The WHO FCTC – Global Impact or Stagnation?


We know tobacco control policies are effective at the national level, but what role does international law play in combating the global tobacco epidemic? Evaluating the impacts of the FCTC is timely and necessary as it is the first treaty negotiated under the auspices of WHO and one of the most important international laws governing global health.

With the World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC) adopted in 2003 and ratified by 182 countries, this international treaty has received nearly universal approval in academic literature, news media, and political speeches. However, the benefits from this international tobacco control treaty are still unclear. We are a world-leading research group evaluating the global impacts and implications of the FCTC. 

Tobacco consumption continues to be one of the leading causes of preventable death worldwide. The WHO estimates that the number of tobacco related deaths will continue to rise without rapid implementation of global tobacco control measures. Though the WHO FCTC and its associated MPOWER policy package has been seen as a watershed moment in global health, there have been few attempts to empirically evaluate its impact.

The WHO FCTC presents a unique opportunity to investigate the role of international law to address global health challenges.  Since randomization is not possible, rigorous quasi-experimental approaches are required to generate evidence across countries, regions, income groups, and genders. These assessments of the FCTC’s impacts will support efforts to strengthen future tobacco control efforts.

Gigi Lin, Prativa Baral
Collaborating Researchers
Jessica Mammone, Maxwell Tran, Safa Al-Khateeb, Andrej Grjibovski, Elliot Gunn, Sara Kamali-Anaraki, Ben Li, Mathura Mahendren, Yasmeen Mansoor, Navneet Natt, Ejike Nwokoro, Harkanwal Randhawa, Melodie Yunju Song, Kelsey Vercammen, Carolyne Wang, Julia Woo

Key Findings

Global impact evaluations

In 2019, we published  two landmark studies in the British Medical Journal. We first outlined the process to collect, appraise, select, and report the best available national estimates of cigarette consumption from 1970 to 2015, resulting in a publicly accessible dataset of international cigarette consumption. We then conducted the first-ever impact evaluation of the WHO FCTC,  finding no change in a pre-existing global decrease in cigarette consumption. However, high income and European countries showed a decrease in annual consumption of over 1000 cigarettes per adult, whereas low and middle income and Asian countries showed an increased annual consumption of over 500 cigarettes per adult. 

Regional impact evaluations

To understand the complex ways that international law can affect health around the world, we are conducting regional impact evaluations. We produced a classification of cigarette consumption trajectories in Europe Link to support comparative analysis of tobacco control policies, and highlights the multilevel and multisectoral causal mechanisms of regional and global cigarette consumption. We are continuing this research through a systematic review of population-level factors that underlie tobacco consumption and policy tracing of European cigarette consumption trends. 

Gendered impact evaluations

This emerging research area will examine the gendered impacts of the WHO FCTC on global cigarette consumption trends. 

Open-access data

The International Cigarette Consumption Database (ICCD) Link  contains cigarette consumption data from 1970-2015 collected through a systematic search coupled with consultation with country and subject-matter experts. Our data is standardized into units of cigarettes consumed and a detailed accounting of data quality and sourcing is available in our open-access dataset. Data was found for 82 countries, representing over 95% of global cigarette consumption and 85% of the world’s population.


September 8, 2022

Most Existing International Treaties Do Not Work