摘要：In some high-, middle-, and low-income countries, law has been employed to limit individuals’ secondhand smoke exposure. Innovative legal tools are still needed, especially in low- and middle-income countries where smoking prevalence continues to rise. For some persons with severe respiratory conditions, the presence of secondhand smoke is intolerable and prevents their entrance into restaurants and other venues. With its adoption of the Convention on the Rights of Persons with Disabilities (CRPD) in 2006, the United Nations gave countries a new way to promote the rights of disabled individuals and simultaneously address secondhand smoke exposure. We analyze the CRPD’s potential to advance tobacco control goals and offer recommendations for advocates, policymakers, and others seeking to apply this approach. Tobacco use is one of the leading preventable causes of morbidity and mortality worldwide and is responsible for nearly 6 million deaths annually. 1 Approximately 1.3 billion people smoke either cigarettes or bidis (the latter consisting of low-grade tobacco and used in South Asia), 2 and about 80% of these smokers live in low- or middle-income countries (LMICs). 3 Although the tobacco industry asserts that tobacco production is a source of economic growth—especially for LMICs—estimates suggest that when health costs are factored in, world tobacco production and use results in a net loss of $200 billion USD annually. 4 The health consequences of tobacco use are not limited to individuals who use tobacco; they are also experienced by nontobacco users, primarily through exposure to secondhand smoke. In 2004, secondhand smoke was responsible for approximately 600 000 deaths and approximately 10.9 million disability adjusted life years worldwide. 5 During the same period, an estimated 40% of children, 33% of male nonsmokers, and 35% of female nonsmokers were exposed to secondhand smoke. Respiratory illnesses represent the largest disease burden from secondhand smoke, with approximately 6 million lower respiratory infections among children younger than 5 years, 1.2 million cases of asthma among adults, and 650 000 cases of asthma among children worldwide in 2004. 5 For some individuals, particularly those with chronic, severe respiratory conditions, the presence of secondhand smoke is intolerable because it makes breathing exceptionally difficult. In both high-income countries and LMICs, the law has increasingly been used to limit individuals’ exposure to secondhand smoke. For at least the past 2 decades, governments throughout the world have employed legislation to establish smoke-free indoor environments, although challenges remain with the implementation, enforcement, and comprehensiveness of these laws. 6 Although progress has been made, innovative legal tools to address secondhand smoke exposure are critical, especially in LMICs where smoking prevalence continues to rise. 7 The United Nations gave countries a new way to promote the rights of disabled individuals and simultaneously tackle secondhand smoke exposure with its adoption of the Convention on the Rights of Persons with Disabilities (CRPD) in 2006. The CRPD introduces protections for disabled persons—including those with severe respiratory conditions and accompanying intolerance to smoke exposure—into international law. Because it provides a legal foundation to argue that indoor smoking restrictions are a necessary accommodation for those with certain chronic respiratory conditions, the CRPD complements the goals of the World Health Organization’s (WHO’s) Framework Convention on Tobacco Control. We analyze the CRPD’s potential to advance tobacco control efforts, and offer recommendations for advocates, policymakers, and other stakeholders who seek to capitalize on this novel approach.
