increased. The report estimates that 24 million 13-to 15-year-old children smoke and 13 million use smokeless tobacco products. 1

Justice without borders: Opportunities from France’s ‘Duty of Care’ Act applied to Uganda

“…Well-documented global examples illustrate companies that lose ability to operate in their home countries due to environmental or health risks-or who lose market profitability as consumers stop buying products-but then move their operations abroad, to benefit from weaker environmental or human rights oversight. Examples include Nestle's controversial marketing of infant formula, Coca-Cola and other companies selling sugar-heavy drinks, tobacco companies, pesticide and chemical manufacturers marketing to developing countries (Anakwue, 2019;Bialous & van der Eijk, 2020;Cheptegei & Yabs, 2016;Hastings et al, 2020).…”