Global and Regional Contexts

Tobacco kills around eight million people every year (more than seven million active smokers and over one million non-smokers exposed to second-hand smoke), of which one million in the Americas. The WHO Framework Convention on Tobacco Control (FCTC) came into effect on February 27, 2005, to combat the tobacco epidemic by guiding tobacco control efforts worldwide. The FCTC has become one of the most rapidly accepted international treaties in the history of the United Nations and currently has 182 State Parties, including 30 out of the 35 PAHO Member States.

In addition to the FCTC, in 2017, PAHO Member States approved the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 offering a roadmap to prioritize key provisions of the treaty that would enable Member States to accelerate its implementation and meet targets established for the reduction of tobacco use and premature deaths from NCDs. This plan encompasses four strategic lines of action that cover: smoke-free environments; tobacco packaging graphic health warnings; plain packaging; bans on tobacco advertising, promotion, and sponsorship; raising taxes on tobacco products; the ratification of the FCTC and protocol to eliminate illicit trade of tobacco products; and mechanisms to prevent tobacco industry interference and those who work to further its interests.

Overall FCTC and MPOWER Implementation

According to the latest edition of the WHO Global Report on Trends in Prevalence of Tobacco Use 2000-2025, the Americas region is likely to achieve a relative reduction in current tobacco use rate of 30% by 2025. Over the last five years, the age standardized prevalence of tobacco smoking has decreased 12% from 18.6% (2015) to 16.3% (2020), although many countries are yet to implement all measures contained in the MPOWER package. Only Brazil is currently implementing all MPOWER measures, and four Member States implement four or more. However, in 2007, only eight countries had at least one of these measures implemented.

Based on the WHO Report on the Global Tobacco Epidemic 2021, of the 35 Member States in the region of the Americas:

M: 10 (28.6%) have policies to monitor tobacco use and prevention, six more than 2007
P: 24 (68.5%) have legislation guaranteeing 100% smoke-free public places, 22 more than 2007
O: 6 (17.1%) offer help to quit tobacco use, four more than 2007
W: 22 (57%) have implemented health warnings of 50% or more of the exposed surface of packaging, 17 more than 2007
E: 9 (25.7%) have adopted a total ban on tobacco advertising, promotion, and sponsorship (TAPS), compared to zero in 2007
R: 3 (8.6%) have policies in place on the taxation of tobacco taxes, compared to zero in 2007

Achievements

Progress Highlights in the Americas (2017-2022)

On December 14, 2021, despite high levels of tobacco industry interference, the Mexican Senate unanimously approved the most important amendment to the 2008 General Law on Tobacco Control, with 97 votes at the Senate, following the approval by the Chamber of Deputies on April 28, 2021. After 13 years of tireless efforts by partners to advance Mexico toward measures set forth in the FCTC, this reform establishes 100% smoke and emission free environments in all enclosed public places and workplaces as well as a total ban on the advertising, promotion, and sponsorship of tobacco products. PAHO congratulated Mexico’s milestone on December 17, 2021.

In 2020, South America became the first sub-region of the Americas to become completely smoke-free. This milestone was achieved thanks to progress in recent years from Bolivia’s General Tobacco Control Law in February 2020 and Paraguay’s Executive Decree in December 2020, both including legal measures establishing smoke-free environments. In 2005, Uruguay was the first Member State to become smoke-free in this sub-region.

Antigua and Barbuda in 2018 and Guyana in 2017, approve within a single comprehensive legislation, a ban on smoking in indoor public places and workplaces; mandatory graphic health warnings on tobacco products; and a ban on tobacco advertising, promotion and sponsorship.

Barbados: Regulation adopting graphic health warnings, 2017
Peru: Periodic update of excise taxes, January 2020
Saint Lucia: Public health (smoking control) regulations, June 2020
Mexico: Decree banning importation and exportation of e-cigarettes and heated tobacco products, October 2021
Costa Rica: Taxes on novel and emerging nicotine and tobacco products, January 2022

Supporting Tobacco Users and Smokers in Quitting

Florence: the world’s first virtual health worker

Launched July 7, 2020, in English and February 8, 2021, in Spanish, this AI provides digital counseling services to those trying to quit tobacco while sharing public health messages and recommendations on tobacco and COVID-19.

Year-long World No Tobacco Day Campaign 2021

WHO launched a year-long campaign in 2021: Commit to Quit. As part of the campaign, cessation support tools were pushed by PAHO through the web including the WHO quitting toolkit, Florence, and toll-free quit lines.

Because of the exposure given to cessation support through the 2021 World No Tobacco Day campaign, countries were able to promote their own tools, including:

Tobacco Cessation Clinic in Trinidad and Tobago
Guide for people to quit smoking (Spanish)
Guide for people with tuberculosis to quit smoking (Spanish)
100 Reasons to Quit (English and Spanish)

Capacity Building Activities

Successful capacity building enhances the organization’s ability to fulfill its mission over time by strengthening relationships with partners, reinforcing PAHO’s role in providing technical assistance, and continuously improving and innovating strategies to tackle tobacco control within the Region.

Historically, these activities have been held in person at both regional and national levels based on specific country demands, but with the start of the COVID-19 pandemic in March 2020, many activities were shifted online to keep up with growing demand. The Tobacco Control team took this challenging time as an opportunity to reach wider audiences using non-traditional means by providing additional online trainings, webinars, and resources.

