Mexico's Journey to Tobacco Control: Overcoming Industry Resistance.

In 2004, Mexico became the first country in the Americas to approve the groundbreaking World Health Organization Framework Convention on Tobacco Control. However, it took another 20 years for its measures to be incorporated into Mexican law. "When faced with one of the world's largest and most powerful industries, patience, perseverance, and cooperation are the only way forward," said Dr. Juan Arturo Sabines, National Tobacco Advisor for the Pan-American Health Organization (PAHO).

Tobacco use is the most preventable cause of death in the world today. Nearly one million people die every year in the Americas alone from direct consumption or exposure to secondhand smoke. It accounts for 15% of deaths from cardiovascular disease, 24% of cancer deaths, and 45% of deaths from chronic respiratory disease.

The opposition to tobacco began in the 1950s, when the medical community started gathering evidence of smoking's link to serious diseases, particularly cancer," said Adriana Bacelar Gomes, a tobacco control expert at the Pan American Health Organization. "That was the first initiative to begin restricting the industry and standardizing tobacco products and their use, and when our work began.

However, 60 years later, tobacco remains the only legal consumer product that causes up to half of its users to die.

In the past 20 years, the Pan-American Health Organization has focused on supporting countries in their efforts to adopt and implement the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). This legally binding international treaty is designed to promote cost-effective measures to control tobacco use, including preventing secondhand smoke in all indoor workplaces and public places, large graphic health warnings on tobacco product packaging, comprehensive bans on tobacco advertising, promotion, and sponsorship, and increasing tobacco product taxes.

Although these measures make a lot of sense in terms of protecting public health and reducing the strain on the healthcare system, strong industry resistance has caused delays in their implementation, often spanning several years.

In tobacco control, there is a very powerful and resourceful industry that directly opposes public health efforts. They are prepared to use everything in their arsenal to prevent a decrease in demand for their products, which is a critical public health goal," said Bacelar Gomes.

Regarding Mexico, the first tangible action taken after the approval of the World Health Organization's Framework Convention on Tobacco Control was the enactment of the General Tobacco Control Law in 2008.

The law has adopted measures from the WHO FCTC, but only partially," said Sabines. "For example, although it proposes smoke-free public places, it still allows people to smoke in designated indoor areas, which fails to protect the public from secondhand smoke.

The efforts of the Pan American Health Organization over the next 13 years will be crucial in amending laws. This includes ongoing technical support for the Mexican Ministry of Health, building capacity, developing and disseminating scientific evidence to support these measures, and public awareness campaigns to educate the public about the dangers of tobacco use.

Lately, technological collaborations have included efforts to help prevent young people from using new products such as e-cigarettes and heated tobacco products, which are actively marketed as "healthier alternatives".

During the period of legal revision from 2008 to 2021, Congress proposed over 100 initiatives to update tobacco control laws. "These measures included improvements to packaging and advertising legislation, as well as initiatives to create smoke-free areas in public places," Sabines stated. However, none of them were implemented.

During this time, the Pan-American Health Organization's national office organized meetings with domestic and international partners, technical experts, and health ministry officials to develop a strategy for advancing the country's tobacco control law amendment. This included collaborating with national media outlets to publish articles and editorials highlighting the importance of tobacco control.

The COVID-19 pandemic has increased the urgency for tobacco control.

Once the pandemic began, the link between tobacco consumption and non-communicable diseases could no longer be ignored. COVID-19 has caused thousands of deaths in the Americas, and those with preexisting conditions, particularly chronic respiratory diseases and other diseases caused by smoking, have been especially affected.

Although it has been challenging during the pandemic to focus on public health issues other than COVID-19, the importance of implementing strict public health policies to protect people from unhealthy products such as tobacco has become immediately evident," said Luciana Severini, an international advisor for the Pan American Health Organization, regarding tobacco control.

The Mexican Senate has unanimously approved a tobacco control bill amendment that establishes 100% smoke-free environments and completely bans advertising, promotion, and sponsorship. This comes as a result of the tireless efforts of the Pan American Health Organization and the tobacco control industry. The new law takes effect on December 14, 2021.

This amendment represents a historic step forward for Mexico in its anti-smoking policies, and reaffirms its role as one of the leaders in the global fight against tobacco," said Christian Morales, former representative of the Pan American Health Organization/World Health Organization in Mexico.

Although Mexico is one of the countries in the region that has successfully implemented laws to protect people from the harmful effects of tobacco use, there is still much work to be done to reduce the risk factors for non-communicable diseases such as smoking in the Americas.

The Pan-American Health Organization is continuing to work with member countries to address non-communicable diseases. This is being achieved through the implementation of policies and legislation, the provision of management guidelines, monitoring and surveillance, capacity building and public awareness campaigns.

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