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GAO-19-533R 1 (2019-08-08)

handle is hein.gao/gaobadztu0001 and id is 1 raw text is: cAO U.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 August 8, 2019 The Honorable Karen Bass Chair Committee on Foreign Affairs Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations House of Representatives The Honorable Lloyd Doggett House of Representatives Global Tobacco Control: U.S. Efforts Have Primarily Focused on Research and Surveillance The United Nations' (UN) World Health Organization (WHO) has reported that tobacco use is one of the world's leading causes of preventable deaths, killing over 8 million people each year- almost three times the number that die from tuberculosis, HIV/AIDS, and malaria combined.1 The majority of those deaths occur in low- and middle-income countries. To address this problem, WHO's Framework Convention on Tobacco Control (FCTC) was adopted by the World Health Assembly in 2003 and came into force in 2005. The FCTC's stated objective is to protect people from the consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for implementing tobacco control measures at the national, regional, and international levels.2 The U.S. government signed the FCTC in 2004 but has not ratified it. The Department of Health and Human Services (HHS), the U.S. Agency for International Development (USAID), and the Department of State (State) engage in global tobacco control efforts. You asked us to review U.S. global tobacco control efforts. This report examines U.S. agencies' funding and activities related to global tobacco control in fiscal years 2015 through 2018. To examine agencies' funding and activities, we reviewed data and documentation from HHS, USAID, and State and met with officials from each agency.3 We reviewed obligations data 1According to WHO, tobacco products include smoked products, such as cigarettes and cigars, as well as smokeless products that are consumed through the mouth or nose without combustion, such as chewing tobacco. Most tobacco consumed throughout the world is in the form of smoked products. 2The FCTC defines tobacco control as a range of supply, demand, and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke. 31n addition to meeting with HHS, USAID, and State officials, we met with officials from the Office of the U.S. Trade Representative (USTR). USTR officials noted that the proposed Trans-Pacific Partnership was the only U.S.-negotiated trade agreement to explicitly include a provision on tobacco regulation. In particular, the partnership would have allowed parties to prohibit private entities from using investor-state dispute settlement to challenge government tobacco regulations, which, according to USTR officials, would have created a safe harbor for FDA tobacco regulation. However, the U.S. government withdrew from the agreement in January 2017, and USTR officials confirmed that the agency did not engage in any other global tobacco-related efforts during the period covered by our review. GAO-1 9-533R Global Tobacco Control Page 1

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