Tobacco control in the Sustainable Development Goals: a precarious inclusion?
Authors: Roy Small, Natalia Linou, Douglas Webb, Mandeep Dhaliwal
Journal: The Lancet Public Health (2017)

The Lancet Public Health editorial in April, 2017, called for tobacco control to be "firmly anchored in the Sustainable Development Goals (SDGs)".1The Lancet Public HealthThe power of a treaty.Lancet Public Health. 2017; 2: e157Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar As development practitioners, we are cognisant that governments face tough resourcing and implementation decisions to achieve this ambitious agenda (17 goals and 169 targets). Despite inclusion of a specific target for implementation of the WHO Framework Convention on Tobacco Control (FCTC; target 3.a), there is a risk that tobacco control will remain a focus for the health community only. To gain insight about how tobacco control featured in the SDG design process, we looked at: 27 970 web-based submissions; 72 reports of national consultations; and nine reports of global thematic consultations organised around themes such as inequality, health, conflict, and fragility. We also looked at five high-level UN synthesis reports of discussions.2UNA new global partnership: eradicate poverty and transform economies through sustainable development. The report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda.http://www.post2015hlp.org/wp-content/uploads/2013/05/UN-Report.pdfDate: 2013Google Scholar, 3UN Development GroupThe global conversation begins: emerging views for a new development agenda.http://www.undp.org/content/dam/undp/library/MDG/english/global-conversation-begins-web.pdfDate: 2013Google Scholar, 4UN Development GroupA million voices: the world we want.http://www.undp.org/content/undp/en/home/librarypage/mdg/a-million-voices--the-world-we-want.htmlDate: 2013Google Scholar, 5UN Global CompactCorporate Sustainability and the United Nations Post-2015 Development Agenda.http://www.unglobalcompact.org/docs/news_events/9.1_news_archives/2013_06_18/UNGC_Post2015_Report.pdfDate: 2013Google Scholar, 6Sustainable Development Solutions NetworkAn action agenda for sustainable development.http://unsdsn.org/news/2013/06/06/an-action-agenda-for-sustainable-development-networks-issues-report/Date: 2013Google Scholar We did a keyword search for terms associated with tobacco, the WHO FCTC, and comparator health issues historically included in development discourse. Tobacco control was discussed far less frequently than many other health priorities, ranking third-to-last in composite score (table). National consultation reports from top cigarette-consuming and producing countries, such as China and Indonesia, did not mention tobacco. The WHO FCTC itself was mentioned very infrequently, (only in six web-based submissions and one health thematic consultation). It was not mentioned once in any of the high-level reports or the 72 national consultations, even though most national consultations were from Parties to the Convention. The Open Working Group tasked to design a proposal for the SDGs met regularly over 2 years, yet the WHO FCTC was only introduced during the 11th of 13 sessions.TableTobacco-related and comparator terms in Sustainable Development Goals design foraWeb-based submissions containing a search termNational consultations containing a search termMentions across the global thematic consultation final reportsMentions across the high-level reportsOverall scoreHIV/AIDS213961244802524Reproductive76841211491069Maternal809497126955Non-communicable diseases457248230593Malaria374283518455Tobacco-related terms2191614*All in the health thematic consultation.6255Alcohol17722197225Obesity10384*All in the health thematic consultation.16131* All in the health thematic consultation. Open table in a new tab Although inclusion of target 3.a is an important accomplishment, it does not itself guarantee strengthened tobacco control efforts. We are concerned that without advocacy the WHO FCTC might not be reflected in national sustainable development frameworks. Governments should be supported to improve understanding of the shared responsibility across sectors in meeting treaty obligations.7WHO Framework Convention Secretariat and UNDPTobacco Control Governance in Sub-Saharan Africa.http://www.undp.org/content/undp/en/home/librarypage/hiv-aids/tobacco-control-governance-in-sub-saharan-africa.htmlDate: 2016Google Scholar Emphasis should be placed on capacity building for coordination and policy coherence across SDG goals and targets and preventing industry interference. Learning from the global HIV response, strong civil society will be crucial for creating urgency for action. World No Tobacco Day offers an opportunity to advocate for improved integration of tobacco control in development planning, governance, and financing. We declare no competing interests. The power of a treatyAccording to WHO, about 6 million people die from tobacco use every year, and this is estimated to increase to more than 8 million a year by 2030 without intensified action. Against this predicament, public health is not unarmed. In response to the globalisation of the tobacco epidemic, the WHO Framework Convention on Tobacco Control (WHO FCTC)—the first international treaty negotiated under the auspices of WHO—was adopted in 2003, and entered into force in 2005. For WHO, the Convention represents "a milestone for the promotion of public health and provides new legal dimensions for international health cooperation." It certainly does. Full-Text PDF Open Access