Global tobacco control: U.S. must prove its mettle

On May 10, an important international health event took place at the United Nations in New York. Health and Human Services Secretary Tommy Thompson added his signature to the Framework Convention for Tobacco Control, making the United States the 108th nation to sign on to this landmark treaty, the first-ever global health agreement negotiated by the World Health Organization. Forty countries now must ratify it before it can be used as a basis for advancing international public health.

For the United States to be counted among this number, two things must happen. First, the Bush administration must send the signed treaty to the Senate. Second, the Senate must approve it by a two-thirds majority.

The American Medical Association has long urged such action. By stepping forward in this manner, the United States can prove its mettle regarding global tobacco control and continue to be an international leader in this effort.

Specifically, the treaty requires ratifying nations to eliminate all tobacco advertising, promotion and sponsorship, with a narrow exception for nations such as the United States that have constitutional constraints on a complete ban. It requires warning labels to occupy at least 30% of the front and back of every pack of cigarettes and prohibits tobacco product descriptors, such as light and mild.

It also commits nations to protect nonsmokers from tobacco smoke in indoor workplaces, urges the strict regulation of tobacco product contents, and calls for higher tobacco taxes and global coordination to fight tobacco smuggling. The treaty also promotes tobacco prevention, cessation and research programs.

Just over a year ago, the treaty's first hurdle was cleared. The World Health Assembly -- including the U.S. delegation -- unanimously approved the Framework Convention. In the months since, at least 18 nations have ratified it.

But each day that has passed also has added to the death toll and to the imperative for other nations -- especially the United States -- to follow suit.

In the same 12 months, for instance, an estimated 440,000 Americans died from tobacco-related ailments, with a price tag for these illnesses of about $157 billion.

Keep in mind that these are domestic numbers. Statistics indicate an even more foreboding international picture. The WHO projects that the number of smokers worldwide will grow to 1.7 billion, from the current 1.3 billion, in 20 years. At the current rate, tobacco will be the world's No. 1 cause of premature death by 2030. In Asia alone, tobacco-related deaths are expected to increase four times by that year as the number of smokers in that region continues to grow, particularly among women and children.

That's why it has been the position of the AMA that reducing both supply and demand for tobacco worldwide saves lives. The FCTC sets out the basic principles that will help countries do exactly that through their own legal systems. The FCTC would have the greatest impact in the developing world, where 70% of new tobacco deaths are occurring.

Meanwhile, research continues to uncover new facts on the far-reaching dangers of smoking. It offers even more reason the convention is necessary. Last month, the U.S. surgeon general released a report concluding for the first time that smoking causes diseases in nearly every organ of the body. It also linked smoking to diseases such as leukemia, cataracts, pneumonia, and cancers of the cervix, pancreas and stomach.

Most Americans agree that the United States should sign "a tough international treaty to protect the world against the spread of tobacco-related death and disease," according to a recent American Cancer Society survey. Sixty-six percent of those contacted by phone as a part of a representative sample of 1,007 U.S. adults either strongly or somewhat favor the treaty, while only 25% strongly or somewhat oppose it.

The Framework Convention offers the United States an important opportunity to be an international leader in tobacco control and public health. The Bush administration and the Senate should act quickly to help this treaty come into force.