2012 GLOBAL PROGRESS REPORT - WHO

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2012GLOBAL PROGRESSREPORTon implementation of the WHOFramework Convention onTobacco Control

2012GLOBALPROGRESSREPORTon implementation of theWHO Framework Conventionon Tobacco Control

WHO Library Cataloguing-in-Publication Data2012 global progress report on implementation of the WHO Framework Convention on Tobacco Control.1.Tobacco industry – legislation. 2.Smoking – prevention and control. 3.Tobacco use disorder - mortality.4.Tobacco – adverse effects. 5.Marketing - legislation. 6.International cooperation. 7.Treaties. I.World HealthOrganization.ISBN 978 92 4 150465 2(NLM classification: WM 290)ACKNOWLEDGEMENTSThis report was prepared by the Convention Secretariat, WHO Framework Convention on Tobacco Control.Appreciation is expressed to the WHO Tobacco Free Initiative for the support provided in relation to section 4of the report, and the research team of the World Bank in relation to section 3.2. World Health Organization 2012All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, WorldHealth Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: 41 22 791 3264; fax: 41 22 791 4857;e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whetherfor sale or for noncommercial distribution – should be addressed to WHO Press, at the above address(fax: 41 22 791 4806; e-mail: permissions@who.int).The designations employed and the presentation of the material in this publication do not imply the expressionof any opinion whatsoever on the part of the World Health Organization concerning the legal status of anycountry, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsedor recommended by the World Health Organization in preference to others of a similar nature that are notmentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capitalletters.All reasonable precautions have been taken by the World Health Organization to verify the informationcontained in this publication. However, the published material is being distributed without warranty of any kind,either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader.In no event shall the World Health Organization be liable for damages arising from its use.Graphic design and layout by: Punto GraphicoPrinted in France.

CONTENTS1. INTRODUCTION52. OVERALL PROGRESS IN IMPLEMENTATION OF THE CONVENTION63. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS103.1 General obligations (Part II of the Convention)103.2 Reduction of demand for tobacco (Part III of the Convention)143.3 Reduction of the supply of tobacco (Part IV of the Convention)443.4 Questions related to liability (Part VI of the Convention)513.5 Scientific and technical cooperation (Part VII of the Convention)524. PREVALENCE OF TOBACCO USE AND TOBACCO-RELATED MORTALITY594.1 Prevalence594.2 Tobacco-related mortality625. PRIORITIES AND CHALLENGES IN IMPLEMENTING THE CONVENTION636. CONCLUSIONS65ANNEXESAnnex 1: Reports received from the Parties – status as at 15 June 201267Annex 2: List of indicators deriving from the reporting instrument used in assessingthe current status of implementation73Annex 3: Status of implementation of time-bound requirements of the Convention78

