Innovative approaches to scaling-up tobacco control efforts in developing countries

Combating the global tobacco epidemic

Von Tobacco Free Initiative

The statistics surrounding tobacco continue to speak for themselves. While many developed nations have begun to slow and even reverse the tide of tobacco use and disease by implementing effective tobacco control policies, low and middle-income countries continue to see strong growth in tobacco consumption. The battle to combat the tobacco epidemic has not been won, but has clearly shifted to a larger and more challenging arena. Without focused interventions on tobacco control, an estimated one billion people are likely to die from tobacco in the 21st century.

Governments representing over 80% of the world's population are now party to the World Health Organization Framework Convention on Tobacco Control, WHO's first global public health treaty and one of the most widely embraced treaties in UN history. Governments around the world clearly understand the burden of the tobacco epidemic whose impact hits hardest in those countries that can least afford it. With the funding available for global tobacco control only a fraction of that being spent by tobacco companies looking to exploit the vast marketplace of developing countries, it is essential that the Framework Convention on Tobacco Control is implemented in a manner that leverages to a maximum the limited resources available to reverse the tobacco epidemic. WHO believes that as many as 200 million lives could be saved by the middle of this century through the implementation of a core package of cost effective demand reduction measures and, to this end, the Organization’s Tobacco Free Initiative, working with partners from the public and private sectors, is taking unprecedented steps to scale up its technical assistance at country level.

An increasing burden for developing countries

5.4 million people die every year due to diseases caused by tobacco, a figure that will rise to 8.3 million a year by 2030 unless urgent action is taken. Of these deaths, an estimated 84% will occur in developing countries. It is the poor and the poorest who smoke the most and the large majority of tobacco users now live in developing and transitional economy countries with tragic consequences for the public health and economies of those nations. In Bangladesh male smokers spend more than twice as much on cigarettes as on clothing, housing, health and education combined, while in countries such as China, Egypt, Indonesia and Russia, people spend 5-6% of their household income on tobacco.

Meanwhile the world’s largest tobacco companies are wasting no time in targeting the vulnerable new clientele of the developing world spending billions of dollars each year on marketing and promotion in these markets. Campaigns aimed at women and girls, often portraying smoking as a key to emancipation and liberation, threaten a huge rise in the number of women smokers even in cultures where tobacco use has traditionally been a male preserve.

In August this year, Altria/Philip Morris announced plans to spin off Philip Morris International as a separate company, a move that financial analysts see as an effort to expand more aggressively in developing nations. Responding to the announcement, Dr Douglas Bettcher, Director of WHO Tobacco Free Initiative said: “An effort to boost long-term shareholder value is presented as the logic of the relentless drive into the developing world by multinational tobacco companies. The reality for their shareholders is that their investment yields millions of additional deaths every year, chronic and crippling illness, and suffering for millions of the poorest families worldwide.“

The role for tobacco control in the achievement of the Millennium Development Goals is clear. Chronic diseases due to tobacco use exacerbate poverty in developing countries, imposing huge public health costs as well as impacting on the workforce. Tobacco use kills workers at the height of their productivity, robbing families of their key breadwinner and rendering workers less productive due to illness.

A successful way forward for tobacco control

However, the picture on tobacco control is not all bleak. The political momentum that has built up around tobacco control in the past decade is a clear signal that governments globally understand the negative health, budgetary and broader development impacts of tobacco use. The success of the WHO Framework Convention on Tobacco Control in securing parties is, in some ways, the “end of the beginning” in the battle to make tobacco control more effective worldwide. The challenge now is to see the political success of the Framework Convention transformed rapidly into practical and effective mechanisms enabling governments, notably those in the developing and transition economies, to roll back tobacco use amongst their citizens. This requires a rapid scaling-up of technical assistance at country level, a goal that WHO Tobacco Free Initiative has placed at the top of its agenda for the next few years.

One of the most important developments and a cornerstone of WHO’s efforts to both scale up and transform the global impact of tobacco control measures is the recently launched Bloomberg Global Initiative. Set against the background of the Framework Convention on Tobacco Control, the innovative new initiative brings WHO into a five way partnership that gathers together UN legitimacy, private foundation financing, and world recognized health expertise to implement a core package of cost effective demand reduction measures for tobacco control.

The initiative targets 15 developing countries where two thirds of the world’s smokers live and promotes evidence-based approaches to tobacco control, namely, tobacco tax increases, advertising bans, anti-tobacco advertising and mandatory health warning labels, smoking bans and cessation support. The initiative also rigorously monitors the status of global tobacco use and the progress of countries in implementing the core package. New York Mayor, Michael Bloomberg, has injected an initial 125 million US$ to capitalize the two-year collaboration with the WHO Tobacco Free Initiative and four partner organizations.1

With its unparalleled regional and country network, WHO is uniquely placed to facilitate tobacco control activities throughout the world. In July this year 146 Parties to the WHO Framework Convention on Tobacco Control met in Thailand for the Second Conference of the Parties, the governing body which oversees, monitors and evaluates the progress of the Treaty and works to develop protocols, specific guidelines and requirements for countries to implement tobacco control measures. The tobacco epidemic and its contribution to the chronic disease burden has been exacerbated by globalization and the Conference of the Parties provides a multilateral forum to address this challenge, highlighted this year by its decision to launch negotiations for the first protocol to the Framework Convention, a new international treaty on illicit trade in tobacco products.

Recognizing the scope and scale of the challenges facing successful scaling up of its technical assistance to developing countries worldwide, WHO works with a range of partners on activities to effect this transformation. These activities include:

World no tobacco day, celebrated on the 31 May each year, providing a launch pad for tobacco control initiatives worldwide. In 2007 activities ranged from a high-level tobacco control conference in Moscow organized by the Russian Duma to an extensive television campaign by Brazilian broadcasters;

The global youth tobacco survey, a joint WHO and Centers for Disease Control and Prevention initiative, a school-based survey that monitors tobacco trends amongst 13-15 year olds. The data gleaned from the Global Youth Tobacco Survey is used to plan and develop comprehensive tobacco control programmes for adolescents;

Tobacco regulatory, an international scientific advisory group whose work is based on cutting edge research on tobacco product issues and which advises WHO as it develops effective regulatory frameworks governing the design and manufacture of tobacco products;

The WHO tobacco laboratory network reated to facilitate transnational and regional testing and research into tobacco products of all forms;

Use of evidence-based training materials to enable countries to develop and implement tobacco control measures tailored to local needs.

Learning from tobacco - a key to noncommunicable disease control

WHO believes that the innovative approach to tobacco control it is now implementing together with partner organizations could offer a key to its broader work in combating noncommunicable diseases by scaling up control and prevention strategies at a country level. “It is projected that by 2015, tobacco will kill 50% more people than HIV/AIDS and be responsible for 10% of all deaths globally. The approach we are now taking to reverse the tobacco epidemic is a new departure for the global public health community in noncommunicable diseases, an approach we believe can save millions of lives from what is a completely preventable epidemic”, said Dr Bettcher.

*Tobacco Free Initiative (TFI), World Health Organization. Thanks to: Alison Clements-Hunt, Communications Officer, Contact:


1 .In addition to the WHO, other partner organizations in the Bloomberg Global Initiative include the Campaign for Tobacco-Free Kids, the Centers for Disease Control and Prevention Foundation, the Johns Hopkins Bloomberg School of Public Health and the World Lung Foundation.