The Framework Convention on Tobacco Control: promising start, uncertain future.

member states of the 56th World Health Assembly unanimously adopted the first global health treaty, the Framework Convention on Tobacco Control (FCTC). A groundbreaking treaty which aims to curb tobacco use worldwide, the FCTC holds the potential to help reverse the global tobacco epidemic, particularly in low income countries. With tobacco projected to claim a billion lives this century, 1 the stakes could hardly be higher. According to the World Bank, tobacco is responsible for half the diseases and deaths in developing countries. 2 Although described by the tobacco industry as a " developed world obsession being foisted on the developing world " *, it was in fact developing countries which saved the FCTC from being gutted by a handful of developed countries which have no intention of ever implementing most of its provisions. Unlike other treaties , where developed countries dominate the debate, developing countries were vocal, spirited, and led the charge for most of the progressive provisions. The final agreement, reached after nearly four years of diplomatic manoeu-vering and at times acrimonious negotiations, provides the basic tools for countries to enact comprehensive tobacco control legislation. Key obligations in the treaty encourage countries to: • enact comprehensive bans on tobacco advertising, promotion, and sponsorship • obligate the placement of rotating health warnings on tobacco packaging that cover at least 30% (but ideally 50% or more) of the principal display areas and can include pictures or pictograms • ban the use of misleading and deceptive terms such as " light " and " mild " • protect citizens from exposure to tobacco smoke in workplaces, public transport, and indoor public places • combat smuggling, including the placing of final destination markings on packs • increase tobacco taxes. 3 Although laudable, few of these measures were made obligatory, a direct result of intense pressure from a handful of countries, particularly the USA, Japan, and Germany. This means that in many cases it will be up to individual countries to decide how far to go in implementing the treaty. Fortunately, the FCTC explicitly encourages countries to implement measures that are stronger than the minimum standards required by the treaty. Enthusiasm for the treaty is running high. Within the first week that the FCTC was open for signature, 41 countries from all six World Health Organization regions, as well as the European Community , had officially signed the treaty. The next step will …