GLOBAL PROGRESS REPORT 20121. INTRODUCTIONThis global progress report for 2012 is the fifth in the series. It has been prepared inaccordance with the decisions taken by the Conference of the Parties (COP) at its firstsession (FCTC/COP1(14)), establishing reporting arrangements under the WHO FrameworkConvention on Tobacco Control (WHO FCTC), and at its fourth session (FCTC/COP4(16)),that harmonized the reporting cycle under the Convention with the regular sessions ofthe COP; furthermore, decision FCTC/COP4(16) requested the Convention Secretariatto submit global progress reports on implementation of the WHO FCTC based on thereports submitted by the Parties in the respective reporting cycle for the consideration ofthe COP at each of its regular sessions.The scope of this global progress report is threefold: first,it provides a global overview of the status of implementation of theConvention, on the basis of the reports provided by the Parties in the 2012reporting cycle;1 second,it tracks progress made in implementation of the Convention betweendifferent reporting periods;2 third,it draws conclusions on overall progress, opportunities and challenges, andprovides key observations by article.In the 2012 reporting cycle the Secretariat received reports from 126 Parties (72%) of the174 that were due to report. Throughout this report, unless otherwise mentioned, theinformation is based on reports submitted by those 126 Parties.3The report follows as closely as possible the structure of the Convention and that of thereporting instrument.1The period for submission of Parties’ implementation reports was from 1 January to 30 April 2012. TheSecretariat has been able to include, in this 2012 global progress report, the reports received within thisperiod, and also the reports submitted by the Parties by 15 June 2012. In accordance with decisionFCTC/COP4(16), Parties that submitted an implementation report in 2011 were not required to report againin 2012. Therefore, reports of the Parties submitted in 2011 were counted as part of the 2012 reportingcycle. Of the 126 reports, 31 were submitted in 2011 (with updates presented by some Parties in 2012) and95 in 2012.2Namely the reports submitted between 2007 and 2010, and those in 2011–2012.3Afghanistan, Albania, Algeria, Antigua and Barbuda, Australia, Austria, Azerbaijan, Bahamas, Bahrain,Bangladesh, Barbados, Belarus, Belgium, Benin, Bhutan, Bolivia (Plurinational State of), Bosnia andHerzegovina, Botswana, Brazil, Brunei Darussalam, Bulgaria, Burkina Faso, Cambodia, Canada, CentralAfrican Republic, Chad, Chile, China, Colombia, Comoros, Congo, Cook Islands, Costa Rica, Croatia, Cyprus,Democratic People’s Republic of Korea, Denmark, Djibouti, Ecuador, Egypt, Estonia, Fiji, Finland, France,Gabon, Gambia, Georgia, Germany, Ghana, Greece, Guatemala, Guyana, Honduras, Hungary, Iceland, Iraq,Ireland, Israel, Italy, Japan, Jordan, Kazakhstan, Kuwait, Kyrgyzstan, Lao People’s Democratic Republic, Latvia,Lebanon, Lesotho, Libya, Lithuania, Madagascar, Malaysia, Mali, Malta, Mexico, Micronesia (FederatedStates of), Mongolia, Montenegro, Namibia, Nepal, Netherlands, New Zealand, Niger, Norway, Oman,Palau, Panama, Paraguay, Peru, Philippines, Portugal, Qatar, Republic of Korea, Republic of Moldova,Russian Federation, Rwanda, San Marino, Sao Tome and Principe, Senegal, Serbia, Seychelles, Sierra Leone,Singapore, Slovenia, Solomon Islands, South Africa, Spain, Sri Lanka, Saint Kitts and Nevis, Saint Vincent andthe Grenadines, Sudan, Suriname, Swaziland, Sweden, Togo, Tonga, Trinidad and Tobago, Tunisia, Turkey,Tuvalu, Ukraine, United Arab Emirates, United Kingdom of Great Britain and Northern Ireland, Vanuatu, VietNam, and Yemen.5

2. OVERALL PROGRESS IN IMPLEMENTATION OF THECONVENTIONCurrent status of implementation4Overall implementation status across all substantive articles of the Convention wasassessed according to implementation rates5 of key provisions referred to in the reportinginstrument for each article. In brief, this included analysis of 138 indicators derivingfrom the reporting instrument across 16 substantive articles (see Annex 2 for the list ofindicators).The articles attracting the highest reported implementation rates, with more than65% average implementation rates across the 126 Parties analysed, are, in descendingorder, Article 8 (Protection from exposure to tobacco smoke), Article 12 (Education,communication, training and public awareness), Article 16 (Sales to and by minors), andArticle 11 (Packaging and labelling of tobacco products).They are followed by a group of articles for which the reported implementation rates arein the range 40% to 60%, namely, and again in descending order, Article 15 (Illicit tradein tobacco products), Article 5 (General obligations6), Article 10 (Regulation of tobaccoproduct disclosures), Article 20 (Research, surveillance and exchange of information),Article 14 (Demand reduction measures concerning tobacco dependence and cessation),Article 6 (Price and tax measures to reduce the demand for tobacco), Article 9 (Regulationof the contents of tobacco products), and Article 13 (Tobacco advertising, promotion andsponsorship7).The articles with the lowest reported implementation rates, of less than 25%, are Article18 (Protection of the environment and the health of persons8), Article 22 (Cooperation in thescientific, technical and legal fields and provision of related expertise), Article 19 (Liability),and Article 17 (Provision of support for economically viable alternative activities9) (seeFigure 1).Progress in implementation between reporting periodsAn attempt was also made to assess the progress made globally in implementation ofselected treaty articles between the two reporting periods.10 There is considerable overlapof Parties in both report groups, allowing for reasonable comparison (107 Parties arerepresented in both groups). The indicators selected were those that consistently appearacross the reporting periods. A total of 59 indicators11 that allow such comparison wereused in assessing the progress made in implementation.124567891011126As at 15 June 2012.Implementation rates were calculated as the percentage of Parties (of all reporting Parties) that provided anaffirmative answer in respect of implementation of each provision.Implementation rates varying from 41% for Article 5.3, on protection from the interests of the tobaccoindustry, to 68% for Articles 5.1 and 5.2 combined, covering multisectoral coordination, legislation,strategies and programmes.Including a comprehensive ban on cross-border advertising, promotion and sponsorship originating fromits territory in line with Article 13.2.Only responses for the Parties reporting that the provisions related to tobacco cultivation andmanufacturing are applicable to them were taken into account.Only responses for the Parties reporting that the provisions related to tobacco growers, workers andindividual sellers are applicable to them were taken into account.Namely the reports submitted between 2007 and 2010, and those in 2011–2012.See Annex 2.Due to the specific nature of data on tobacco taxation and pricing, the progress made in implementation ofArticle 6 is described under that article.

