Health ministers from around the world made medical history yesterday by adopting the first global treaty designed to curb the tobacco industry.
The Framework Convention on Tobacco Control agreed at the World Health Assembly in Geneva provides for a general ban on tobacco advertising and promotion except in countries such as the United States where a total prohibition would violate the constitution.
It says hard-hitting health warnings, including pictures such as diseased lungs, should take up at least half the packet and urges the use of pricing and taxation to persuade people to give up. It also provides for tough measures to restrict smoking in public places and to cut cigarette smuggling.
It is the first global public health treaty agreed by the 192 members of the World Health Organisation and was hailed as a milestone in the battle against one of the world's biggest killers.
Dr Gro Harlem Brundtland, director general of the World Health Organisation, said yesterday: "We are acting to save billions of lives and protect people's health for generations to come. This is a historic moment in global public health, demonstrating the international will to tackle a threat to public health head on."
The treaty, which has taken four years to negotiate, will come into force when 40 countries have ratified it, in line with the requirements of their national constitutions. Most delegates at the assembly indicated yesterday that their governments would move swiftly to sign the treaty, including the European Union - which overcame German opposition - China, the world's biggest manufacturer and consumer of cigarettes, and Japan, where the government has a majority stake in Japan Tobacco International.
The treaty was almost wrecked last month when the US wrote to all WHO member nations urging the inclusion of a clause allowing governments to opt out of any part of the treaty they found unacceptable. The proposal was thrown out and countries will now be asked to ratify the treaty in its entirety.
The US health secretary, Tommy Thompson, said he wished to "adopt and celebrate" the treaty but then added that Washington was "reviewing the text of the convention", indicating that no decision had been made about signing it.
Deborah Arnott, director of Ash, the anti-smoking pressure group, said: "One by one countries declared their strong support for the treaty as it stood, and it was adopted as is. It was a slap in the face for the US which rather grudgingly agreed to adopt but said it would be reviewing the text before going any further."
There are an estimated 1.25 billion smokers in the world, and nearly 5 million die each year from cancer and other smoking-related diseases. This is expected to double over the next 20 years. The WHO estimates that one in five 13-15 year-olds smokes and says the percentage is rising, especially among girls.
Professor Sir Richard Peto, director of the Cancer Research UK Oxford unit, said: "This treaty is part of a global solution to a global problem. Worldwide the only two big causes of death that are getting bigger fast are tobacco and HIV."
Jean King, director of tobacco control for Cancer Research UK, said the treaty was a "monumental achievement" to rival that on climate change agreed at Kyoto, Japan, and would be particularly important in developing countries where it would empower governments to resist the tobacco industry.
The effectiveness of the treaty will depend on how governments implement it in national law and whether there is sufficient political will to enforce it.
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