健康權與貿易利益衡平的新模式――以菸草終局政策為例

A New Regulatory Model for Balancing Health Rights and Trade Interests: Insights from Tobacco Endgame Policy

世界衛生組織於2003年通過的菸草控制框架公約（The WHO Framework Convention on Tobacco Control，簡稱FCTC公約），為全球菸害防制奠定規範基礎。儘管此公約生效後促使全球吸菸率逐年下降，但2023年報告卻顯示FCTC公約在條文落實與根本解決菸害上仍存在落差，僅有三分之一的FCTC公約締約國達成2025年設定的降菸目標。在此背景下，「菸草終局（Tobacco Endgame）」政策試圖挑戰FCTC公約的政策邏輯，從傳統減害轉往全面禁絕，強調健康權優先的核心價值。歷經十幾年的討論與推動，已有部分國家將菸草終局的相關作為納入菸害控制政策。該趨勢反映出國際衛生法由折衷走向人權至上的轉變，卻也延續了FCTC公約未解的健康權與貿易利益衝突。為此，本文提出「健康權與貿易利益互動」分析架構，探討各國實踐菸草終局的程度差異。透過比較立法經驗可知，菸害管制作為常因政府對經濟利益的執著，導致決策上產生「政策猶豫」，導致菸草終局在實務上依然受制於貿易利益困境。本文認為，近年自由貿易協定中關於公共健康規範的發展，或能為菸草終局與全球菸害防制提供新視野，成為緩解健康權與貿易利益衝突的潛在路徑。

The adoption of the WHO Framework Convention on Tobacco Control (FCTC) in 2003 established a foundational regulatory framework for global tobacco control. Although the FCTC has contributed to a steady decline in global smoking rates since its entry into force, a 2023 report indicates a significant gap in policy implementation and the fundamental eradication of tobacco epidemic. Only one-third of FCTC parties are on track to meet the 2025 tobacco reduction targets. Against this background,“Tobacco Endgame”policies have emerged to challenge the underlying logic of the FCTC, shifting the focus from traditional harm reduction toward complete eradication while securing the supremacy of the right to health.
After over a decade of discourse and promotion, certain countries have integrated endgame strategies into their tobacco control frameworks. This trend sheds light on a paradigm shift in international health law from compromise toward a human-rights-centered approach. Yet, the measures that have emerged perpetuate the unsettled tension between the right to health and trade interests inherent in the FCTC. To address this, this article proposes an analytical framework of“interaction between the right to health and trade interests”to examine the dynamics of tobacco control and endgame measures across jurisdictions. The findings reveal that tobacco control measures often encounter governmental persistence regarding economic interests, resulting in“policy hesitancy”that leaves endgame initiatives constrained by trade-related dilemmas. This article concludes that recent developments concerning public health provisions within Free Trade Agreements (FTAs) may offer a new perspective for tobacco endgame and global tobacco control policies, paving a potential pathway to reconcile the conflict between health and trade.