GLOBAL PROGRESS REPORT 2012Figure 1.Average implementation rates (%) of substantive articlesThere are three articles that attracted relatively high positive changes over the tworeporting periods. The average rate of implementation13 of provisions in Article 8 increasedby 15 percentage points (from 44% to 59%); the next highest positive change was seenin regard to Article 13 ( 12 percentage points for the comprehensive advertising ban14);followed by Article 12 ( 11 percentage points). In four other articles progress is slower:Article 16 ( 7 percentage points); Article 20 ( 5 percentage points); Article 2215 ( 4percentage points); and Article 14 ( 3 percentage points). In the remaining cases thechange is less notable (see Figure 2).Overall, the average rate of implementation of treaty provisions across all substantivearticles has increased by 4 percentage points over that period, from 52% by 2010 to 56%in 2012.A similar exercise to be concluded in 2014 would have a broader base of comparison dueto the achieved stability of the reporting instrument. In the meantime, it is vital that effortsto improve comparability of reported data are continued and strengthened. Such effortsshould include enhancing reporting capacity in countries, strengthening the knowledge,skills and training of reporting officers, and facilitating treaty-specific data collection atthe national level by promoting a common understanding of the data requirements of thereporting instrument. The Secretariat’s proposals for further development and promotionof definitions and indicators used in the reporting instrument are to be considered by theCOP at its fifth session.As an additional observation in relation to progress made, information available fromthe 159 Parties that have submitted at least one implementation report starting from2007 indicates that 79% of the Parties strengthened their existing laws or adopted newtobacco-control legislation after ratifying the Convention (see section 3.1). However, thecurrent reporting instrument does not allow an assessment of the comprehensiveness ofsuch legislation and its full compliance with the Convention.131415Implementation rates were calculated as the percentage of Parties that provided an affirmative answer inrespect of implementation of each analysed provision of the 107 Parties with comparable reports over thetwo reporting periods.The change across reporting periods on the inclusion of cross-border advertising, promotion andsponsorship originating from a Party’s territory in the comprehensive ban is even steeper ( 16 percentagepoints).In relation to implementation assistance received by Parties.7

Figure 2.Changes in percentages of average rates of implementation by articleParties also provided their own assessments and explanations of the progress they havemade in implementing specific requirements of the treaty in their responses to the openended questions that are placed in all policy sections of the reporting instrument. Thenumber of Parties reporting on progress varies widely across different articles. Almost100 Parties reported progress in the areas of education, communication, training andpublic awareness; developing tobacco-control legislation, strategies and action plansand establishing supporting infrastructure; and promoting smoke-free environments. Incontrast, less than 20% of Parties reported progress in the areas of liability; alternatives totobacco growing; and protection of the environment. Irrespective of the numbers, sharingsuch information allows Parties to identify other Parties with relevant experience andpromotes dissemination of good practices.Examples of recent strong achievementsMany Parties reported on recent stricter measuresthey have taken in implementation of the Convention,in line with Article 2. These measures mark strongachievements, as, inter alia, called for by the guidelinesadopted by the COP, which in some cases may inspireaccelerated implementation of the Conventioninternationally. Some examples are provided below.In relation to Article 8, an emerging trend concernsthe extension of smoking bans to include partlycovered or outdoor areas, for example beaches (insome Australian states) and playgrounds and parks(for example, in Canada). In relation to Articles 9 and10, Brazil has banned the use of additives in cigarettesand other tobacco products sold in the country. Inrelation to Article 11, some Parties have considerablyincreased the size of their pictorial health warnings –for example Uruguay (to 80%) and Mauritius (to 65%)8

