Education And Debate

WHO Framework Convention on Tobacco Control: development of an evidence based global public health treaty

BMJ 2003; 327 doi: (Published 17 July 2003) Cite this as: BMJ 2003;327:154
  1. Kenji Shibuya, scientist, global programme on evidence for health policy (,
  2. Christina Ciecierski, health economist, global programme on evidence for health policy1,
  3. Emmanuel Guindon, economist, research policy and cooperation1,
  4. Douglas W Bettcher, coordinator, Framework Convention On Tobacco Control2,
  5. David B Evans, director, global programme on evidence for health policy1,
  6. Christopher J L Murray, executive director1
  1. 1Evidence and Information for Policy, World Health Organization, CH-1211, Geneva 27, Switzerland
  2. 2Tobacco Free Initiative, World Health Organization
  1. Correspondence to: Kenji Shibuya
  • Accepted 4 June 2003

Many health problems require international action, but getting governments to agree on strategies for prevention or treatment is difficult. By making use of scientific evidence on the effects of tobacco, the member states of WHO have negotiated their first global health treaty. If the treaty can be implemented effectively, it could act as a possible model for tackling other health issues

When Dr Gro Harlem Brundtland became director general of the World Health Organization in 1998, she clearly stated that the tobacco epidemic should be tackled by an international collective action and that WHO should take a leadership role.1 In 1999, WHO started work on the WHO Framework Convention on Tobacco Control, which was endorsed by member states on 21 May 2003. It is the first time WHO has used its constitutional authority in global public health to develop a legal instrument aimed at improving population health. The initiation and negotiation of the framework convention was based strongly on the accumulation of scientific evidence.2 We review the development and scientific basis of the convention and discuss its implications and the potential of international collective action against threats to global public health.

Developing a framework convention

The structural basis for framework conventions is to use an incremental process in making law. It begins with a framework convention that establishes a general consensus on the relevant facts and the system of governance for an issue. This is followed by the development of more specific commitments and institutional arrangements in subsequent protocols.3 However, depending on the political will, framework conventions can also include quite specific provisions. In the case of the WHO Framework Convention on Tobacco Control, the powerful political momentum behind the treaty has ensured that several detailed provisions have been incorporated into the final text.4

The framework convention is the first …

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