The World No Tabacco Day (WNTD) 2021 theme and year-long global campaign ‘Commit to Quit’1 offers a welcome focus on providing essential support to tobacco users to become tobacco-free and start the road to better health. This is especially relevant for smokers for whom the COVID-19 pandemic was a motivator to quit, and to support those struggling with additional social and economic stressors imposed by the pandemic. The emphasis on providing social support through digital communities is timely as many people continue to deal with and recover from the trauma of forced and prolonged social isolation. However, in promoting this essential component of tobacco control, the focus on individual behavior change should not obscure the fact that governments in almost every country give the tobacco industry exceptional treatment by allowing continued sales of their deadly products.
As tobacco use is a health, social, economic and human rights issue, the benefits of successful cessation extend beyond the individual, most immediately and directly through reduced involuntary smoking exposure and tobacco-related poverty for household members. Globally, non-smoking women and children are disproportionately affected by others ‘tobacco use.2 3 Providing effective treatment for cessation of tobacco use is an essential component of governments’ human rights obligations, 4 more of the seven WHO Framework Convention on Tobacco Control (FCTC) MPOWER Tobacco Measures (Monitoring, Smoke-Free Environments, Strike Programs, Package Alerts, Mass Media, Advertising Bans and Taxes), is the one with the lowest percentage of countries implementing it at best practice level.5
Except for individual strikes, a broader issue is that the largely unimpeded privilege that corporations enjoy selling tobacco products is itself deeply at odds with the fundamental human right to good health. Violation of this right occurs throughout the entire production cycle of tobacco products, from cultivation to the consumer. By focusing on strikes, and demand reduction issues more generally, we can take our eyes off the tobacco industry and the fact that it has no social license. It is widely acknowledged that if the tobacco industry tried to establish itself as a new business today, it would not be allowed to operate in many places, and most of its products would never be approved for sale. Even in jurisdictions where e-cigarettes, heated tobacco products and other alternative products are allowed for sale, it is mainly in the context of the extent of the harm of smoked tobacco that they are approved.
Rather than establishing tolerance for known or potential harm caused by new tobacco and other nicotine products based on the most deadly consumer products in history, alternative frameworks may be considered to shift the paradigm of tobacco control forward. The numerous demand reduction strategies that have been successfully implemented by countries in line with their FCTC commitments have laid the foundation for progress. Indeed, a new approach — such as phasing out commercial tobacco sales — would be in line with FCTC Article 2.1, which calls on governments to go beyond the minimum obligations set out in the FCTC.6
Another approach that may hold promise is the concept of an ‘industry-wide corporate death penalty’. A 2019.7 study based on publicly available data estimated that the U.S. tobacco industry kills four times more people than it employs. In comparison, the US coal industry kills more than one person for each coal mine. Based on the Universal Declaration of Human Rights, the author proposes that an industry’s right to exist be based on three principles: (1) everyone has the right to life; (2) everyone has the right to work; and (3) human rights should give corporations the right to exist if they are beneficial to humanity. On these principles, the study concluded that the tobacco industry meets the criteria for a corporate corporate death penalty7 (even though the analysis did not include tobacco’s broader social and economic damage, and the high burden of poor health it causes) ). Corporate capital punishment, although legal, has not been used recently in the US. However, they played a role in the closure of the Tobacco Research Council and the Tobacco Institute, Inc. — two industry front groups — in 1999.8 This approach recognizes that no corporation has a natural right to exist.
Recent WNTD themes have alternated between focusing on specific tobacco-induced disease issues and the tobacco industry and its activities. Focusing on the industry is a powerful contradiction to the neglect of commercial determinants of health in many health frameworks.9 In promoting strike support for individuals to become tobacco-free, we must not address these WNTD themes of previous years and the need do not lose sight of the eye. for society as a whole to quit tobacco. The continued existence of the legal tobacco industry, and widespread promotion and sales of its products, are a serious example of privatized profits and socialized, unfair costs, despite clearly articulated justifications for abolishing commercial sales of its most harmful products. 10 11
When the FCTC first came into operation, it was difficult to imagine many of the achievements that followed. Widespread implementation of strategies such as mass media campaigns, warning labels and ordinary packaging, tobacco tax and non-smoking spaces – all of which support strike action in the broadest sense – testify to the power of this landmark treaty. It is instructive here to consider an earlier landmark document, the 1986 Ottawa Health Promotion Charter. It included five areas of action (building sound public policies, creating supportive environments, strengthening community action, developing personal skills, and reorienting health care services toward prevention and health promotion), many of which were operationalized by the FCTC. Strike support clearly fits within ‘the development of personal skills’. Public health policy, community action and, to some extent, reorientation of health services have all been achieved to a greater or lesser extent. Similarly, FCTC demand reduction measures have created supportive environments for people to become and remain tobacco-free. Although tobacco products are widely available for sale, the most powerful step in creating a supportive environment for people to be tobacco-free has been missed.
Increasing cessation of adult tobacco use is necessary, but not sufficient, to accelerate progress to end the tobacco epidemic and to reduce the socio-economic gradient in tobacco use. Achieving these goals requires much more than individual behavior change. All of us – governments, civil society and individuals – must stop smoking together.