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Impact of the WHO FCTC on tobacco control: perspectives from stakeholders in 12 countries
  1. Lorraine Craig1,
  2. Geoffrey T Fong1,2,3,
  3. Janet Chung-Hall1,
  4. Pekka Puska4
  5. for the WHO FCTC Impact Assessment Expert Group
    1. 1 Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
    2. 2 School of Public Health and Health Systems, Waterloo, Ontario, Canada
    3. 3 Ontario Institute for Cancer Research, Toronto, Ontario, Canada
    4. 4 National Institute for Health and Welfare, Helsinki, Finland
    1. Correspondence to Lorraine Craig, University of Waterloo, Waterloo N2L3G1, Ontario, Canada; lvcraig{at}


    Background The WHO Framework Convention on Tobacco Control (WHO FCTC), the first WHO treaty, entered into force in 2005. In April 2015, a seven-member independent expert group (EG) was established by a decision of the FCTC Conference of the Parties to assess the impact of the Treaty in its first decade.

    One component of the EG’s methodology was to gather evidence on WHO FCTC impact from Parties themselves. This paper presents findings from 12 country missions on how the FCTC impacted progress on tobacco control.

    Methods Between November 2015 and May 2016, EG members conducted missions in 12 countries representing each of the six WHO regions and the four World Bank economic development levels. In each country, the EG interviewed a broad range of stakeholders to assess the extent to which the FCTC had contributed to tobacco control. The primary objective was to assess whether tobacco control measures would have been developed or passed, or implemented at all, or as quickly, if there had been no FCTC. Through this counterfactual inquiry, the EG sought to determine the FCTC’s causal role.

    Conclusion The FCTC was reported to have made contributions along the entire policy/regulation process: the development of a measure, building legislative and political support for a measure and its implementation. These stakeholder perspectives support the conclusion that the FCTC has played a pivotal role in accelerating and strengthening the implementation of tobacco control measures, although tobacco industry interference continues to be a significant obstacle to further advancement.

    • global health
    • public policy
    • tobacco industry

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    • Collaborators Pekka Puska (Chair), National Institute for Health and Welfare, Helsinki, Finland; Mike Daube (Vice-Chair), Curtin University, Perth, Western Australia; Geoffrey T. Fong (Technical Coordinator), University of Waterloo, Waterloo, Ontario, Canada and Ontario Institute for Cancer Research, Toronto, Ontario, Canada; Sudhir Gupta, Directorate General of Health Services, Ministry of Health and Family Welfare, New Delhi, India; Thomas F. McInerney, Treaty Effectiveness Initiative, Rome, Italy; Corne van Walbeek, University of Cape Town, Cape Town, South Africa; Ghazi Zaatari, American University of Beirut, Beirut, Lebanon

    • Contributors LC led the writing of the draft manuscript in collaboration with GTF. JCH, PP and GTF critically reviewed and revised draft versions of the paper. The Impact Assessment Expert Group conducted interviews in the 12 mission countries which provided the data for this paper.

    • Funding This paper was supported by grants from Health Canada and the Canadian Institutes of Health Research (FDN-148477). Geoffrey T. Fong was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research.

    • Disclaimer The Impact Assessment Expert Group was independent of both the WHO and the FCTC Secretariat in the preparation of its report and of this article. GTF and PP received honorarium from the Secretariat of the WHO FCTC for their work as member of the impact assessment expert group.

    • Competing interests GTF has served as an expert witness on behalf of governments in litigation involving the tobacco industry.

    • Patient consent for publication Not required.

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

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