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We must do more to discourage global tobacco use
November / December 2013 | Volume 12, Issue 6
We face formidable challenges in global health - from pathogens and parasites that have been around for millennia to diseases brought on by diet and other lifestyle changes. But one totally avoidable, major health danger persists today even though we've known for half a century how to prevent it. I'm talking about tobacco use.
While tobacco use has decreased in the U.S. and much of Europe, it is rising in many low- and middle-income countries (LMICs). The most recent Global Burden of Disease Study 2010 by the Institute of Health Metrics and Evaluation (IHME) noted that disease attributed to tobacco is second only to that from high blood pressure. The study blamed tobacco for about 6.3 million deaths per year. Tobacco use is increasing most rapidly among young people, who may cement their addiction before adulthood, and among women, who risk harming their fetuses as well as themselves. At the same time, the industry is producing new products - flavored cigarettes and chewing tobacco, broader social use of hookahs and e-cigarettes that provide nicotine without smoke - that might pose other as yet unknown long-term health risks.
Cigarettes were long believed to be harmless until a landmark study published in 1964 definitively linked smoking to premature death from lung cancer and heart disease. Early in my career, I worked at Oxford University with Sir Richard Doll. He surveyed all male physicians in England about their smoking habits and then collected their death certificates to determine the cause of death and link this to their smoking histories. The lethal effects of smoking were evident: one-third of those who smoked died of related causes. We asked Sir Richard why he didn't try to ban or reduce tobacco use in the U.K. immediately. He responded like a true scientist - that he was responsible for gathering the evidence but tobacco control was an issue for the politicians, a decision he regretted later in life.
Since then, scientists have come up with many interventions that health authorities use to persuade people to quit or, preferably, avoid starting a tobacco habit in the first place. Some of these policies are money saving propositions, such as placing high taxes on cigarettes, a venture that raises funds while discouraging smoking. Some countries have required new laws to remove smoking from public places, stop advertising at sports events, reduce smoking in movies and place severe health warnings on packaging. In fact, the WHO Framework Convention for Tobacco Control - agreed to by 168 signatories and adopted in 2005 - laid out some global activities to which all could agree. But new interventions must be based upon sound evidence they are effective and what works in one region or country may not work in another.
For the last decade, Fogarty has run a small program designed to address this problem. Our tobacco grants have successfully developed research capacity in 30-plus developing countries and trained more than 3,500 scientists in skills such as epidemiology and biostatistics.
Health policymakers have used the project findings to advocate for tobacco control measures, such as restricting public smoking in Hungary and limiting cigarette vending machines in China. Our support has helped researchers study how peer outreach can discourage youth in India from taking up tobacco. Another Fogarty project provided the first-ever studies of the prevalence and dangers of hookah use in Syria and Jordan - useful information throughout the Middle East and also for us here in the U.S., where it's become a worrisome trend.
After a decade of investment in research and research training in the field of global tobacco control, we at Fogarty are weighing how best to move the field forward. Still far too many of those who use tobacco are unaware of the dangers or believe they can quit before it harms them. We need to help low-resource countries build sufficient expertise to figure out what strategies will work best to save their citizens from this deadly addiction.
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