What’s New in Tobacco Control?

Saturday was World No Tobacco Day which prompted me to ask: “What’s new?” After looking at the press releases, I decided that the most significant thing that happened last year was that another 30 million young people have started smoking around the world. Of these, 25 million are in low- and middle-income countries and about 12 million of them will die prematurely from disease linked to tobacco – 10% of them because of second-hand smoke. This epidemic is not caused by a virus or spread by mosquitoes. It is intentionally planned and profited from by large tobacco companies – for-profit multinationals as well as state-owned monopolies.

The irony is that 178 countries are parties to the Framework Convention on Tobacco Control, an international agreement that commits them to implementing a series of highly effective and legal measures to reduce the prevalence of smoking – raising tobacco taxes, restricting advertising, prohibiting smoking in public places. The World Bank and IMF have staff available to provide technical support to countries wishing to proceed with these measures. WHO has all the technical materials and explanations necessary for countries to implement six basic cost-effective strategies which are part of the MPOWER initiative. The Bloomberg Initiative to Reduce Tobacco Use, with additional funding from the Gates Foundation, have contributed to MPOWER and have their own research material, advocacy documents, and toolkits to help out.

There’s no excuse for inaction, and yet the epidemic is growing – particularly in low- and middle-income countries.

At a recent meeting with a high-level British official, I made a pitch for them to take a leading role in combatting tobacco. I argued that in the world of development assistance, there may be no easier way to save lives, promote development, and simultaneously improve country fiscal conditions than combatting tobacco. Though persuaded, he asked a simple question: If that is so, then why isn’t it being done? I didn’t have an answer at the time, but now I think I do.

Three factors conspire to keep the tobacco epidemic spreading. First, tobacco doesn’t look like a crisis to anyone with the power to do anything about it. Second, tobacco companies apply enormous resources and ingenuity to keep policymakers ignorant or cowed. Third, academics, technical staff in international agencies, and government officials repeat and elaborate Tobacco Company propaganda – like worrying about the regressive impact of tobacco taxes without understanding the enormous burden of smoking on poor people or treating smoking as a consumer choice without recognizing its addictive quality and the lengths to which tobacco companies go to get adolescents hooked.

Officials in rich countries are used to smoke-free environments and find it easy to forget the invisible costs in shortened lives. In institutions like the World Bank, regional development banks, and aid agencies, most health sector staff are focused on improving the delivery of health care services and addressing diseases that require medical treatment – like the cancers and strokes caused by smoking – and have limited standing to push for changes in tax policies or trademark protection laws. For staff who work on fiscal policy, trade, and private sector development, tobacco is frequently viewed as a distraction, and the need for laws and regulations that distinguish a legal-but-toxic product from legal-and-non-toxic ones are simply a headache. Low- and middle-income officials have plenty of other things to do, particularly when the international community offers limited resources to tackle the problem.

However, there is a constituency with a very focused interest in tobacco: tobacco companies and the people who work for and profit from them. British American Tobacco, Japan Tobacco International, Phillip-Morris, the China National Tobacco Corporation, and their peers have billions of dollars and plenty of time to spread deceptions, obfuscate issues, and file lawsuits.

And they are extremely successful – as the British government should know. Cameron’s government has dallied over advertising restrictions and - despite a recent high-level government report strongly supporting graphic warnings on cigarette packs - the government has decided to do “further consultations with the industry.”

I’m not saying there hasn’t been any progress. It is true that many countries are implementing tobacco control policies and prevalence in many countries has declined. But smoking prevalence globally is unchanged since the mid-1990s and current estimates suggest that in this century, unless smoking is severely curtailed, 1 billion premature deaths will be caused by diseases linked to tobacco. Tobacco companies are cruelly indifferent.  But effective measures exist. All governments need to implement them. And governments that protect tobacco companies have to stop protecting them. Otherwise, the only thing new at next year’s World No Tobacco Day will be the knowledge that another 30 million young people have succumbed to advertising and peer pressure and started on the road to addiction and premature death.