Tobacco-Free World by 2040 – Call for Turbocharged Efforts

March 13, 2015

By Fran Lowry

An international group of public health experts is calling for renewed efforts to stop the sale and consumption of all tobacco products around the world by the year 2040.

“The time has come for the world to acknowledge the unacceptability of the damage being done by the tobacco industry and work towards a world essentially free from the sale (legal and illegal) of tobacco products,” write the researchers, led by Robert Beaglehole, DSc, and Ruth Bonita, PhD, from the University of Auckland, in New Zealand.

Tobacco kills almost 500,000 people in the United States and 6 million globally each year, notes coauthor Derek Yach, MD, from the Vitality Institute, New York City.

With sufficient political support and stronger evidence-based action against the tobacco industry, by the year 2040, a tobacco-free world, in which fewer than 5% of the population uses tobacco, is possible, they write in a new series in the Lancet.

“We are not making sufficient progress towards reducing the damage caused by the tobacco industry. We need an ambitious end goal, hence, the tobacco-free world goal by 2040,” Dr Beaglehole told Medscape Medical News.

“The solution is essentially a political one. Political practicality depends on strong government and intergovernmental political leadership. The existing tobacco control efforts are insufficient to achieve this goal because progress is not happening fast enough, especially in Eastern Europe, South America, and, of course, China and Indonesia,” he said.

Ten years ago, the World Health Organization (WHO) introduced the Framework Convention on Tobacco Control (FCTC), which is now ratified by 180 countries, excluding the United States.

Despite the efforts of 135 of these countries, only 15% of the world’s population have access to smoking cessation programs, and fewer than 10% are covered by the most effective tobacco control measure ? high taxes on tobacco products to make them prohibitively expensive.

No If’s, And’s, or Butts

Although the prevalence of smoking has fallen in the past 3 decades ? globally, from 41% to 31% in men and from 11% to 6% in women ? the actual number of smokers has increased steadily from 720 million in 1980 to almost 1 billion in 2012, mainly because of population growth.

In addition, evidence from many countries shows that more girls now smoke compared with their mothers, mostly because of aggressive marketing on the part of the tobacco industry.

To counter the tobacco industry’s aggressive tactics, a “turbocharged” approach is essential, Dr Beaglehole said.

Such an approach can be achieved by accelerating the FCTC in countries where implementation has been slow or incomplete, judging on the basis of successes of the leading countries.

“Global tobacco control started when a handful of jurisdictions, including Australia, Canada, Hong Kong, Singapore, and some US states, such as Massachusetts and California (and a few large cities, such as New York), showed what was possible with active nongovernmental organizations, tobacco control activists, and brave politicians,” he said.

The turbocharged effort would build on the efforts of the FCTC by adding extra elements.

These include fighting the tobacco industry’s efforts to thwart the FCTC, which is particularly strong in vulnerable countries; having a fully engaged private sector take action; and enacting more harm-reduction strategies.

Tobacco Kills

According to coauthor Dr Yach, who led the development of the WHO FCTC treaty on tobacco, the time has come to push harder for new ideas and a higher level of ambition to tackle the world’s most preventable cause of death.

“The most important step towards virtual elimination of tobacco use” is building support for the argument that tobacco kills, that nicotine causes addiction, Dr Yach told Medscape Medical News.

“Separating approaches to reducing the harm caused by tobacco while supporting innovations in providing clean forms of nicotine could be transformative and cut deaths fast. That requires a shift in how regulators do their work, a shift in how doctors provide advice, and a shift in how consumers of tobacco understand their risks and ways of reducing them,” he said.

Such “clean” forms of nicotine include “snus,” a smokeless tobacco popular in Sweden that is placed on the gums and gives a nicotine buzz, and e-cigarettes, which deliver nicotine without the dangers created by burning tobacco, Dr Yach said.

Funding this ambitious initiative to achieve a global reduction in tobacco use, especially in vulnerable, low-income populations, will be a challenge, he said.

“This is a crucial problem. Currently, only the Bloomberg and Gates Foundations provide serious funding for poorer countries and communities. Along with Princess Dina of Jordan, we will chair a plenary on this very topic at the World Conference on Tobacco Control next week in Abu Dhabi and hope to gain stronger support from funders,” he said.

However, a long-term solution requires better use of market forces that are able to shift consumption from “killing” tobacco to relatively inert nicotine and related products, Dr Yach said.

“Recall that most smokers want to reduce the harm of their habits, and way back when filter cigarettes were first introduced, within a decade, 50% of smokers were using them. That did not reduce their risks, however. This time, new forms of reduced-harm products have a chance of achieving the same scale but with dramatically better health outcomes,” he said.

There is still an important role each individual can play to achieve the goal of a world free of tobacco products, Dr Yach added.

“Each of us can remind people that tobacco still kills almost 500,000 people in the US and 6 million globally, that the harm it causes is preventable, and that new alternatives exist,” he concluded.

Dr Beaglehole and Dr Yach report no relevant financial relationships.

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