IN DEVELOPING COUNTRIES, NEW SURVEY SHOWS

The tobacco companies - facing court proceedings and an increasingly vocal anti-smoking movement in industrialized countries - are turning their sights on developing countries. About 20% of schoolchildren in these countries are already regular smokers, according to a survey coordinated by WHO in collaboration with the United States Centers for Disease Control and Prevention (CDC) and published in the latest, July 2000, issue of the WHO Bulletin. The survey, which was conducted in 12 developing or transitional countries also found that nearly 25% of the child smokers started the habit before the age of 10 and more than two-thirds wanted to quit.

The CDC's Charles Warren and his co-authors note in the Bulletin article that worldwide some 250 million children and teenagers alive today will eventually die as a result of their tobacco habit and that 70% of them will be in developing countries. "The high prevalence [of smoking] in such a young age group portends a lifetime of addiction for a large number of people, half of whom will die prematurely of tobacco-related diseases," they write.

The survey, known as the Global Youth Tobacco Survey (GYTS), was launched two years ago by WHO to obtain baseline data on tobacco use among young people in developing countries. The project also involves the collaboration of coordinating researchers in the individual countries. Ultimately, it is hoped the survey will cover all 191 countries that are members of the WHO.

A total of 50,207 school children aged 13 to 15 years in this first group of 12 countries--Barbados, China (only four provinces), Costa Rica, Fiji, Jordan, Poland, Russia (only Moscow), South Africa, Sri Lanka, Ukraine (only Kiev), Venezuela and Zimbabwe (only two cities)—responded to the survey questionnaire. Up to 70% of children admitted to have smoked at some time in Ukraine, which topped the list for this questionnaire item. With a 30% positive response, Poland scored highest for current child smokers (Ukraine and Russia lowest with 9%). About half of all the children surveyed were exposed to second-hand smoke in their homes.

Women's special risks

Tobacco advertising ("You've come a long way, baby," "Mild as May"), is one way the tobacco industry has been enticing more and more women to join the smokers' community, up to now a predominantly male domain. Today, of the estimated 1.2 billion smokers in the world, about 200 million are women and of the 4 million or so people dying of tobacco-related deaths every year, about 500,000 are women. Ernster et al. (pp. 891–901) review some of the strategies the tobacco industry has been using to bring women into the fold. They also highlight the major tobacco-related health problems specific to women — associated with pregnancy and oral contraceptive use for the most part but also with postmenopausal problems (notably, loss of bone density) — not to mention the afflictions, such as cancers, cardiovascular and respiratory diseases, that women share with men. Anti-tobacco policy should, the authors argue, protect women from perverse advertising and take into account their specific vulnerabilities. Giving women a broader role in formulating anti-tobacco policy and legislation would be a start in this direction.

The games "Big Tobacco" play

Six years ago, thanks to the courage of two whistle-blowers and a handful of anti-tobacco activists and litigation lawyers in the United States, millions of internal tobacco industry documents became available for public viewing in books and on the Internet. These documents have revealed that industry executives knew as early as the 1950s that tobacco is carcinogenic and nicotine, addictive. Saloojee & Dagli (pp.902–910) chronicle the ploys of industry strategists to deflect the public opprobrium "big tobacco" has been facing, mainly in the United States, since the discovery of these "cigarette papers". Tobacco's hold on industrialized countries may be slackening, but the battle between public health and corporate wealth is not over. The industry's sights are now on developing countries. Enter WHO and other international health bodies, that are marshalling worldwide consensus — through instruments like the International Framework Convention on Tobacco Control (see next paragraph) — on the need to regulate tobacco and its purveyors.

A global treaty

"Globalization" is much in the news these days — as a boon or a bane. For the international public health community, tobacco is clearly a global bane. By means both legal (international trade agreements and transnational marketing practices, for example) and illegal (smuggling now accounts for a third of exported cigarettes worldwide), the reach of the handful of firms dominating the tobacco industry now encircles the planet. Tobacco itself has become a truly global product, with over 70% of consumers (800 million people) in the developing world, plus an untold number of passive smokers, now sharing with their counterparts in the industrialized world the risks of disease and early death their habit incurs. Only a global response that harnesses the planet's powerful legal and scientific resources can counter this planetary threat to health. Taylor & Bettcher show (pp. 920–929) how the proposed WHO Framework Convention on Tobacco Control (FCTC), as a global "public good" in the world's attempt to counter the spread of tobacco consumption, can constitute such a response.

Measuring the world's smoking habits

In its battle against tobacco, the public health community has suffered from the lack of an efficient global information system for tracking tobacco production, trade and consumption, as well as tobacco-related mortality and morbidity. To fill this need, in 1998, WHO and the Centers for Disease Control and Prevention in the United States set up a "National Tobacco Information Online System" (NATIONS) for gathering baseline data. From data relating to 198 countries and territories, Corrao et al. report (pp.884–890) that in 1998 about 30% of the world's population smoked and that the highest prevalence of smoking was in the Western-Pacific region of WHO (34%), the lowest in the Eastern Mediterranean region (22%). Globally, 48% of men smoked, vs 12% of women, but the proportion of women smokers rose to a high of 23% in Europe and the Americas. The data also show that in most developing countries, prices of imported cigarettes have fallen, in real terms, over the past decade. These and other analyses using the NATIONS database could pinpoint areas where specific anti-tobacco activities might be stepped up.

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