The fourth pillar of the Framework Convention on Tobacco Control: Harm reduction and the International human right to health

The Framework Convention on Tobacco Control (FCTC), while successful in its execution, fails to acknowledge the harm reduction strategies necessary to help those incapable of breaking their dependence on tobacco. Based on the human right to health embodied in Article 12 of the International Covenant on Economic, Social and Cultural Rights, this article contends that international law supports a harm reduction approach to tobacco control. Analyzing the right to health as an autonomy-enhancing right, countries must prioritize health interventions to promote those treatments most likely to increase autonomy among those least able to control their own health behaviors. Harm reduction can involve the use of novel, purportedly less hazardous tobacco products. By dissociating nicotine from the ancillary carbon monoxide and myriad carcinogens of smoking, these tobacco harm-reduction products may allow the individual smoker to retain addictive behaviors while limiting their concomitant harms. These less hazardous products, while not offering the preferred benefits of abstaining from tobacco entirely, might nevertheless become a viable strategy for buttressing individual autonomy in controlling health outcomes. Working through the FCTC framework, countries can create the international regulatory and research capacity necessary to assess harm-reduction products and programs. The harms of smoking are truly global in scope. More than 1.1 billion people smoke worldwide, resulting in cardiovascular diseases, various cancers, and obstructive lung diseases.' Approximately one-quarter of all lifelong smokers will die in middle age (between 35 and 69) as a result of smoking, losing between 20 and 25 years of life. Another quarter of these smokers will die in their latter years as a result of smoking.(2,3) Globally, this "quiet pandemic" claims the lives of approximately 5 million persons per year, a figure that will rise to 10 million by 2030, with the burden of death increasingly being felt by developing countries.' With globalization's dismantling of trade barriers permitting the burgeoning initiation of smoking in unsated developing countries-particularly among the children and adolescents of these countries-tobacco is projected to become the world's leading cause of avoidable death.(5)