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A treaty would protect lives, livelihoods, security, and human rights

Public health instruments have been under constant development and renewal for decades. International legal instruments, with their binding character and strength, have a special place in this development. The start of the 21st century saw, in particular, the birth of the first World Health Organization (WHO)-era health treaties - the WHO Framework Convention on Tobacco Control (WHO FCTC) and its first Protocol. The authors analyze the potential impact of these instruments on global health governance and public health, beyond the traditional view of their impact on tobacco control. Overall, the very fact that globally binding treaties in modern-era health were feasible has accelerated the debate and expectations for an expanded role of international legal regimes in public health. The impact of treaties has also been notable in global health architecture as the novel instruments required novel institutions to govern their implementation. The legal power of the WHO FCTC has enabled rapid adoption of further instruments to promote its implementation, thus, enhancing the international instrumentarium for health, and it has also prompted stronger role for national legislation on health. Notably, the Convention has elevated several traditionally challenging public health features to the level of international legal obligations. It has also revealed how the legal power of the international health instrument can be utilized in safeguarding the interests of health in the face of competing agendas and legal disputes at both the domestic and international levels. Lastly, the legal power of health instruments is associated with their potential impact not only on health but also beyond; the recently adopted Protocol to Eliminate Illicit Trade in Tobacco Products may best exemplify this matter. The first treaty experiences of the 21st century may provide important lessons for the role of legal instruments in addressing the unfolding challenges in global health.

It is 10 years since the World Health Organization (WHO) Framework Convention on Tobacco Control entered into force. This binding treaty, the first to be negotiated under the auspices of WHO, is widely recognized as a major milestone in global health. The treaty's legal framework has enabled the rapid adoption of key instruments to promote its implementation. Challenges in fully implementing the treaty have also been revealed in recent years. Another observation from the treaty era in tobacco control is the growing ambition of governments and societies to end the tobacco epidemic. The WHO Framework Convention on Tobacco Control offers a model for addressing the negative effects of globalization on health.

[...]the WHO FCTC elevated major public health action to the level of an international treaty. [...]there are fundamental factors suggesting that the two legal frameworks could be implemented without contradiction. In turn, the WTO rules contain provisions in support of public health, such as exceptions and flexibilities to implement measures necessary to protect health (as long as such measures do not constitute ‘arbitrary or unjustifiable discrimination between countries…or a disguised restriction on international trade’).10 In addition, those rules articulate the need to protect intellectual property rights ‘in a manner conducive to social and economic welfare, and to a balance of rights and obligations’, with a particular reference to public health.11 In summary, and also as stated in the United Nations Secretary General’s report to Economic and Social Council,12 the WTO agreements and implementation of the WHO FCTC are not incompatible as long as the FCTC is implemented in a non-discriminatory fashion and for reasons of public health. Interestingly, the recent legal disputes launched in WTO and other international and national settings against governments introducing strong tobacco control measures such as plain packaging prompted increased dialogue and coordination between the two sectors.13 There is evidence of an increasing number of countries’ trade representatives continuing the trend of the general support for tobacco control in meetings about international trade policy, including in WTO’s Technical Barriers to Trade committee, using the language of trade policy, employing scientific evidence and citing the FCTC.3 However, such multisectoral diplomacy needs to improve also at the day-to-day level to ensure coherent implementation of countries’ international obligations in both health and trade.

In a brief, clear and easily accessible way, this summary illustrates the dynamics of the obesity epidemic and its impact on public health throughout the WHO European Region, particularly in eastern countries. It describes how factors that increase the risk of obesity are shaped in different settings, such as the family, school, community and workplace. It makes both ethical and economic arguments for accelerating action against obesity, and analyses effective programmes and policies in different government sectors, such as education, health, agriculture and trade, urban planning and transport. The summary also describes how to design policies and programmes to prevent obesity and how to monitor progress, and calls for specific action by stakeholders: not only government sectors but also the private sector - including food manufacturers, advertisers and traders - and professional, consumers', and international and intergovernmental organizations such as the European Union.