In an era in which governments withdraw from international commitments, prioritize national policies and seem reluctant to cooperate at a multilateral level, a global instrument reaffirming the right to health may look impossible. Yet, in the midst of this exacerbated nationalism, there are advocates for a Framework Convention for Global Health (FCGH), a treaty aimed at closing the inequalities in access to health care. By clarifying priorities in the health agenda and promoting accountability and participation strategies, the FCGH is meant to strengthen the right to health and adapt it to a globalized world. Although the international arena may not appear ready for such a widespread pledge, tobacco control arises as a contemporary example of successful international health regimes and paves the road for deeper multilateral cooperation in global health.

globe with a stethoscope In 2003, the World Health Organization (WHO) played an important part as a nexus of global efforts to protect public health in the face of the tobacco epidemic. The result was a Framework Convention on Tobacco Control (FCTC), that currently has 181 Parties and represents more than 90% of the world’s population. Due to the transnational nature of the tobacco phenomenon and the diversity of actors involved, the only way to properly tackle this issue was through multilateral cooperation.

The FCTC turned out to be one of the most significant accomplishments of the WHO, rallying global support against tobacco and motivating many states to develop far-reaching tobacco regulation. This treaty gave birth to a series of institutions and norms that harmonize state interests over this particular matter. The FCTC helped shape an international regime in the field of health. In international relations literature, international regimes refer to rule-oriented institutions created by states, that limit their legal freedom of action but enhance predictability and promote cooperation to achieve similar goals.

And that is exactly what the FCTC has proven to be, both a legitimate and an effective regime. Its legitimacy comes from the number of parties involved, as well as from the prompt process of ratification it experienced. It created a set of principles born from consensus that serve as a guideline for its members. That unity has enabled the rapid adoption of key instruments to promote its implementation. In many cases, the FCTC has had an effective influence on the legal framework on tobacco control measures, providing a basis for government authority to act or offering guidance on the interpretation or application of constitutional provisions. Most parties have passed or are renewing and strengthening national legislation related to the treaty, and this trend is even replicating in states that haven’t ratified it or aren’t members of the FCTC at all. Though challenges in fully implementing the treaty remain, these achievements are indicative of its effectiveness in regulating tobacco.

Unfortunately, there have been several difficulties in having the same level of legitimacy and effectiveness across the global health landscape. There has been an increase in players and resources, but their efforts are often impeded by an uncoordinated and incoherent system. Part of this fragmentation may be due to the lack of leadership guiding cooperative practices in the global health realm. The position of the WHO, as the envisioned centralized forum for these topics, has been challenged over the last few decades by other institutions that emerged to deal with specific global health issues, such as HIV/AIDS or tuberculosis.

Despite this seemingly fragmented scenario, the success of the FCTC is evidence of the possibility of an international regime on global health. The performance of the FCTC raises hopes on the feasibility of the FCGH. Establishing such a wide international framework on global health requires the coordinated efforts of a complex web of international actors, such as states, international organizations, enterprises and NGOs. That level of harmonization demands a strong center that fosters multilateralism and involvement from different stakeholders. Given that effectiveness enhances legitimacy, the experience of the FCTC suggests that WHO’s leadership in the FCTC could be also asserted at the FCGH level.

Whether that happens or not, the FCTC exemplifies that the construction of international rules and procedures can vastly reproduce at a domestic level, legitimizing and allowing the continuity of an effective regime. In my opinion, one thing is undeniable: the successes of the FCTC lays the path for a greater regime in global health.