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Worldwide news and comment
  1. Marita Hefler
  1. Darwin, Northern Territory, Australia
  1. Correspondence to Marita Hefler, Menzies School of Health Research; marita.hefler{at}

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Timor Leste: world’s largest graphic health warnings

The journey of tobacco control in Timor-Leste dates back to 2004, just two years after the country became independent in 2002. Timor-Leste ratified the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) in December 2004, which came into force in March 2005.

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The ratification of the FCTC, however, did not immediately translate into effective measures for tobacco control. A breakthrough in tobacco control was the decree-law passed in 2006 which dealt with health warning labels, tax control of manufactured tobacco products, and customs duties. Although the law is testament to the Government’s commitment to tobacco control in the island nation, implementation remained a formidable challenge and was admittedly lax given the lack of resources and limited technical capacity. The passage of the first decree law in 2006 was followed by a number of other laws; however, implementation remained weak.

In 2006, the Ministry of Health (MoH) conducted the first-ever Global Youth Tobacco Survey (GYTS) which revealed alarmingly high youth tobacco use prevalence at 41%. The subsequent Noncommunicable Diseases (NCD) STEPS survey in 2014 showed tobacco use prevalence among male adults was 70%. This evidence opened doors for tobacco control advocacy at the highest political level, resulting in the passage of comprehensive tobacco control legislation in 2016. This was the beginning of a wide range of tobacco control measures – community engagement, dissemination of NCD STEPS findings, and most importantly, the enforcement of tobacco products packaging provisions laid out in the law.

The tobacco control law was a watershed moment in the public health sphere, given the inordinately high prevalence in such a young country with a nascent health system and a large proportion of young people. The then Prime …

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