International strategy for tobacco control

The enormity and the gravity of the present and future worldwide tobacco epidemic make urgent the adoption and implementation of an international instrument for tobacco control. Although 91 countries have enacted national tobacco control legislation, many countries still have weak or no legislation and limited response to the dangers of tobacco use. The aggressive marketing practices of the multinational tobacco companies threaten the lives and health of the people in both developing and industrialized countries.
An international instrument for tobacco control is justified by an incontrovertible science base demonstrating that tobacco use is the largest single cause of preventable, premature death and disease. The political feasibility of achieving an international instrument for tobacco control depends to a great extent on its content. Considering World Health Assembly (WHA) resolutions, existing national legislation on tobacco control, and recommendations of the Ninth World Conference on Tobacco and Health, the authors suggest priorities for legislation and economic policies.
The legal authority of World Health Organization (WHO) and the United Nations (UN) General Assembly to sponsor, adopt, and implement an international instrument for tobacco control is set forth. The various options for an international instrument are analyzed, including the advantages and disadvantages of each. Non-binding instruments include (i) intergovernmental resolutions, and (ii) intergovernmental codes of conduct. Legally binding instrument include (i) comprehensive treaties or conventions, (ii) the convention-protocol approach, and (iii) international regulations. Precedents for each of these types of international instrument are described.
A brief exploration of the impact of the General Agreement on Tariffs and Trade (GATT) / World Trade Organization (WTO) on an international instrument for tobacco control concludes that GATT/WTO obligations should not interfere with the capacity of states to adopt and enforce national measures in accord with an international tobacco control instrument.
Strategies for implementing an international instrument for tobacco control are reviewed, including (i) a system of national monitoring and reporting and (ii) an international tobacco control fund. The important roles of other international agencies and nongovernmental organizations in the implementation process are noted.
Finally, after a summary of the issues to be decided, a proposal is submitted for a feasible and effective combination of international instruments - non-binding instrument sponsored by the General Assembly of the UN and a legally binding framework-protocol convention sponsored by the World Health Organization. (Author's abstratc)