White paper on tobacco takes a laudable stance

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7183.604a (Published 27 February 1999) Cite this as: BMJ 1999;318:604
  1. Derek Yach, Programme manager (yachd{at}who.ch),
  2. Eric LeGresley, Legal adviser
  1. Tobacco-Free Initiative, World Health Organisation, Geneva, Switzerland

    EDITOR—Whatever the domestic health impact of Britain's new white paper on tobacco,1 it will resonate loudly and positively around the world. The United Kingdom has done what few countries have done to date—it has formally recognised the global nature of the tobacco problem; accepted the necessity of international efforts to complement concerted domestic action; and acknowledged the responsibility of states to help internationally, both financially and technically.

    With tobacco on track to be the world's leading preventable cause of death within a couple of decades, with British health and legislative experience sorely needed around the world, and with a British tobacco company as a chief propagator of this carnage all over the globe, it is right that international tobacco control should move to centre stage at Whitehall.

    The white paper's pledge of strong and early support for a Framework Convention for Tobacco Control is particularly timely. With operations in more than 170countries, and revenues exceeding the gross domestic product of many countries in which their subsidiaries operate, global tobacco enterprises such as British American Tobacco adroitly sidestep many domestic tobacco control efforts. Spillover advertising, rampant smuggling, and abusive power politics mean that without effective international coordination of control policies, tobacco's present rapid escalation in the developing world will not be halted.

    Britain's stance sets the responsible standard other nations must match. Otherwise, these nations will have to account for why they sat silent and let today's one million annual tobacco deaths in the developing world escalate to seven million annually by 2025.

    Finally, a single criticism. Though most of the white paper is laudatory, its call for an international code of conduct for transnational tobacco companies, even while awaiting global legal controls on the industry's marketing, is likely to fail, as other voluntary agreements have done. Codes of conduct—voluntary by definition—have long been prominent in the tobacco industry's attempts to forestall effective controls on its activities.


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