The Global War on Tobacco: Mapping the World’s First Public Health Treaty by Heather Wipfli (review)

The Framework Convention on Tobacco Control (FCTC) stands as a valuable contribution to public health. It is an example of how international law can meaningfully impact population health at the local level, especially when transsectoral and transnational collaboration is present. Considering the growing interest in addressing other major global health challenges, like obesity and alcohol, understanding the tobacco control experience is critical. Therefore, while much has been written on global governance and tobacco control, Heather Wipfli’s book The Global War on Tobacco: Mapping the World’s First Public Health Treaty is a tale waiting to be told. It is a thorough and yet succinct analysis of the forces and trends that led to the negotiation of the FCTC and the treaty’s immediate results—both intended and unintended.

The role of international law in addressing and improving the public’s health has been downplayed despite its historical contribution to advancing population health.¹ The emergence of the global health law field is both a response to this reality and an opportunity for international law to achieve its full potential. Promoting the study and use of international law, global health law “seeks innovative ways to mobilize resources, set priorities, coordinate activities, monitor progress, create incentives, and ensure accountability among a proliferation of global health actors.”² Importantly, the field understands that “[it] must foster collective action, facilitating partnerships among state and nonstate actors and across public and private spheres” in order to be effective.³ The FCTC has done exactly this. Its entire existence has been defined by transdisciplinary, transsectoral, and transnational collaboration, where international and national nonstate actors have been instrumental. As Wipfli emphasizes, philanthropists like Michael Bloomberg and Bill Gates and organizations like the Campaign for Tobacco-Free Kids and medical associations have played a vital role in advancing tobacco control policies across the globe.

The transnational network of tobacco control advocates relied on innovative ways of sharing experiences, collecting evidence and data, and garnering support for the creation of a treaty that would set legal standards and obligations for countries to comprehensively tackle the tobacco epidemic. For these reasons, what led up to the FCTC and what followed constitute an important case study of global health law in practice.

Wipfli’s country case studies provide an insight into how countries’ experiences can vary and how their historical and sociopolitical context can substantially determine their ability and willingness to incorporate international legal and public health standards, as well as the level of influence that they can have on global health governance. For example, while a middle-income country, Thailand was critical to including key tobacco control measures within the FCTC. Thailand’s experience in combating transnational tobacco companies since the 1970s and experimenting with various types of tobacco control measures (including legislation and taxation) gave the country the necessary tools to become a leader in developing and negotiating the FCTC. The process was not a one-way street, however. Thailand stood to benefit from its involvement in and the eventual adoption of the FCTC. As Wipfli explains, “the [FCTC] did not initiate tobacco control efforts in Thailand, but it has provided a credible foundation for ongoing efforts to strengthen existing regulations, build greater infrastructure, and counter industry influence” (p. 114).

Germany, on the other hand, represents a country whose close and historical ties to the tobacco industry significantly undermined tobacco control efforts to set more effective standards than those eventually established under the FCTC, not to mention the implementation of the treaty. The tobacco industry’s infiltration in scientific research and policy making in Germany meant poor access to credible information on tobacco and weak tobacco control advocacy. Tobacco control efforts under the FCTC (and outside of it) face a tremendous obstacle in Germany. The way Wipfli presents it, any advancement in tobacco control in the country is more...