WHO Report on the Global Tobacco Epidemic (2008): questions and answers
Q. Is there cause for optimism that the epidemic can be stopped?
A. Tobacco control efforts are gaining momentum globally – we are at a unique point in public health history, as the forces of political will, policies and funding are aligning to dramatically reduce tobacco use and save millions of lives. New partnerships are being formed and an unprecedented effort is now under way on a global and country level to conduct effective monitoring, to develop, implement and enforce policies and to counter tobacco industry lobbying. The means to curb the epidemic are clear and achievable – the MPOWER package works. Countries that have already begun putting in place the key strategies have experienced dramatic declines in tobacco use.
Q. Generally, how reliable is the data in the report?
A. The WHO Report on the Global Tobacco Epidemic, 2008 is the most successful data collection effort to date in tobacco control at the global level. It provides essential data representing more than 99% of the world's population. For the first time ever, a consistent methodology was applied to the assessment of compliance with tobacco control policies related to smoke-free environments and bans on tobacco advertising, sponsorship and promotion. Data was collected by country-level experts from both governmental and non-governmental organizations, and in the vast majority of cases, validated by governments as a fair representation of the state of tobacco control in their countries. Although every effort has been made to obtain valid, comparable data, this is the first such global attempt; gaps and inconsistencies will be addressed in future publications.
Q. Why is this new? Don’t we already know all this?
A. This is the first time country-by-country data is available to guide implementation of proven interventions. The information allows governments and the public to monitor progress in saving lives through effective tobacco control – we must measure to improve. It is also the first time tobacco control interventions are being branded together as one package, allowing countries to easily track what they need to do to protect their citizens.
Q. Why have so few countries taken sufficient steps to reduce tobacco use?
A. Many countries have, in fact, begun efforts to implement tobacco control measures, but much more needs to be done. There are many reasons, dependent also on country-specific circumstances, why so few have yet to fully implement and enforce any one of the core measures effectively:
- Lack of awareness of the dangers of tobacco - While there is a growing understanding that tobacco is not good for health, few people fully realize the devastating effects it can have on the health of both users and non-users exposed to second-hand smoke.
- The myth that smoke-free places infringe smokers' rights and freedom of choice - Most people do not smoke and most who smoke want to quit. Many smokers do not use tobacco by choice, but continue to consume tobacco because they are addicted to the nicotine in all tobacco products.
- The myth that tobacco use is good for the economy - Tobacco use imposes tremendous costs on economies, resulting in millions of premature deaths and undermining the health and well-being of millions of people. Tobacco use jeopardizes the productivity and efficiency of a country’s labour force. In addition, significant evidence is building that smoking bans to create smoke-free environments do not have a negative impact on business and, in fact, appear to have either a neutral or slightly positive economic impact.
- Concerns that higher taxes on tobacco will reduce government tax revenues or will boost smuggling - It has been repeatedly demonstrated that higher tobacco taxes translate into higher tobacco-related tax revenues, even taking into account the related drop in tobacco sales. Countries such as Canada, Spain and the United Kingdom have shown that smuggling can be effectively tackled with measures whose cost amounts to a mere fraction of the additional tax revenues.
- Efforts by the tobacco industry to undermine tobacco control initiatives - The tobacco industry actively creates and encourages the myths that surround tobacco and its use. Strategies such as those advocated by MPOWER reduce tobacco consumption and tobacco sales, thus reducing tobacco companies’ profits. Tobacco companies have actively worked at the local, national and international levels to oppose the effective implementation of the policies proposed by MPOWER and the WHO Framework Convention on Tobacco Control. The industry voices unfounded arguments on economic loss and deceitfully portrays tobacco use as a problem of “rich countries”, thereby misleading policy-makers and the public into believing that immediate action is not required.
