Governments representing over 80% of the world's population are now party to
the World Health Organization Framework Convention on Tobacco Control, WHO's
first global public health treaty and one of the most widely embraced treaties
in UN history. Governments around the world clearly understand the burden of
the tobacco epidemic whose impact hits hardest in those countries that can least
afford it. With the funding available for global tobacco control only a fraction
of that being spent by tobacco companies looking to exploit the vast marketplace
of developing countries, it is essential that the Framework Convention on Tobacco
Control is implemented in a manner that leverages to a maximum the limited resources
available to reverse the tobacco epidemic. WHO believes that as many as 200
million lives could be saved by the middle of this century through the implementation
of a core package of cost effective demand reduction measures and, to this end,
the Organization’s Tobacco Free Initiative, working with partners from the public
and private sectors, is taking unprecedented steps to scale up its technical
assistance at country level.
An increasing burden for developing countries
5.4 million people die every year due to diseases caused by tobacco, a figure
that will rise to 8.3 million a year by 2030 unless urgent action is taken.
Of these deaths, an estimated 84% will occur in developing countries. It is
the poor and the poorest who smoke the most and the large majority of tobacco
users now live in developing and transitional economy countries with tragic
consequences for the public health and economies of those nations. In Bangladesh
male smokers spend more than twice as much on cigarettes as on clothing, housing,
health and education combined, while in countries such as China, Egypt, Indonesia
and Russia, people spend 5-6% of their household income on tobacco.
Meanwhile the world’s largest tobacco companies are wasting no time in targeting
the vulnerable new clientele of the developing world spending billions of dollars
each year on marketing and promotion in these markets. Campaigns aimed at women
and girls, often portraying smoking as a key to emancipation and liberation,
threaten a huge rise in the number of women smokers even in cultures where tobacco
use has traditionally been a male preserve.
In August this year, Altria/Philip Morris announced plans to spin off Philip
Morris International as a separate company, a move that financial analysts see
as an effort to expand more aggressively in developing nations. Responding to
the announcement, Dr Douglas Bettcher, Director of WHO Tobacco Free Initiative
said: “An effort to boost long-term shareholder value is presented as the logic
of the relentless drive into the developing world by multinational tobacco companies.
The reality for their shareholders is that their investment yields millions
of additional deaths every year, chronic and crippling illness, and suffering
for millions of the poorest families worldwide.“
The role for tobacco control in the achievement of the Millennium Development
Goals is clear. Chronic diseases due to tobacco use exacerbate poverty in developing
countries, imposing huge public health costs as well as impacting on the workforce.
Tobacco use kills workers at the height of their productivity, robbing families
of their key breadwinner and rendering workers less productive due to illness.
A successful way forward for tobacco control
However, the picture on tobacco control is not all bleak. The political momentum
that has built up around tobacco control in the past decade is a clear signal
that governments globally understand the negative health, budgetary and broader
development impacts of tobacco use. The success of the WHO Framework Convention
on Tobacco Control in securing parties is, in some ways, the “end of the beginning”
in the battle to make tobacco control more effective worldwide. The challenge
now is to see the political success of the Framework Convention transformed
rapidly into practical and effective mechanisms enabling governments, notably
those in the developing and transition economies, to roll back tobacco use amongst
their citizens. This requires a rapid scaling-up of technical assistance at
country level, a goal that WHO Tobacco Free Initiative has placed at the top
of its agenda for the next few years.
One of the most important developments and a cornerstone of WHO’s efforts to
both scale up and transform the global impact of tobacco control measures is
the recently launched Bloomberg Global Initiative. Set against the background
of the Framework Convention on Tobacco Control, the innovative new initiative
brings WHO into a five way partnership that gathers together UN legitimacy,
private foundation financing, and world recognized health expertise to implement
a core package of cost effective demand reduction measures for tobacco control.
The initiative targets 15 developing countries where two thirds of the world’s
smokers live and promotes evidence-based approaches to tobacco control, namely,
tobacco tax increases, advertising bans, anti-tobacco advertising and mandatory
health warning labels, smoking bans and cessation support. The initiative also
rigorously monitors the status of global tobacco use and the progress of countries
in implementing the core package. New York Mayor, Michael Bloomberg, has injected
an initial 125 million US$ to capitalize the two-year collaboration with the
WHO Tobacco Free Initiative and four partner organizations.1
With its unparalleled regional and country network, WHO is uniquely placed
to facilitate tobacco control activities throughout the world. In July this
year 146 Parties to the WHO Framework Convention on Tobacco Control met in Thailand
for the Second Conference of the Parties, the governing body which oversees,
monitors and evaluates the progress of the Treaty and works to develop protocols,
specific guidelines and requirements for countries to implement tobacco control
measures. The tobacco epidemic and its contribution to the chronic disease burden
has been exacerbated by globalization and the Conference of the Parties provides
a multilateral forum to address this challenge, highlighted this year by its
decision to launch negotiations for the first protocol to the Framework Convention,
a new international treaty on illicit trade in tobacco products.
Recognizing the scope and scale of the challenges facing successful scaling
up of its technical assistance to developing countries worldwide, WHO works
with a range of partners on activities to effect this transformation. These
activities include:
World no tobacco day, celebrated on the 31 May each year, providing
a launch pad for tobacco control initiatives worldwide. In 2007 activities ranged
from a high-level tobacco control conference in Moscow organized by the Russian
Duma to an extensive television campaign by Brazilian broadcasters;
The global youth tobacco survey, a joint WHO and Centers for
Disease Control and Prevention initiative, a school-based survey that monitors
tobacco trends amongst 13-15 year olds. The data gleaned from the Global Youth
Tobacco Survey is used to plan and develop comprehensive tobacco control programmes
for adolescents;
Tobacco regulatory, an international scientific advisory group
whose work is based on cutting edge research on tobacco product issues and which
advises WHO as it develops effective regulatory frameworks governing the design
and manufacture of tobacco products;
The WHO tobacco laboratory network reated to facilitate transnational
and regional testing and research into tobacco products of all forms;
Use of evidence-based training materials to enable countries
to develop and implement tobacco control measures tailored to local needs.
Learning from tobacco - a key to noncommunicable disease control
WHO believes that the innovative approach to tobacco control it is now implementing
together with partner organizations could offer a key to its broader work in
combating noncommunicable diseases by scaling up control and prevention strategies
at a country level. “It is projected that by 2015, tobacco will kill 50% more
people than HIV/AIDS and be responsible for 10% of all deaths globally. The
approach we are now taking to reverse the tobacco epidemic is a new departure
for the global public health community in noncommunicable diseases, an approach
we believe can save millions of lives from what is a completely preventable
epidemic”, said Dr Bettcher.
*Tobacco Free Initiative (TFI), World Health Organization. Thanks to: Alison
Clements-Hunt, Communications Officer, Contact: clementshunta@who.int
Note
1 .In addition to the WHO, other partner organizations in the Bloomberg Global
Initiative include the Campaign for Tobacco-Free Kids, the Centers for Disease
Control and Prevention Foundation, the Johns Hopkins Bloomberg School of Public
Health and the World Lung Foundation.
