Tob Control doi:10.1136/tc.2009.035352
  • Research paper

International trade versus public health during the FCTC negotiations, 1999-2003

  1. Stanton A Glantz3
  1. 1Department of Health Services Administration, College of Public Health, USA
  2. 2Independent consultant, USA
  3. 3Department of Medicine and Center for Tobacco Control Research and Education, University of California, San Francisco, USA
  1. Correspondence to Dr Hadii Mamudu, Department of Health Services Administration, College of Public Health, East Tennessee State University, S Dossett Drive, Lamb Hall, PO Box 70264, Johnson City, TN 37614, USA; mamudu{at}
  1. Contributors HMM and RH identified the debate over the relation between trade and health during the FCTC negotiation as important subject and did the data collection for this paper and wrote the first draft. RH assisted in identifying important documents and reviewed the final revised manuscript. SAG supervised the project and participated in preparing all versions of the manuscript.

  • Received 10 December 2009
  • Accepted 6 June 2010
  • Published Online First 13 October 2010


Objective To examine why the Framework Convention on Tobacco Control did not include an explicit trade provision and delineate the central arguments in the debate over trade provision during the negotiations.

Methods Triangulate interviews with participants in the FCTC negotiations, the FCTC negotiations documents, and tobacco industry documents.

Results An explicit FCTC trade provision on relation between international trade and public health became a contentious issue during the negotiations. As a result, two conflicting positions, health-over-trade and opposition to health-over-trade emerged. Opposition to explicit trade language giving health priority was by both tobacco industry and countries that generally supported strong FCTC provisions because of concerns over ‘disguised protectionism’ and setting a precedent whereby governments could forfeit their obligations under pre-existing treaties. Owing to lack of consensus among political actors involved in the negotiations, a compromise position eliminating any mention of trade emerged, which was predicated on belief among some in the public health community that public health would prevail in future trade versus health conflicts.

Conclusion The absence of an explicit FCTC trade provision was due to a political compromise rather than the impact of international trade agreements and decisions on public health and lack of consensus among health advocates. This failure to include an explicit trade provision in the FCTC suggests that the public health community should become more involved in trade and health issues at all levels of governance and press the FCTC Conference of the Parties for clarification of this critical issue.


  • Funding Legacy Foundation, USA; and National Cancer Institute, USA.

  • Competing interests HMM has no competing interest to declare. RH was the head of the lobbying committee for the Framework Convention Alliance during the negotiations and participated actively in the discussions over the role of trade in the FCTC. SAG was present for part of INB6 and met with WHO Director General Gro Harlem Bruntlund regarding the (lack of) necessity to compromise the FCTC to increase the chance that the USA (under the George W Bush Administration) would ratify the treaty; SAG was not involved in any of the issues discussed in this paper.

  • Ethics approval This study was conducted with the approval of the Institutional Review Board of University of California, San Francisco.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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