The ‘diverse, dynamic new world of global tobacco control’? An analysis of participation in the Conference of the Parties to the WHO Framework Convention on Tobacco Control

INTRODUCTION The increasingly inequitable impacts of tobacco use highlight the importance of ensuring developing countries' ongoing participation in global tobacco control. The WHO Framework Convention on Tobacco Control (FCTC) has been widely regarded as reflecting the high engagement and effective influence of developing countries. METHODS We examined participation in FCTC governance based on records from the first four meetings of the Conference of the Parties (COP), comparing representation and delegate diversity across income levels and WHO regions. RESULTS While attendance at the COP sessions is high, there are substantial disparities in the relative representation of different income levels and regions, with lower middle and low income countries contributing only 18% and 10% of total meeting delegates, respectively. In regional terms, Europe provided the single largest share of delegates at all except the Durban (2008) meeting. Thirty-nine percent of low income countries and 27% of those from Africa were only ever represented by a single person delegation compared with 10% for high income countries and 11% for Europe. Rotation of the COP meeting location outside of Europe is associated with better representation of other regions and a stronger presence of delegates from national ministries of health and focal points for tobacco control. CONCLUSIONS Developing countries face particular barriers to participating in the COP process, and their engagement in global tobacco control is likely to diminish in the absence of specific measures to support their effective participation.