Protecting future generations from commercially driven health harms: lessons from tobacco control

[...]progress in tobacco control has been underpinned by a deliberate focus on the tobacco industry as an object of public health inquiry and action.2 Key here is Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC);4 this Article, informed by evidence on the tobacco industry's misconduct, recognised the inherent conflict between its interests and public health.2 Article 5.3 therefore required parties to the FCTC treaty (now 183 in total) to protect the “setting and implementing [of] their public health policies…from the commercial and other vested interests of the tobacco industry”.5 Although tobacco industry attempts to undermine policy continue and implementation of Article 5.3 remains inadequate,4 it has driven efforts to exclude the tobacco industry from policy arenas, reducing its power and influence.2,5 This approach has been key to progress.2,5 The second lesson is that such protection from industry influence is insufficient to secure long-term advances. The enormous gains made in tobacco control are now under threat: long-standing declines in global cigarette sales6 and smoking prevalence—both globally7 and in every world region8—have stalled, and policy implementation has slowed.9 This is because the tobacco industry, concerned by the threat to its profits, is fighting back.6 From 2012 revenue from global cigarette sales (excluding China) began to be seriously threatened, largely as a result of implementation of the FCTC.6 Since then transnational tobacco companies began selling a variety of new addictive products (eg, e-cigarettes, oral nicotine, and cannabis) and later launched global public-relations campaigns that claimed they had changed and were, therefore, now part of the solution to the tobacco epidemic they had created.6 Inevitably, behind the glossy public-relations façade, the tobacco industry continues to market to children,10 oppose policies that would reduce smoking, and buy up new cigarette companies—all in an effort to expand sales of tobacco while adding new addictive products into the mix.6,11 How can the global NCD community apply these lessons? A Mokhtari via Getty Images Second, the stalling of tobacco control shows that governments must move well beyond these initial measures to address the system problems that are simultaneously driving ill health and making it harder to develop and implement effective solutions to it.1 The 2023 Lancet Series on the CDOH was instrumental in outlining these problems and ways