One billion deaths: The imperative of global tobacco control

The recent deaths of Christopher Hitchens and Vaclav Havel provide a timely reminder that tobacco use is the most prevalent behavioral threat to life and health.

In 2012, an estimated six million people around the world will die as a result of tobacco use. The World Health Organization projects that one billion people could die of tobacco-related causes over the remainder of this century. That’s an almost unfathomably huge number. If anything like this comes to pass, tobacco will numerically dwarf just about every other threat to human life and health.

I ran across the numbers in my capacity as an assistant editor at Addiction, where I helped shepherd a manuscript concerned with smoking cessation in Vietnam. The rapidly developing economics of Southeast Asia face especially high tobacco-related health burdens. An estimated 47 percent of Vietnamese men (though fortunately very few women) smokes. Eighty-two percent of Vietnamese smokers smoke daily. Rising per-capital incomes, modern media, and globalization may well worsen the problem by lowering the economic and cultural barriers to tobacco use….

Of course the same trends may create opportunities to help. Rising incomes may support the use of more costly and more effective prevention strategies and smoking cessation therapies. Globalization may promote the proliferation of best-practice models of smoking cessation in primary medical care and public health. Signatories to the World Health Organization Framework Convention on Tobacco Control (FCTC) now encompass 87 percent of the world’s population.

In 2008, the World Health Organization initiated the MPOWER effort to encourage every nation to pursue a package of evidence-based measures. MPOWER includes a broad range of measures from epidemiological surveillance to smoke-free environments, warning labels, media campaigns and commercial advertising bans, tobacco taxes, and more. That’s a good start. Yet only a very small percentage of the world’s people receive the recommended help in primary prevention or in encouragement and practical help in halting their tobacco use. Many of these measures are extremely cost-effective when compared with other widely-accepted measures to prolong life and improve health. 

Tobacco manufacturers, distributors, and end-sellers–firms that you’ve heard of, but many others, too—fight against many effective measures in the United States and across the world. The political economy of public health often works against effective measures, too.  Within many societies, it is easier to build political coalitions for medical treatment than for effective prevention measures. There’s more money to be made selling cigarettes and providing help and services to sick smokers than there is to be made preventing and halting tobacco use.

Tobacco is no ordinary product. We need the same effectiveness and passion behind global tobacco control that one sees in the best efforts against AIDS. One billion lives are at stake. It’s hard to even imagine such a number. So it’s good to remember specific special people such as Hitchens and Havel. I would add two more: Gregory and Janice Perrone, both of whom died bad deaths from lung cancer before their grandchildren–my daughters–could really get to know them.

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