Not just Smoke and Mirrors: A Tobacco-Free Future

By Derek Yach

This year marks the 50th anniversary of the publication of “Smoking and Health,” the US Surgeon General’s landmark report. “The Health Consequences of Smoking – 50 Years of Progress” report released earlier this month highlights 50 years of advancements in tobacco control and prevention, presents new data on the health consequences of smoking, and discusses opportunities that hold potential for ending the smoking epidemic in the United States.

As mentioned in the supporting Surgeon General’s factsheet, 20 million premature deaths can be attributed to smoking in the past 50 years and smoking rates have declined from 42% in 1964 to 18% in 2012 – but according to the CDC, tobacco is still the leading preventable cause of death today. With that in mind, acknowledging progress is important but must go hand in hand with an awareness of the remaining challenges to curb this global epidemic.

In a Lancet article released today, I provide my views on “The origins, development, effects, and future of the WHO Framework Convention on Tobacco Control” (WHO FCTC), based on my time at the WHO working on the FCTC as well as my experience in health promotion and chronic disease prevention in the private sector.

From a policy perspective, the features that contributed to the success of the WHO FCTC – from strong leadership provided by the then Director General, Gro Harlem Bruntland, and targeted strategies used to mobilize support for the WHO FCTC – demonstrate the complexity of working and establishing impact across geographic and organizational borders. Our approach at WHO was multifaceted, building out support while establishing the systems required to measure progress and working to highlight the tobacco industry’s efforts that impede progress. All the strategies we used can and should be leveraged to tackle other health issues, reinforcing them with current day opportunities such as public-private partnerships.

On the ground, the MPOWER framework provided six evidence-based measures deemed the most effective for reducing tobacco use. An evaluation of these interventions from 2007 to2010 suggest that the largest number of smoking-attributable deaths averted will result from increased cigarette taxes, smoke free air legislation, health warnings, cessation treatments, and bans on tobacco marketing.

A few trends worth noting are an evolution of the tobacco industry’s target audiences and their recent focus on women and girls leading to increases in smoking rate in both populations, as well as the growing e-cigarette market, providing a tobacco free alternative but claimed by some to be a gateway “drug”.

Looking to the future to foster a tobacco-free future, my three key recommendations are to:

  1. Build the research and evidence base on e-cigarette use,
  2. Focus on women and girls as a population with increasing rates of tobacco use, and
  3. Inspire young leadership into the existing work on tobacco control.

Finally, Abraham Lincoln and Peter Drucker are attributed the quote: “the best way to predict the future is to create it”. I hope this is what we will continue to do, working step by step to create a tobacco-free future – because if we don’t, it means 1 billion people will die of tobacco this century.

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