CHICAGODespite 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 worlds
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
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
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
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.
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, were 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 Organizations 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.
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.