Q. What is the connection between tobacco use and poverty?
A. The net economic effect of tobacco is to decrease an economy's productive capacity through death, increased poverty and higher health care costs. The tobacco epidemic makes global health inequalities worse. In most countries, tobacco use is higher among the poor than the rich and the poor suffer more from the consequences of tobacco-related diseases, creating economic hardship and perpetuating the cycle of poverty and illness. The early death of the primary wage earner is especially catastrophic for poor families and communities. In addition, money spent on tobacco means money not spent on basic necessities such as food, shelter, education and health care. In some developing countries, the lowest income group spend more than 10% of their household income on tobacco.
Q. What are the economic impacts of tobacco use?
A. The epidemic poses a long-term economic threat to countries and may slow their development. Tobacco negatively affects the welfare of users and costs the world hundreds of billions of dollars each year in lost productivity. If the epidemic worsens, the economic losses in highly populated developing countries will be severe. Many of these countries are manufacturing centres for the global economy and the growing number of tobacco-related deaths - half of which occur during prime productive years - will impose a heavy burden on these economies.
Q. How is MPOWER linked to the WHO Framework Convention for Tobacco Control (WHO FCTC)?
A. All six MPOWER policies are found among the many tobacco control measures advocated by the WHO FCTC. For many governments that have become Parties to WHO FCTC, MPOWER provides key entry points into the treaty and helps focus their limited resources on the most cost-effective measures to reduce tobacco use. The WHO FCTC, a multilateral treaty with more than 150 Parties, is the first treaty negotiated under the auspices of WHO and was the result of a number of years of focused, coordinated efforts by governments and other groups concerned about the tobacco epidemic. The treaty, which came into force in 2005, presents a blueprint for governments to reduce both the supply of and demand for tobacco and has created political momentum for global tobacco prevention . The WHO FCTC is intended to provide governments with the basic structure necessary to implement a strong tobacco control programme. At the same time, its text and the spirit indicate that Parties are encouraged to go beyond the treaty’s obligations. By reflecting and building on the obligations under the WHO FCTC, the clear set of core policies that comprise the MPOWER package provides all governments, regardless of their status vis-à-vis the treaty, guidance on how to effectively implement, enhance and expand their tobacco control programmes.
Q. Will developing countries be able to stand up to the tobacco industry?
A. No industry is stronger than the will of a government to protect and promote the health of its population. Tobacco industry cash cannot forever interfere with truth and countries now have the knowledge and tools to overcome any barriers that the tobacco industry may put in place to prevent the promotion of public health. Although tobacco companies may be cash-rich, their history of fraudulent and deceitful activities have been revealed in the millions of pages of internal documents that the industry has been forced to make public since the 1990s . WHO has also revealed attempts by tobacco companies to undermine its work and Member States have resolved to counteract the harmful effects of this. The operating environment of the tobacco industry will become more difficult in every country as governments and populations gain a better understanding of the tactics of the industry as well as the devastating health, social and economic burdens of tobacco. Developing countries will be strengthened by these international trends and underpinned by the WHO FCTC. The treaty obliges Parties to protect their tobacco control policies "from commercial and other vested interests of the tobacco industry." Some low- and middle-income countries have already shown that they can stand up to the tobacco industry by successfully putting in place and enforcing one or more of the MPOWER strategies despite tobacco industry attempts to sabotage their efforts. The MPOWER package, implemented by countries with the support of WHO and its partners, will provide the tools to undo decades of tobacco industry deception.
Q. What is WHO doing to help countries combat the epidemic?
A. WHO is scaling up its ability to help countries put in place the MPOWER strategies. The Organization has long provided its Member States with strong technical support to combat the tobacco epidemic. However, this support is now being substantially scaled up, both to help in the implementation of the Framework Convention on Tobacco Control and in response to WHO being named one of the five partners in the Bloomberg Initiative to end the global tobacco epidemic. This initiative is acting as a catalyst, attracting other donors to fund tobacco control activities.
WHO and its partners in the Initiative - the Campaign for Tobacco Free Kids, the Centers for Disease Control and Prevention, the Johns Hopkins Bloomberg School of Public Health and the World Lung Foundation - are working together to build national capacity, coordinate tobacco control activities, and provide grants to other organizations, mostly at country level, to promote freedom from tobacco use.