U.S. engagement on global tobacco control has been limited. The United States helps monitor smoking internationally, provides technical assistance when asked on tobacco regulation, and lends its financial support to WHO, some of which spills over into global tobacco control efforts. U.S. officials no longer use trade measures to pry open emerging economies to imported cigarettes, as had been done throughout the 1980s and 1990s, and, despite occasional, significant congressional pressure, have also refrained from trade disputes against other countries’ tobacco control measures.

On the other hand, tobacco use, which annually kills more people worldwide than HIV/AIDS, tuberculosis and malaria combined, is not even a line item in the $8 billion U.S. global health budget. The U.S. Agency for International Development has a formal tobacco policy, last reissued in 2009, that indicates that the agency will not undertake international tobacco control programs for staffing and budget reasons, although it will participate in international policy discussions. Nearly every U.S. trade and investment agreement negotiated over the last decade has reduced tobacco tariffs and continued to protect tobacco investments like those of any other U.S. industry. The United States is one of a handful of countries, along with Cuba, Somalia and Zimbabwe, that has yet to ratify the WHO Framework Convention on Tobacco Control.

We can do better, at little cost. The mandate and resources of federal agencies should be increased to help developing countries build their own programs to tax and regulate tobacco, and to warn against smoking.