Low-income and middle-income countries leading the way with tobacco control policies

© Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. GLOBAL TOBACCO USE AND POLICY INTERVENTIONS Tobacco products are the world’s single largest cause of preventable death, accounting for more than 8 million deaths each year and causing suffering from avoidable illnesses among tens of millions more. Tobaccocaused death and disease disproportionately affects people in lowincome and middleincome countries (LMICs). 2 The WHO Framework Convention on Tobacco Control (FCTC), with 182 parties from all regions of the world, was developed in response to the globalisation of the tobacco epidemic and lays out evidencebased demand and supply reduction strategies. These strategies have resulted in measurable progress: global cigarette sales have been declining since 2012 despite overall population growth. It is estimated that tobacco control interventions have saved more than 37 million lives as fewer people start and more people quit, using tobacco products. However, there is much more work needed ahead. Over 1 billion people worldwide still use tobacco products, and the tobacco industry continues to aggressively fight the enactment and effective implementation of proven policy interventions. The demand and supply measures outlined in the FCTC, adopted by the World Health Assembly in 2003, are considered a floor (after all, the Framework Convention was based on the best evidence available through the dawn of the 21st century). However, FCTC Article 2.1 explicitly encourages countries to go beyond the measures outlined, and they have! Early tobacco control policy innovations, with data of their impacts feeding into the development of the FCTC, included smokefree air policies in states and cities in the USA, pictorial health warning labels (HWLs) in Canada, restrictions on tobacco advertising and sponsorship in Canada, and the use of tobacco excise taxes as a measure to reduce smoking in Canada. Since the FCTC came into force, innovations have included a ban on the display of tobacco products at the point of sale in Iceland, and plain and standardised packaging in Australia. However, policy innovations have also occurred across LMICs. This commentary highlights seven diverse examples from across the globe, selected by the authors, of world precedent setting, firstoftheir kind interventions that have originated in LMICs.