A human rights-based approach to tobacco control

How human rights can help end the tobacco epidemic in LMICs and around the world

By Laurent Huber and Kelsey Romeo-Stuppy

Without urgent action, 1 billion people will die from smoking this century (WHO, 2008) Tobacco already kills more than 8 million people every year, and 80% of these deaths occur in low- and middle-income countries (WHO Fact Sheet, 2021). The products emanating from the tobacco industry negatively impact the most vulnerable members of society, and governments have allowed it. One path towards curbing the tobacco epidemic for good is through a human rights-based approach to tobacco control.

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How human rights can help end the tobacco epidemic in LMICs and around the world
Young man smoking, Uganda. Photo: © Action on Smoking and Health (ASH)

What are human rights?

Human rights are rights inherent to all human beings, regardless of race, sex, nationality, ethnicity, language, religion, or any other status (UN Human Rights) that have been codified in international law through the development and adoption of human rights treaties. One right in particular, the right to health, is essential in a human rights-based approach to tobacco control. As humans, our health is one of our most valuable assets. The right of “everyone to the enjoyment of the highest attainable standard of physical and mental health” is enshrined in several human rights treaties, including the International Covenant of Economic, Social, and Cultural Rights (ICESCR, 1976) and in numerous other international and regional treaties.

How does the tobacco industry negatively impact human rights, particularly in LMICs?

Tobacco has been recognized as an obstacle to human rights and to the inter-related issue of development, an issue of great importance to low- and middle-income countries. When negotiating the world’s first public health treaty, the World Health Organization Framework Convention on Tobacco Control (FCTC), (FCTC, 2005) countries acknowledged the link between tobacco and human rights by citing Article 12 of the International Covenant on Economic, Social and Cultural Rights, (ICESCR, Article 12, 1976) as well as the WHO Constitution (Constitution, 1948) recognizing that every human has the fundamental right to enjoy the highest attainable standard of physical and mental health. References to human rights also are included in several FCTC decisions and Guidelines (FCTC COP 7/19, 2019). Both the Committee on Economic, Social and Cultural Rights (CESCR, 2000) and the Committee on The Rights of the Child (CRC, 2013) have recognized tobacco as a hurdle to achieving the right to health, and they require governments to take action to address that hurdle.

Boy selling cigarettes, Niger. Photo:  © Laurent Huber<br>
Boy selling cigarettes, Niger. Photo:  © Laurent Huber

This is especially true in lower- and middle-income countries. For example, some high-income countries allow tobacco corporations to manufacture cigarettes in their countries and export them to others, usually lower income countries (Maurisse, 2019). Switzerland produced cigarettes that were not deemed safe for the Swiss market, yet were exported to African countries. An investigative report concluded, “the cigarettes produced on Swiss soil and sold in Morocco are much stronger, more addictive and more toxic than those sold in Switzerland or France” (Maurisse, 2019).The higher income countries negatively impact human rights in countries whose markets are being flooded with foreign made cigarettes, contributing to the shift of the burden of disease from high income countries to low-income countries. Over 80% of the world’s 1.3 billion tobacco users live in low- and middle-income countries (WHO Fact Sheet, 2021).


The power of human rights treaties

Despite these challenges, there are many tools that advocates and governments can use to help achieve health equity and protect human rights around the world, and especially in lower- and middle-income countries. First and foremost, countries can and should accelerate the full implement the FCTC. The FCTC has been incorporated into the UN Sustainable Development Goals, which calls on countries to “Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control” (SDG, goal 3, 2015) as well as the Global Action Plan on Non-Communicable Diseases which calls on countries to reduce tobacco use by 30%. As the United Nations Development Program notes, the FCTC is an accelerator for Sustainable Development and reducing tobacco use is critical to achieving every goal in the SDGs (FCTC Development, 2017). Accelerating the implementation of the FCTC is key to protecting health and human rights.

Cigarette sales in Uganda. Photo: © Action on Smoking and Health (ASH)
Cigarette sales in Uganda. Photo: © Action on Smoking and Health (ASH)
Despite these challenges, there are many tools that advocates and governments can use to help achieve health equity and protect human rights around the world, and especially in lower- and middle-income countries.

In addition to utilizing public health measures to end the tobacco epidemic, governments and civil society should employ the power of human rights mechanisms. There are several international human rights treaties that are relevant to health and human rights that could accelerate tobacco control objectives, and countries are obligated to report to those treaties about the human rights situation in their countries. However, because of lack of action from the public health community, those reports seldom include tobacco. The reports are submitted to the committee for each treaty, which in turn makes recommendations back to the country that submitted the report. Advocates have the opportunity to submit parallel reports to draw each treaty committees’ attention to the way tobacco devastates the populations the treaties are bound to protect and to demonstrate how, by addressing the tobacco epidemic countries can make progress towards not only health, but also development and human rights.

One study reviewed the Concluding Observation of the Committee on Economic, Social, and Cultural Rights (CESCR). When a tobacco specific parallel report was submitted, the Committee included tobacco in its concluding observations 28.9% of the time. When no parallel report was submitted, tobacco was mentioned a mere 7% of the time (Dresler, 2018).

There are several international human rights treaties that are relevant to health and human rights that could accelerate tobacco control objectives, and countries are obligated to report to those treaties about the human rights situation in their countries. However, because of lack of action from the public health community, those reports seldom include tobacco.

It is crucial to act now!

Health, development, and human rights are mutually reinforcing. Accelerating tobacco control, through implementation of the best practices laid out in the FCTC and measures that go beyond the FCTC, will help countries make progress in all of these goals.

It is crucial that we take these steps now. In some LMICs, like in Sub-Saharan Africa, smoking prevalence is fairly low. However, recent trends illustrate a serious rise in smoking rates in this region and other LMICs, dueto income growth and increasing cigarette affordability, as well as the tobacco industry’s strategy of aggressive marketing in those countries (Tobacco Atlas, 2021). Tobacco control advocates need to act quickly, to prevent future life-long addictions in these countries and save lives. A human rights-based approach to tobacco control can help us protect people all over the world from the harms of tobacco and the tobacco industry.


References
Laurent Huber
Laurent Huber is the Executive Director of Action on Smoking and Health (ASH); a non-governmental organization fully devoted to supporting global health and international tobacco control efforts. He was first Director of the Framework Convention Alliance (FCA), an international coalition of over 500 Non-Governmental Organizations from more than 100 countries that played a vital role in shaping the WHO Framework Convention on Tobacco Control (FCTC) and later helped facilitate the integration of tobacco control alongside non-communicable diseases and its risk factors in the UN and global development agendas. He received the American Lung Association-C. Everett Koop Foundation Award in 2005 and under his direction, the FCA also received the prestigious Luther Terry Award in 2006, the Premio SEDET in 2008, the WHO World No Tobacco Day Award in 2011, and ASH was awarded the Health Leadership Award by the U.S. Surgeon General in 2014. Email
Kelsey Romeo-Stuppy
Kelsey Romeo-Stuppy, Managing Attorney at Action on Smoking and Health, leads ASH’s program on liability, including pursuing criminal and civil cases against the tobacco industry. Kelsey also leads ASH’s human rights program, which includes drafting reports and advocating with the United Nations Human Rights Council and various human rights treaty bodies, as well as launching and managing ASH’s Tobacco and Human Rights Hub, among other projects that lead us closer to ending the tobacco epidemic. Email