The 20th anniversary of the WHO Framework Convention on Tobacco Control: hard won progress amid evolving challenges

Psychomodulatory substances: New legislative framework for control of psychoactive substances in Czechia

This article challenges drug prohibition advocated by UN conventions as the prevailing regulatory model for psychoactive substances, highlighting its ineffectiveness, harmfulness and outdated nature. At the same time, the conventions exclude some psychoactive substances from international regulation, leaving control to individual countries. Presenting an innovative approach, this article outlines an approach to the legal regulation of psychomodulatory substances (psychoactive substances with low health and societal risk) in non-medical contexts. Acknowledging the potential benefits of such psychoactive substances and balancing them with potential harms, it suggests stringent rules for marketing, safety, and preventing sales to minors. This approach aims to quell illicit markets, safeguard vulnerable populations, and encourage controlled use. Through a case study of the Czech Republic's introduction of a new category of psychomodulatory substances, this article showcases a paradigm shift from the prevailing repressive approach to drug regulation. This adaptive model effectively navigates the regulatory void, offering a viable alternative to the UN's prohibition framework.

Update on numbers of tobacco-attributable deaths by country in the South-East Asia region: implications for policy

BACKGROUND

The WHO South-East Asia Region is home to around 33% of adult tobacco users. To inform tobacco control policy and practice, we conducted a study using the latest available data to update mortality attributable to overall tobacco use, including smoked tobacco, smokeless tobacco (SLT) and secondhand smoke (SHS) exposure, in the 11 countries of the Region.

METHODS

We estimated smoking, SLT use and SHS exposure using the latest available surveys for each country during 2016-2021, and then estimated all-cause and lung cancer-attributable annual deaths for each using the population-attributable fraction method. Finally, we estimated the annual total tobacco-attributable deaths including all three exposures using the multiplicative aggregation method.

RESULTS

We estimated the occurrence of 4 087 920 all-cause deaths and 105 279 lung cancer deaths annually attributable to tobacco use among the 11 countries investigated. India accounted for 63.9% of all-cause tobacco-attributable deaths.

CONCLUSIONS

The high annual number of tobacco-attributable deaths in the Region highlights the need for accelerating progress in reducing tobacco use. Implementation of the WHO Framework Convention on Tobacco Control (FCTC) and MPOWER policy package needs prioritisation at the country level. Tobacco cessation services, supply-side measures and policies to counter tobacco industry interference should be strengthened. Further work is needed to monitor progress towards FCTC implementation and analyse the impacts of policies on tobacco-related outcomes, including attributable mortality and disease burden, to inform advocacy efforts.

Capitalism and the 'commercial determinants of health': A more-than-human micropolitics

This paper argues that studies of the 'commercial determinants of health' (CDoH) need to acknowledge fully the part the capitalist mode of commodity production and exchange plays in producing negative health outcomes. This proposition is supported by recourse to a recent development in political economy that has established a more-than-human, relational and monist (or 'flat') ontology of capitalism, in place of the more conventional neo-Marxist perspective. This ontology reveals a dynamic to capitalism that operates beyond human intentionality, driven by the supply of, and demand for the capacities of commodities. This dynamic determines the production and consumption of all commodities, some among which (such as tobacco, alcohol and processed foods) contribute to ill-health. A case study of food consumption reveals how these supply and demand affects drive 'unhealthy' food choices by consumers. Ways to undermine this more-than-human dynamic are offered as an innovative approach to addressing the effects of commerce and capitalism upon health.