BACKGROUND: The smoking epidemic causes over 8 million deaths annually, making it the leading preventable cause of death globally. In response, the World Health Organization (WHO) introduced the Framework Convention for Tobacco Control (FCTC), an international treaty aimed at reducing tobacco demand and supply through a set of measures known as MPOWER. However, its effectiveness remains uncertain.
METHODS: We employed Interrupted Time Series Analysis (ITSA) with synthetic control groups formed by countries that never ratified the FCTC. This approach compared changes in smoking trends and levels before and after ratification between treated and control groups. The effect of the FCTC on the number of current smokers (25 years and less) was quantified by contrasting the current levels and trends in ratifying countries with the counterfactual scenario, represented by synthetic control groups composed of countries that never ratified the FCTC. Additionally, we analysed the differential impact of the FCTC by classifying countries according to their level of implementation of MPOWER measures.
RESULTS: Focusing on countries that ratified the FCTC by 2010 (more than 95% of the global population), we found that, in the population under 25 years (when consumption usually begins), if these countries had not ratified, they would have had 19% more current smokers 10 years after ratification than there had (about 23 million more current smokers). Considering that smoking kills about half to two-thirds of those who start early and don’t quit, the FCTC may have avoided at least 11-15 million deaths in the first decade of implementation. Notably, reductions were statistically higher in countries that maintained a high implementation of MPOWER measures or moved to high implementation.
CONCLUSIONS: The FCTC has demonstrably reduced the number of current smokers in ratifying countries. However, ratification alone is insufficient, and a high implementation of MPOWER measures is essential to maximise the treaty’s impact.