Global Tobacco Control: U.S. Efforts Have Primarily Focused on Research and Surveillance

The majority of those deaths occur in low- and middle-income countries. To address this problem, WHO's Framework Convention on Tobacco Control (FCTC) was adopted by the World Health Assembly in 2003 and came into force in 2005. The FCTC's stated objective is to protect people from the consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for implementing tobacco control measures at the national, regional, and international levels. The U.S. government signed the FCTC in 2004 but has not ratified it. The Department of Health and Human Services (HHS), the U.S. Agency for International Development (USAID), and the Department of State (State) engage in global tobacco control efforts. According to WHO, in 2016, 1.1 billion people worldwide smoked tobacco and at least 380 million used smokeless tobacco. Eighty-seven percent of smokers and 65 percent of smokeless-tobacco users were male. WHO also estimated in 2016 that about 20 percent of adults worldwide were tobacco smokers during that year and that about 7 percent of children aged 13 to 15 years worldwide were cigarette smokers. WHO's primary role is to direct and coordinate international health programs within the UN system. Its main areas of work include noncommunicable and communicable diseases as well as preparedness, surveillance, and response. WHO's Department for the Prevention of Noncommunicable Diseases focuses on reducing the major risk factors for noncommunicable diseases, including tobacco use. In particular, its Tobacco Free Initiative focuses on three core areas of global tobacco control: (1) tobacco control economics, (2) national capacity building, and (3) surveillance and information systems for tobacco control. WHO is funded through assessed and voluntary contributions, including contributions from the United States. The FCTC was the first treaty negotiated under WHO auspices. The treaty includes 38 articles addressing issues such as the reduction of demand for tobacco, the supply of tobacco, and scientific and technical cooperation between treaty parties. Because the U.S. government has not ratified the FCTC, the United States has observer status, does not have the right to vote in the FCTC Conference of the Parties, and is not legally bound by the treaty's provisions. WHO identified five key measures that promote evidence-based tobacco demand reduction, which are outlined in the treaty articles. These measures include increasing taxation, anti-tobacco advertising, and protecting people from second-hand smoke. The U.S. government's global tobacco control efforts are primarily focused on research and surveillance. The Department of Health and Human Services (HHS), the U.S. Agency for International Development (USAID), and the Department of State (State) engage in global tobacco control efforts. HHS's Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), National Institutes of Health (NIH), and Office of Global Affairs are involved in global tobacco control efforts. USAID's Global Development Lab obligated funds for tobacco control awards during the period covered by the review. The U.S. government's global tobacco control efforts are primarily focused on providing funding and technical assistance to international organizations and countries to support their tobacco control efforts.