President Clinton is known to be strongly against tobacco, but it remains unclear whether his government will actively support the World Health Organization Framework Convention on Tobacco Control (FCTC). At the first meeting of the working group on the FCTC in Geneva in October 1999, the well prepared US delegation was only in favour of addressing non-compliance with FCTC requirements by consultations and diplomatic means, not by binding mechanisms. It seemed that the American delegation could only accept what was already in place in the USA, or what did not need to be ratified by the Senate. A total ban on advertising was certainly not acceptable for “constitutional” reasons.

The attitude of the American delegation at the WHO consultative technical conference on the FCTC in New Delhi from 7 to 9 January 2000 was even worse. The aim of this meeting was to obtain a developing country perspective towards the negotiation of the WHO framework convention with participants from 50 developing countries. The draft resolution of the conference was discussed in the working groups and did not call for a total ban on advertising but mentioned, “deploring all direct advertising, marketing, promotion, sponsorship, and other practices by the tobacco industry aimed at encouraging the use of tobacco”. The American delegates in two working groups asked to add “advertising . . . aimed at encouraging the use of tobacco by children and young adults”.

According to the American delegation, the text without their suggested addition could imply a total ban on tobacco advertising, which was unacceptable to their government. In my working group there was no agreement to accept this addition, but I was surprised that the addition was finally included in the final declaration. When the chairman of the meeting asked in the final plenary session whether everybody could agree with the final declaration, I asked for the floor and proposed to add one word—“especially”—to the declaration, as follows: “encouraging the use of tobacco, especially by children and young adults”. My main justification was that advertising is not only aimed at youngsters or young adults. The promotion of light cigarettes, for example, has kept many middle aged people smoking who otherwise could have stopped. Even the US surgeon general's report of 1998 admits that advertising might increase tobacco consumption by encouraging adults to take up smoking or undermining existing smokers' motivation to give up.

The addition of the word “especially” was, however, not acceptable to the American delegation, and after some discussion it was decided to keep the declaration as it was. My feeling was that the American delegation had been overreacting. I do not see the link between a consideration in a consultative technical conference resolution and the automatic obligation for all countries to ban all tobacco advertising. But, even more worrying, it seems that the most powerful country in the world, and the home country of the world's largest international cigarette producer, may not fully support an international solution for an international problem. A bitter disappointment for health can only mean big satisfaction for the tobacco industry in its global war against health.

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This poster for the US women's soccer team highlights the fact that all the players are non-smokers, regularly lending their celebrity status to help the fight against smoking among young American women.