Why countries like Nepal cannot implement the Tobacco Control Act very effectively ?

[PHP Nepal Vol 2 Issue 6 Jun 2012] | In 2010, World Health Organization (WHO) estimated there were around 1.3 billion smokers in the world. Among them, more than 80% lived in low and middle income countries, where  the burden of tobacco-related illness and death is high. In response to this tobacco pandemic, WHO promulgated the Framework Convention on Tobacco Control (FCTC) in 2003, which came into effect on 27 February 2005.

The global increase in tobacco consumption originates from factors such as the global marketing and advertising of tobacco, promotion and sponsorship from transnational tobacco companies, trade liberalization and direct foreign investment, and the international movement of counterfeit cigarettes. To understand global tobacco consumption it is necessary to go beyond the normal considerations of health and diseases and to consider impacts of trade globalization. Indeed, rapid increases in tobacco use are largely attributable to liberalization of trade.

There are numerous instances in which contradictions exist between FCTC and World Trade Organization (WTO) agreements. There is the principle of WTO on tax reduction which results in lowering of imported consumer goods prices like cigarettes.  However, overwhelming evidence has shown that increase of taxation on tobacco product is the single most effective tobacco product control measure. Clean indoor air rules, including banning smoking in restaurants and bars, are likely to decrease cigarette consumption.  Arguments by entertainment and restaurants against this ban revolve around the potential loss of revenues and jeopardize company profits.

Tobacco companies have often complained that use of large warnings label violates their trademark intellectual property rights. Tobacco companies also argued plain paper packaging regulation as enforced by WHO would violate numerous rights under WTO Agreements.

Despite WHO’s proposal to ban the use of misleading terms like mild, low, light etc, tobacco companies insist on the use of such terms to make consumers aware of the difference in taste of different tobacco products. Lastly, if countries agree to the General Agreement on Tariffs and Trade (GATS) rules under WTO affecting advertising, a ban on cigarette advertising could be challenged as trade violations. Wholesale and retail licensing controls on vending machines and restrictions on sales to children could be subject to challenge under rules governing distribution services in GATS.

Consequently, there is a built-in conflict between trade liberalization and public health. WHO recommendations for comprehensive tobacco control programs are to some extent countered by the WTO’s trade agreements which prioritize trade over health. At present there are 175 countries ratified the FCTC, Nepal ratifying on 7 November 2006 and 155 countries are member of WTO, Nepal became a member on 23 April 2004.WTO penalty countries if trade agreements are not strictly followed while there is no mandatory for enforcing FCTC.

Specifically in Nepal, implementation of the legislation is weak due to unstable government. Likewise, health awareness is less among general citizen and awareness campaign by the government, key stakeholders and media is lacking behind. Thus, countries like Nepal face significant opposing forces that make implementing tobacco control policies very difficult due to a high priority put by the country on trade to the detriment of citizens’ health. 

Bikesh Bajracharya is a MPH (Global Health) student at Thammasat University, Thailand.

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