With the support of partners (Bloomberg Initiative to Reduce Tobacco Use, Secretariat of the FCTC, Mexico’s National Institute of Public Health – INSP, The Union, Campaign for Tobacco-Free Kids – CTFK, World Bank, UN Development Programme – UNDP, University of Illinois-Chicago, among others) live online workshops and trainings were offered, as well as online self-learning courses through PAHO’s Virtual Campus for Public Health.

July 2022 – Tobacco Control During the COVID-19 Pandemic in the Americas: Lessons Learned and Opportunities (hybrid event)
March 2021 – Strengthening multisectoral action for tobacco control in the Region of the Americas
June-November 2021 – Virtual Technical Training on Tobacco Control: Accelerating the MPOWER Package Implementation during COVID-19 in the Americas (Block 1 June-July 2021 and Block 2 August-November 2021)
September 2021 – Online Training on Tobacco Cessation for Caribbean Countries
September 2021 – Developing Tobacco Legislation for Caribbean Countries (Mixed method)
July 2021 – Weekly training sessions of Primary Health Care Professionals in Paraguay
May 2021 – Saint Lucia Monitoring and Evaluation of Tobacco Cessation Program
December 2020 – Training for primary care providers: brief tobacco interventions
July 2019 – Simulating tobacco tax increases and measuring illicit trade of tobacco products in Latin America and the Caribbean
February 2019 - Data to Action and Training of Trainers Workshop for the Pan American Health Organization (PAHO) Region
August 2018 – GYTS Global Analysis Workshop (Global workshop hosted by PAHO)
February 2018 – Training on Economics of Tobacco Control for Practitioners, Researchers, and Advocates in Latin America and the Caribbean
May 2017 – Caribbean Subregional Workshop on Alcohol, Tobacco and Sugar Sweetened Beverages Taxation

Positioning Tobacco Control at the Forefront in Public Policy Discussion

PAHO was able to support national authorities in positioning tobacco control within the public policy debate; subsequently, executive and legislative branches of several countries discussed measures aimed at implementing key FCTC mandates. Tailored technical and legal assistance for ongoing national executive and legislative processes with strategic relevance for the region was also provided, including the engagement of different partners like those of the Bloomberg Initiative to Reduce Tobacco Use. Actions included presenting evidence before legislative bodies and sending technical notes with evidence to national authorities of the executive branch, especially the MoH, and countering tobacco industry interference in national initiatives for tobacco control.

Ongoing technical and legal assistance for legislative or executive measures

Regulation of general tobacco control laws/acts: Antigua and Barbuda, Bolivia, Mexico
Adoption of plain packaging: Chile, Costa Rica, Panama
Novel and emerging nicotine and tobacco products: Colombia, Mexico
Enacting tobacco control acts: Grenada, Dominica, Jamaica, Saint Kitts and Nevis
Ratification of the Protocol to Eliminate Illicit Trade in Tobacco Products: Paraguay
Banning all forms of advertisement, promotion and sponsorship: Peru
Establishing smoke-free environments: Dominican Republic

Monitoring tobacco use and key policies

Under the scope of the Global Tobacco Surveillance System (GTSS), PAHO maintains a cooperation agreement with the Centers for Disease Control and Prevention (CDC) that provides technical and financial assistance to countries for the implementation of the Global Youth Tobacco Survey and with CDC Foundation with funds from Bloomberg Philanthropies to support the Global Adult Tobacco Survey (GATS). All PAHO Member States have information on tobacco consumption among youth. Only four out of 35 countries have outdated information, considering the appropriate periodicity.

Over the last five years, 14 countries carried out a new round of GYTS, and 14 countries carried out national surveys that collected data on tobacco use among adults, it includes a new round of GATS in Uruguay in 2019.

The COVID-19 pandemic impacted on the survey implementation due to social distance restrictions and countries were prevented from carrying out data collection activities. As of late 2021, these activities have resumed.

Challenges and a Way Forward

Tobacco industry interference plays a big role in slowing progress in tobacco control throughout the region, especially at country level. Intersectoral country level work, free of conflict of interest, is important for tackling these challenges, but needs to be strengthened.

At the 9th Conference of the Parties (COP9), 23 PAHO Member States, Parties to the FCTC, presented a declaration to maximize transparency of the delegations and reaffirm their determination to protect public health policies, in accordance with national laws, against commercial and vested interests of the tobacco industry and voluntarily submitted the Declaration of Interest form approved at COP8. Only three of the Parties that attended COP9 explicitly opposed the declaration.

Although advancements have been made on the goals outlined in the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022, there is still room for progress in:

Strengthening Member States’ capacity in terms of public health policies to counter attempts at interference by the tobacco industry and those who work to further its interests
Raising taxes on tobacco and reducing affordability of tobacco products
Encouraging the ratification of the Protocol to Eliminate Illicit Trade in Tobacco Products
Enforcing total bans on tobacco advertising promotion and sponsorship (TAPS)
Implementation of plain packaging
Providing updated evidence on novel and emerging nicotine and tobacco products, in line with the COP decisions and FCTC guidelines for implementation
Encouraging banning of additives
Continuing strengthen tobacco surveillance systems so that more Member States have up-to-date information on tobacco use among adults

Progress in line with the pending agenda and strategy and plan of action is continuously being monitored, and PAHO and the Tobacco Control team will continue to support and provide technical assistance for legislative processes to Member States advocating to strengthen tobacco control.