Tobacco treaty adds up: It's time for action

Anyone interested in public health or tobacco control efforts will find the following collection of numbers important.

For starters: Three. That's how many years it took nations from around the globe working through the World Health Organization to negotiate the terms of the Framework Convention on Tobacco Control. This document, which was unanimously adopted by the 56th World Health Assembly in May 2003, marked an important first. Never before had a global agreement been formulated to respond to the rising worldwide death toll of tobacco-related illnesses.

Here's another number: 5 million. That's the annual tally of lives claimed by smoking, making tobacco-related illness responsible for the death of one in 10 adults, according to WHO estimates. Seventy percent of these deaths occur in the developing world, making tobacco a more deadly force there than HIV/AIDS. Moreover, if current tobacco-use patterns continue, the totals also will grow, and by 2020 smoking will cause some 10 million deaths each year.

These mortality numbers represent the underlying imperative for the Framework Convention. But there are also figures that show how life-saving inroads could occur. WHO officials estimate that cigarette sales will decline by 1% to 2% annually as a result of implementing these international treaty rules. Many public health experts say that this will translate into millions of lives spared from the ravages of tobacco-related illnesses.

There is one more number: 57. This figure represents the countries that actually ratified the treaty by Feb. 27, the date it came into full force. The United States, which last year signed the FCTC, was not among this group.

This point has compelled the American Medical Association to urge the White House to take action. Long-standing AMA policy supports the WHO's international tobacco-control efforts and urges the U.S. government to participate fully.

In a Feb. 24 letter coordinated by the Campaign for Tobacco-Free Kids, the AMA joined with more than 60 medical and public health organizations to urge President Bush to send the Framework Convention to the U.S. Senate to be considered immediately for ratification. By law, the treaty requires the Senate's two-thirds approval.

It's an important step that the administration must take.

Ratification of the treaty is critical to ensuring that the United States remains a leader in protecting public health around the world. Never before has this leadership role been so important. Other nations -- especially lesser-developed ones -- will look in this direction for essential technical assistance in implementing the treaty's provisions.

Among them are requirements that tobacco companies disclose ingredients in cigarettes, print advisory labels that cover no less than 30% of cigarette packs and no longer use terms such as "ultra light" or "light." Additionally, it calls on participating nations to impose high taxes on tobacco products and enact stringent measures against cigarette smuggling.

Countries that ratify the FCTC are required to implement these rules by enacting national laws and regulations. For instance, they will have three years from when they join to enact health-warning and packaging measures.

Timing also compels the United States to follow through in its commitment now. Some public health experts say the nation's failure to do so will leave it on the sidelines at a critical juncture.

The United States cannot vote as a member of the FCTC governing board until it ratifies the document, leaving it unable to guide early key decisions that are made in terms of how the treaty body functions. It also will not be able to participate in the treaty's "conference of parties" and, therefore, will not be part of the forum that exchanges valuable technical and scientific information integral to the FCTC's success.

Many of the controls laid out in the landmark Framework Convention already are in place in the United States. But in issues such as this one, where lives are at stake, the perspective must be global.

This treaty provides many countries with more tools to control tobacco use. It does so in a coordinated manner that reduces the loopholes across national borders that in the past have allowed the tobacco industry always to find new opportunities and footholds.

Clearly, the time for action is now -- a reality underscored by one last number: tens of thousands. That's how many lives tobacco claims or harmfully affects worldwide each day.

The White House should send the Framework Convention on Tobacco Control to the Senate. The Senate, in turn, should ratify it. The result will be heard and felt around the world.