International Trade and Public Health: Trade vs. Tobacco Control during the Framework Convention on Tobacco Control Negotiation

In the mid-1980s and the early 1990s, the US used threat of trade sanctions and trade liberalization arguments to open tobacco markets in Asia. A General Agreement on Trade and Tariffs panel ruled in the 1990s in a case involving the US and Thailand that tobacco control policies should be non-discriminatory. Whether health should take precedence over trade within the international system became an issue during negotiation of the Framework Convention on Tobacco Control (FCTC). We used WHO and Framework Convention Alliance archival documents on the FCTC negotiations, tobacco industry documents, and interviews of participants in the FCTC negotiations for this analysis. The tobacco companies lobbied states against supporting any FCTC provision that would allow heath to take precedence over trade. Also, countries with strong domestic tobacco interests were more likely to be against the idea that health should take precedence over trade. In addition, countries concerned that health over trade provision would undermine the international trade regime were more likely to be against such a provision. In spite of strong advocacy by tobacco control civil society organizations, the FCTC preamble only provided that health should be given a priority. This outcome of this highly contested issue during the FCTC negotiation illuminates the influence of the tobacco industry and major countries' unwillingness to take collective action in public health that would allegedly undermine the trade regime under the World Trade Organization. The FCTC negotiation provides a case for how concern over trade is prevalent in global public health discussions.