Podium: Our failure to control smoking

From a speech by the general secretary of the World Health Organisation to a conference in Berlin

IN THIS century - a century of astounding public health gains - tobacco control stands out in most countries as an appalling failure. Too few resources have been committed; too often national governments have chosen soft options.

Consider the facts.

More people smoke today than at any other time in human history. Worldwide, the tobacco death rate is up - way up. Four million people are killed each year by tobacco industry products.

Half of all long-term smokers will be killed prematurely by tobacco industry products. Five hundred million people alive today are likely to be killed by tobacco.

Half of these will die in their productive middle years. This robs families of economic support and countries of the contribution of some of its most experienced workers.

It will get worse, much worse, before it can get better.

Tobacco promotion is linked to smoking initiation. Initiation leads to addiction. Eighty per cent of smokers reveal that they were addicted before the age of 18. Addiction results in prolonged use. And the use of tobacco causes avoidable premature deaths decades later.

So the focus of today's tobacco promotion will largely determine who will be killed by this product in 2025. By that date tobacco will kill 10 million a year. That is almost a tripling of today's level. Tobacco will then be the single largest contributor to the global burden of disease.

And, perhaps saddest of all, smoking is growing rampantly in the developing world. Nearly all the consumption growth - and the 7 million extra deaths each year - are expected to be in developing countries.

Part of the failure of past tobacco control stems from the incongruous way tobacco products have been regulated.

Tobacco's selling price is often influenced through taxes. The cigarette box is marginally controlled in many countries through mandated health warnings. Tobacco advertising is controlled only in some countries. But the root problem is not the cigarette package, or the price of the advertising. The problem is the product itself.

Cigarettes are inherently dangerous products. The tobacco companies, despite knowing this for many years, have chosen not to remedy the matter, and to press forward their sales.

It is this failure of the market-place to solve the problem that is our invitation to step in and make a difference.

Though this will not be easy, too often the challenges have been overstated, and too often countries have chosen to tinker with the problem rather than attacking the root cause.

One of the largest transnational tobacco companies opposes tobacco content regulation. But this company is not unfamiliar with product regulation, because it has a food products division and these products are regulated.

How can any of us justify the fact that the contents of food products made by a company are regulated, but the contents of cigarettes, another of its products, are not?

The tobacco companies will tell you that they are selling a simple agricultural product, chopped-up tobacco leaves rolled into a little paper tube. This is untrue. Cigarettes are among the most highly engineered products available.

The companies say that nicotine occurs naturally and inevitably in tobacco, rather like seeds in an apple. There is evidence that nicotine delivery to the smoker may be skilfully controlled so that the cigarette delivers a sufficient dose of nicotine to create, then maintain, addiction.

So-called "light" cigarettes deliver lower tar and nicotine to the machines, but under real smoking conditions smokers obtain just as much tar, just as much nicotine, from "light" brands as they do from regular cigarettes.

Unregulated cigarette design lets the companies fool smokers into believing they are choosing less hazardous products. This is a misconception. Health concerns should not be exploited as a marketing opportunity.

We know that the global nature of the problem will require partnership between national governments and international agencies, and between the public and private sectors. The legal framework to regulate tobacco product content and design should be set in place. Then those matters for which existing knowledge is sufficient should be tackled. For example, cherry-flavoured chewing-tobacco is sold in several countries. What more do we possibly need to know to decide that fruit- or candy-flavoured tobacco should not be sold? The answer is simple: nothing.

We can reverse the trends of what is developing into a major pandemic. Let's start work.