Treatment in the FCTC

The Framework Convention on Tobacco Control is the world's first global treaty for public health, committing its parties to a comprehensive set of measures to tackle the tobacco epidemic. Among the FCTC Articles outlining measures concerned with reducing demand for tobacco, Article 14 states that:

“Each Party shall develop and disseminate appropriate, comprehensive and integrated guidelines based on scientific evidence and best practices, taking into account national circumstance and priorities, and shall take effective measures to promote cessation of tobacco use and adequate treatment of tobacco dependence.”
Source: WHO Framework Convention on Tobacco Control (pdf), 2005

It has however been argued that the FCTC does not impose sufficiently strong obligations on Parties in relation to treatment. There have been calls for a specific Protocol on the Treatment of Tobacco Dependence, such as that drafted by WHO in 2000. Although that draft Protocol was abandoned during the FCTC negotiating process, the first Conference of the Parties in February 2006 agreed that Article 14 would be considered as one for which guidelines should be drawn up outlining how to proceed at country level. The COP Secretariat is now working on a report on treatment issues for presentation to the Second Conference of the Parties (late 2008). The Global Treatment Partnership can meanwhile provide assistance to countries that are interested in producing their own guidelines.

National guidelines

There is now a wealth of experience, from diverse countries, on how to produce national evidence and consensus based treatment guidelines, and on how to design and introduce treatment systems. Twenty-one countries now have published guidelines, although they vary widely with regard to the extent of their evidence base and the extent to which they are formally endorsed at national level. The best-known national guidelines are probably those of the UK (specifically England), and the USA.

National guidelines on treatment typically follow similar broad formats. They make reference to the evidence base, the country's particular patterns of tobacco use and any national targets or health policy objectives relating to tobacco. They then provide recommendations on what interventions should be provided in the various settings available. Depending on their level of national endorsement, these documents can have the effect of setting standards for treatment provision in the settings they cover.

If national guidelines are truly to affect the extent and the quality of treatment provision, then experience suggests that wide professional and governmental endorsement is necessary. This process, which can be lengthy, raises the profile of treatment and builds support for its implementation. It has been suggested that the success of England's and Scotland's national guidelines was due largely to the effort invested in securing wide endorsement by prestigious health groups.

Please contact us for advice on the process of creating national guidelines.

National guidelines examples

1. UK
Within the UK, England and Scotland each have their own guidelines tailored to their respective health systems. The English guidelines were published in the journal Thorax in 1998, updated in 2000. They led to the establishment of a nation-wide system of services for smokers provided under the National Health Service, including NHS prescription of medications for service users. For a full description of the English system and links to its background policy papers click here.

In Scotland, updated guidelines published in 2004 drew on the first few year's - experiences of NHS stop-smoking services to make recommendations the organisation and implementation of clinical interventions to promote smoking cessation in Scotland. The guidelines are intended for use by health professionals and health planners at all levels. The underlying clinical evidence base is broadly similar to that of the English guidelines. Click here for the full Scottish guidelines text.

2. USA
First published in 1996 but currently being updated, The US Agency for Health Care Policy and Research Clinical Practice Guideline on smoking cessation makes recommendations on smoking cessation for three audiences: primary care clinicians, tobacco cessation specialists and programmes, and health care administrators, insurers, and purchasers. The AHCPR guideline took several years to produce and involved around 125 people. It has been widely used by health professional organisations to create setting-specific treatment recommendations based on the "Ask, Advise, Assess, Assist, Arrange follow-up" model. Click here for the US guidelines documents.