GLOBAL PROGRESS REPORT 2012– and Australia requires plain packaging of tobacco products with some other Partiesindicating that they are likely to follow suit. In relation to Article 13, nine Parties16 reportedrecently implementing a ban on displays of tobacco products and five Parties17 a ban onadvertising of tobacco products at points of sale. In relation to Article 16, Nepal’s newtobacco-control legislation forbids the sale of tobacco products not only to minors butalso to pregnant women.In another development, Bhutan reported adopting legislation requiring a comprehensiveban on the sale of tobacco, and Finland and New Zealand reported on their endeavoursto become completely tobacco-free.1617Australia (at subnational level), Canada, Finland, Ireland, Nepal, New Zealand, Norway, Palau and Panama.Australia (at subnational level), Finland, Ireland, Nepal and Ukraine.9

3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS3.1 General obligations (Part II of the Convention)Article 5General obligationsThis Article requires Parties to establish essential infrastructure for tobacco control,including a national coordinating mechanism, and to develop and implementcomprehensive multisectoral tobacco-control strategies and plans, as well as tobaccocontrol legislation, and to ensure that this process is protected from the interests of thetobacco industry. The Article also calls for international cooperation and refers to raisingthe necessary financial resources for implementation of the Convention.Comprehensive tobacco-control strategies, plans and programmes (Article 5.1).Over half of the Parties (74) reported having such strategies, plans and policies, andseveral also indicated the specific challenges they face in relation to this obligationunder the Convention, which has overarching importance and impact. In addition, 21Parties18 actually provided the relevant text, either as a web link or as an annex to theirimplementation reports. Forty-three of the Parties that reported not having standalone,comprehensive tobacco-control strategies, plans and programmes indicated that tobaccocontrol is embedded in other national strategies and plans with broader scope (suchas: health promotion, noncommunicable disease prevention, cardiovascular diseaseprevention, cancer control, drugs, alcohol and tobacco, national development plans, andhealth sector strategic plans).In most Parties such programmes are led by health ministries (alone or in coordinationwith an agency subordinated to them), and their responsibilities in relation to theseprogrammes include planning, implementation, coordination, follow-up and evaluation.In Parties with federal systems, the responsibility for developing and implementing thenational programme is shared with states, regions and/or municipalities. When providingadditional details, several Parties also indicated challenges or setbacks. For example,Sao Tome and Principe and Yemen indicated that while a national action plan exists, itsimplementation has been delayed due to the lack of funding, and Paraguay indicated thatthe budget dedicated to implementation of the tobacco-control programme has beenreduced.Infrastructure for tobacco control (Article 5.2(a)). Parties reported on whether theyhave established or reinforced and financed a focal point for tobacco control, a tobaccocontrol unit and a national tobacco-control coordinating mechanism. Focalpoint for tobacco control. Most of the Parties (102) reported that they havedesignated a national focal point for tobacco control. However, in some cases theresponsibilities of this focal point cover multiple areas, which may indicate thatnational capacity for tobacco control remains insufficient. Tobacco-controlunit. Over half of the Parties (76) reported having established atobacco-control unit. In most cases, such units are hosted by the health ministryor a public health agency under the supervision of the health ministry. SeveralParties provided additional details. Afghanistan and Peru indicated that they planto establish a tobacco-control unit in their health ministries, while in Malaysia andSpain the capacity of the existing units has been strengthened.1810Australia, Belarus, Brazil, Burkina Faso, Chad, Congo, Cook Islands, Djibouti, Equador, Fiji, Germany,Kyrgyzstan, Latvia, Madagascar, Philippines, Republic of Moldova, Sweden, Turkey, Ukraine, United Kingdom,and Viet Nam.

GLOBAL PROGRESS REPORT 2012 Nationalcoordinating mechanism for tobacco control. More than two thirds ofParties (91) reported having such a coordinatin

CONTENTS 1. INTRODUCTION 5 2. OVERALL PROGRESS IN IMPLEMENTATION OF THE CONVENTION 6 3. IMPLEMENTATION OF THE CONVENTION BY PROVISIONS 10 3.1 General obligations (Part II of the Convention) 10 3.2 Reduction of demand for tobacco (Part III of the Convention) 14 3.3 Reduction of the supply of tobacco (Part IV of the Convention) 44 3.4 Questions related to liability (Part VI of the Convention) 51

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