The Head of Secretariat of the World Health Organisation Framework Convention on Tobacco Control (WHO-FCTC) Adriana Blanco Marquizo spoke to Vincent Owino on how the region can step up tobacco control.
Your country, Uruguay, is among the few countries that have successfully become smoke-free. What lessons can Kenya and East Africa pick up on tobacco control?
In Latin America all the countries are now smoke-free. But Uruguay was the first in the region to be smoke-free, and, of course, as the first one, it was more difficult.
But the important thing is to inform the population why you’re looking for a smoke-free environment, so they can understand that you’re not trying to ban smoking, but just regulating where one can smoke.
Why regulate? Because there’s a proven health damage to those exposed to tobacco smoke.
Then, you can show and prove that it’s not only non-smokers who’ll benefit from this but also the smokers because they’ll smoke less and get incentivised to quit.
Also, it is important to learn that there’s a human rights aspect to it as well. There’s one group of people that cannot avoid smoke from tobacco –those who work in designated or common smoking areas, like bars or restaurants. So, tobacco control laws should seek to protect everyone.
I think now it’s much easier to do it than when Uruguay did it in 2006, because now there are experiences to learn from.
What role does political will play in making a country smoke-free?
Political will is necessary because this is a regulatory issue. But we have to assume that countries that are parties to the WHO-FCTC are committed to comply with the measures of the convention.
In terms of the economics costs, I would say it’s not a problem because it requires a very low enforcement capacity. In Uruguay, when we started to do this, we had only four people working in enforcement in the Ministry of Health.
Sometimes what governments say regarding tobacco control is different from what they do. What can be done to ensure parties to the FCTC keep their commitments?
Countries are sovereign – they can do what they think is best. But still, countries that are parties to an internationally legally binding instrument are supposed to comply with it. They need to know that they’ll have peer scrutiny on what they’re doing because we have 182 parties to this treaty.
At national levels, civil society groups play a big role and that’s why even in the convention itself in Article 4.7, the importance of their participation in the implementation of the treaty is highlighted. It is the civil society groups that can hold the governments accountable.
Have there been cases where a country chooses to not comply with the treaty?
Yes. But the beauty of the convention is that it covers not only reduction of demand, but also of supply. So, if a country wants to increase, say, their exports on tobacco, they won’t find a market for it because other countries are decreasing their tobacco consumption and hence imports. That’s why the convention needs to be taken as a whole.
Why do you think tobacco control deserves similar attention to climate change mitigation?
Tobacco use is a very important problem because it’s killing eight million people every year. We cannot fail to pay attention to something that is the biggest killer in the world.
Beside the production and manufacture of tobacco is bad for the environment. The soil used to plant it is usually depleted and cannot always be used for other crops. They consume a lot of pesticides, fertilisers and water, which negatively impact the environment. On top of that, cigarette filters are a problem because they are plastic and contribute to the micro plastic pollution of the world. That’s why I think we have common grounds to work together.
Do you support the emerging alternatives like smokeless cigarettes and nicotine pouches?
There’s no scientific research to prove that they are entirely safe. They could be safer than the heated tobacco products, but that doesn’t mean they’re good. For example, jumping from the 10th floor of a building is probably safer than jumping from the 45th floor, but you’d probably end up dead anyway.
The nicotine products have not been there long enough so there’s not enough research to tell what exactly are their risks. You may be exposed to very little of something, but still have the same risks as someone who’s exposed to too much of it. The WHO has not identified them as something that can be used for cessation.
I know the tobacco industry say they want these products for smokers to give them a safer alternative, but the reality is that they’re marketing them to the youth.
But we don’t want the youth to take them because we don’t know that they’re safe. They might be safer for the smokers but for young people, they shouldn’t begin. It’s riskier for them, because they impair brain development.
So, how do you suggest these alternatives be regulated?
Countries have two options: either to ban them, or regulate them. Some countries have chosen to ban them until the science is clear. What’s not an option is leaving them in the market without regulations.
But they can be regulated either as tobacco products, as pharmaceuticals, or as consumer goods. Whichever way a country chooses, the goal should be to protect public health and young people.
What is your key takeaway from your visit to Kenya?
I’m generally pleased with what I’ve seen. Apart from being a party to the FCTC, Kenya is also a party to the protocol to eliminate illicit trading of tobacco. Of course, there are things that can still be done to improve the implementation. For example, taxes can be increased more to reach the level where they will impact consumption of tobacco.