Public participation in the successful formation of the World Health Organization's Framework Convention on Tobacco Control (FCTC) demonstrated that this process could also benefit the creation of other public health policies, according to a study in the January 2010 issue of the journal Global Public Health.
The study analyzed public testimony from 489 written documents and 142 hearings submitted to the World Health Organization (WHO) during a comment period on the FCTC in 2000. The FCTC marked the first time the WHO used its constitutional mandate to create an international convention.
The FCTC was adopted at the World Health Assembly in May 2003 and entered into force in February 2005. It provides an internationally coordinated response to addressing the globalization of the tobacco epidemic.
Issues Addressed by the FCTC
The FCTC addressed many of the concerns raised by the public:
- the effect of tobacco on children and youth
- advertising and sponsorship of tobacco
- labeling of tobacco products
- secondhand smoke
- tobacco taxes
- tobacco smuggling
- liability
- tobacco product regulation
- involvement of non-governmental organizations (NGOs) in public health policy
Benefits of Public Participation
Public health advocates benefited from new communications technology. The public had the option of mailing, faxing or e-mailing their commentaries. Written commentary was due in advance and was posted on a WHO-sponsored website. In-person hearings were broadcast via internet in real time. Translations were made available in the five official languages of the WHO.
"Many who testified in person referred to their own or others' submissions, implying a feedback loop," stated the analysis. "The FCTC demonstrated that internet technology facilitates the collection of commentary and the exchange of ideas and opinions, as well as offering the potential to hold electronic global hearings on international issues."
Other benefits of public participation in the creation of public health policy identified by the analysis included:
- leveling the playing field for public health activists and NGOs
- building the expertise of advocates that can be generalized to other public health efforts
- giving the political process legitimacy and credibility
- coalition building
- increasing grassroots momentum
Public Participation from Poor Nations
Written comments submitted via postal mail, fax and e-mail from poor nations (where ability to attend the hearings was limited by lack of resources) tended to be in favor of the treaty. The majority of participants supported the FCTC, especially if it protected children.
The minority who opposed the treaty argued that restrictions on tobacco trade would further damage the economies of poor nations that are financially dependent upon tobacco. The less numerous, oral testimonies of people representing poor nations tended to be against the treaty. According to the analysis, testimony of representatives against the treaty showed great uniformity, suggesting that in-person participation was sponsored.
"Opening up the process and inviting public participation allowed the public to come forth and express support for a public health effort. Public support of the FCTC enabled the WHO to deflect industry accusations of promulgating 'nanny state' policies," read the analysis.
Participation by Non-governmental Organizations
NGOs were the majority of parties that offered written and oral testimony (57%). Participation in public venues was one of the few ways in which public health advocates could influence the convention language, according to the analysis.
Tobacco industry representatives, on the other hand, had the option of less-public ways to influence policy "behind the scenes." The analysis stated: "Public commentary and public hearings appear to function to level the playing field between the for-profit public and the public health public."
Applying Lessons Learned to Other Public Health Efforts
The analysis found trends in opinions and beliefs of stakeholders that can be generalized to other public health efforts.
Because industry representatives often recycle the same arguments in different venues, it may be possible to take lessons learned from this analysis "to anticipate the political and economic arguments that will be raised in public health efforts that run counter to corporate interests, such as alcohol or fire arms, food and food safety, intellectual property protection and pharmaceutical access, or worker safety protections."
"If public health advocates build a historical record, that legacy will enable activists to hone a more sophisticated approach to core and chronic concerns so they can better position themselves at subsequent public hearings," concluded the analysis.
References:
- Montini T, George A, Martin-Mollard M, Bero LA. The role of public participation in public health initiatives: An analysis of the WHO Framework Convention on Tobacco Control. Global Public Health 2010; 5(1): 48-61.
Juan Ramos - Juan Ramos is a health communication specialist based in Boston, Massachusetts, USA. He has worked in the non-profit sector for more than ...
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