In 2004, Mexico became the first country in the Americas to approve the historic Framework Convention on Tobacco Control (FCTC) by the World Health Organization, but it took another 20 years for its measures to be incorporated into Mexican law. "When you're dealing with one of the world's largest and most powerful industries, resistance, persistence, and cooperation are the only way forward," said Dr. Juan Arturo Sabines, national advisor for tobacco control for the Pan American Health Organization (PAHO), speaking about tobacco control in Mexico.
Tobacco use is the most preventable cause of death in the world today. Nearly one million people in the Americas die every year as a result of direct consumption or exposure to secondhand smoke. It is responsible for 15% of deaths from cardiovascular diseases, 24% of deaths from cancer, and 45% of deaths from chronic respiratory diseases.
The fight against tobacco began in the 1950s, when the medical community started collecting evidence showing that smoking could lead to serious diseases, particularly cancer, according to tobacco monitoring expert Adriana Bacelar Gomes of the Pan American Health Organization. "It was then that the first initiatives to restrict the industry and regulate tobacco products and consumption began, and that was the starting point for our work," she added.
However, 70 years later, tobacco is still the only legal consumer product that causes half of its users to die.
Over the past 20 years, the Pan American Health Organization has primarily focused on supporting countries in their efforts to adopt and implement the World Health Organization Framework Convention on Tobacco Control, a legally binding international treaty aimed at promoting cost-effective tobacco control measures. These measures include protection from second-hand smoke in all indoor workplaces and public places, large graphic health warnings on tobacco product packaging, a comprehensive ban on tobacco advertising, promotion and sponsorship, and increased taxation on tobacco products.
Although these measures make sense worldwide in protecting public health and reducing the impact on healthcare systems, strong opposition from the industry has led to their implementation being delayed, often for years.
In regards to tobacco control, there is a very strong and resource-rich industry directly opposing public health. They are willing to use their entire arsenal to prevent a decrease in demand for their products, which is a crucial target affecting public health," stated Bacelar Gomes.
As far as Mexico is concerned, the first concrete action taken after the approval of the World Health Organization's Framework Convention on Tobacco Control was the approval of the General Tobacco Control Law in 2008.
This law has incorporated some of the measures from the framework agreement, but only partially," Sabines said. "For example, while proposing smoke-free public places, designated indoor smoking areas are still permitted, which does not protect the public from second-hand smoke.
Over the next 13 years, it will be crucial for the Pan American Health Organization to work towards legal reform. This includes providing ongoing technical support to the Mexican Ministry of Health, developing capacity, creating and disseminating scientific evidence to support these measures, and conducting outreach campaigns to educate the public about the dangers of tobacco consumption.
Recently, there have been efforts in technology partnerships aimed at helping prevent underage use of novel products such as electronic cigarettes and heated tobacco products, which are actively marketed as "healthier alternatives.
Between 2008 and 2021, Congress updated the tobacco control law with over 100 bills whenever there were changes to the law. These bills included measures to improve packaging and advertising, as well as legislation for smoke-free public places, according to Sabines. However, none of these bills have resulted in any changes.
During this time, the Pan American Health Organization's office in the country organized meetings with domestic and international partners, technical experts, and health officials to design a strategy for revising the tobacco control law. This included collaborating with national media to publish articles and editorials emphasizing the importance of tobacco control.
The urgency of tobacco control has been heightened by the COVID-19 pandemic.
COVID-19 has caused thousands of deaths in the Americas, with those who have underlying health conditions, particularly chronic respiratory diseases and other illnesses caused by smoking, being particularly affected.
According to Luciana, despite the difficulty of focusing on public health issues other than COVID-19 during a pandemic, the importance of enforcing strong public health policies to protect people from the harms of unhealthy products such as tobacco becomes immediately apparent. This was stated by Sebastian Sevigny, a consultant for tobacco control in the Pan American Health Organization.
On December 14, 2021, the Mexican Senate unanimously approved the amendment to the "General Law on Tobacco Control," establishing a 100% smoke-free environment. This is the result of the tireless work and dedication of the Pan American Health Organization and the tobacco control industry. The amendment also prohibits the advertising, promotion and sponsorship of tobacco products.
This amendment represents a historic advancement in Mexico's anti-tobacco policy and reaffirms its role as one of the leaders in the global fight against tobacco," said Cristian Morales, former Pan American Health Organization/World Health Organization representative to Mexico.
Although Mexico is among the countries in the region that have successfully implemented laws to protect people from the harmful effects of tobacco use, there is still a lot of work to be done in reducing risk factors for non-communicable diseases (NCDs) such as smoking.
The Pan-American Health Organization (PAHO) is continuing to collaborate with member countries to address non-communicable diseases through the development of policies and legislation, guidelines for management, monitoring and surveillance, capacity-building, as well as public education and awareness campaigns.
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