Efforts to Reduce Tobacco Deaths May Fail in the Short Term

CHICAGO—Despite comprehensive efforts to prevent lung and oral cancers as well as other diseases related to tobacco use around the world, experts in tobacco control do not expect to see a drop in the number of deaths due to smoking in the next 15 years.

Even Yussuf Saloojee, MD, executive director of the National Council Against Smoking in South Africa, who believes tobacco control programs will progress rapidly, especially in developing countries, predicted that the harm caused by tobacco use will get worse before it gets better.

“The worldwide volumes [of tobacco use] are still increasing and can be expected to continue to do so, particularly given the trends in incidence of female smoking, the increase in the world’s population, as well as the prospects for continuing world economic growth and the increase in disposable income,” he said at the 11th World Conference on Tobacco or Health.

Judith P. Wilkenfeld, director of the Framework Convention Initiative, Campaign for Tobacco-Free Kids, Washington, DC, likewise sees no end to the rise of tobacco use, at least in the next few years.

“We have a product here that is addictive, and users are victims who do not want to lose their victimhood. This [addiction] is a problem that will keep tobacco use around for a long time,” she said.

Dr. Saloojee, Ms. Wilkenfeld, and Simon Chapman, PhD, associate professor of public health and community medicine, University of Sydney, Australia, were asked to give their views of the outcomes for tobacco control in the year 2015 during a panel discussion at the meeting that explored future scenarios for the tobacco industry and the marketplace.

Although Ms. Wilkenfeld does not foresee any reductions in death or disease related to tobacco use in the next 15 years, she feels that efforts to control tobacco will achieve interim goals that eventually will lead to decreases in tobacco-related death and disease in the next 20 to 50 years.

Ms. Wilkenfeld feels that tobacco control programs can make great progress by stopping young people from starting to smoke. She acknowledges that tobacco control efforts cannot eliminate youthful indiscretion, but they can, in fact, make inroads into preventing the young as a group from starting to use tobacco products or getting young people to quit early.

She also contends that tobacco-related death and disease may decline as a result of regulatory initiatives that make it more difficult for people to smoke, such as restrictions on smoking in public places and business office settings.

“The major problem with tobacco,” Ms. Wilkenfeld emphasized, “is that it is unregulated. Its content is unregulated, sales are unregulated, and its market is unregulated. As we find solutions to some aspects of tobacco use, such as restrictions on marketing or sales, the tobacco industry mutates like a virus, and it mutates with unlimited funds. Therefore, we need to have strong responses that meet these challenges,” she said.

‘Easy’ Goals Have Been Achieved

Dr. Chapman pointed out that many countries already have developed aggressive antitobacco campaigns. Australia, for example, has banned advertising, placed high taxes on cigarettes, and instituted widespread public information programs. Yet the prevalence of smoking in Australia is still unacceptably high, and the number of children who use tobacco is moving upward.

“So the easy answers and goals have been achieved; progress toward achieving subtle goals probably will be slower in the next 15 years than it has been in the past,” he commented.

Meanwhile, in other parts of the world, tobacco control has barely begun. As a result, Dr. Saloojee said, “my hope as well as my belief is that, of course, we’re going to progress more rapidly in the next 15 years because we now know the truth about this industry.”

The panelists are encouraged by international cooperation in tobacco control, such as the World Health Organization’s Framework Convention on Tobacco Control, which calls together representatives from countries across the globe to create a treaty for public health.

The convention will address a wide range of issues surrounding tobacco use, such as advertising, smuggling, and regulation of tobacco products; smoking cessation and treatment; governmental policies on pricing, taxation, and agriculture; passive smoking; information exchange; and health education and research.

Cooperation Threatened

The panelists agreed that international cooperation may be threatened by tobacco industry attempts to exploit the division between developed and developing countries.

As Dr. Saloojee explained, “Currently in South Africa and certainly in the rest of the continent, the debate is that Africa has more important problems to worry about than tobacco,” such as HIV infection and poverty.

He consequently issued a warning to the tobacco control community: “If it [international antitobacco cooperation] is dominated in resource terms by western countries, if we are not sensitive and do not create an agenda very carefully, the tobacco industry will be able to exploit the divide between countries. It will be able to say that tobacco use really is a problem of the rich countries, and the rich countries are using tobacco control to put forward their agenda.”

Tremendous progress still can be made by tobacco control in individual developing countries, Dr. Saloojee added. In the last 10 years, tobacco control programs in South Africa have reduced tobacco consumption by 55%.

“That level of success is achievable in every developing country in the world, provided we get the political will to do it,” he said.

‘Tobacco Epidemic Will End’

Dr. Saloojee went even further to predict that “sometime in this century, the battle between public health and corporate wealth will be decided in favor of health. The current economic, social, and health costs will continue to mount until eventually no government will be able to deny the harm caused by tobacco. The tobacco epidemic will then end.”