Tobacco Free Initiative (TFI)

Mayo report on addressing the worldwide tobacco epidemic through effective, evidence-based treatment

Report of an expert meeting, March 1999, Rochester (Minnesota) USA

I. Background

The worldwide epidemic of tobacco-related disease and death continues to worsen as tobacco use spreads. This unnecessary, human-created epidemic will kill about 500 million people who are alive today. The Director General of the World Health Organization, Dr Gro Harlem Brundtland (1999) has described her first awareness of tobacco’s health impact: "The evidence told a shocking story. . . . What I saw was an emerging epidemic. Worldwide mortality from tobacco is likely to rise from about 4 million deaths a year in 1998 to about 10 million a year in 2030. Ten million deaths — that is more than the total deaths from malaria, maternal and major childhood conditions, and tuberculosis combined". Not only were those statistics "shocking", but more than 70% of the deaths are predicted to be in the developing world. She added: "By 2020, smoking will cause about one in three of all adult deaths, up from one in six adult deaths in 1990".

The day that Dr Brundtland took office, on 21 July 1998, WHO launched its Tobacco Free Initiative, with the goals of galvanizing global support for scientifically sound tobacco control policies and strategies; building partnerships to heighten awareness and mobilize resources; and accelerating national, regional, and global strategies. A significant aspect of this overall approach is a "focus on individuals". In her words, "To change the trends, we need to get smokers to quit and nonsmokers not to pick up the addictive habit".

Effective treatment for tobacco addiction, also called tobacco dependence, is a significant component of an overall tobacco control strategy to reduce exposure to tobacco worldwide. Through effective treatment for tobacco dependence, millions of people could be saved from disease and premature death. Treatment and prevention can work hand in hand as complementary strategies that reduce tobacco-caused disease and maximize benefits to public health. Henningfield & Slade (1998) explain that reducing tobacco exposure at individual and population levels through treatment could result in dramatic decreases in mortality from smoking-related causes, even within just a few years (see Figure 1). By the year 2010, nearly 2 million fewer smokers would die each year worldwide if effective treatment were combined with tobacco control measures. By 2025, the annual number of lives saved would be 4 million. By 2050, more than half of the cumulative premature deaths from tobacco would be prevented, representing some 12 million lives (World Health Organization, 1999b).

Such treatment, however, is not widely available. Even in developed areas such as Europe and North America, treatment is not available for all tobacco users who need or want it. When it is available, many tobacco users are not motivated to take advantage of it. Although smoking has been studied more extensively than any other form of tobacco, public access to effective treatment remains low throughout much of the world. Additionally, treatment regimens for forms of tobacco other than cigarette smoking are largely unavailable in most countries. In the United States of America, historically only about 2.5% of smokers who attempt to quit smoking without assistance succeed in any given cessation effort (e.g. Garvey et al., 1992; Giovino, Shelton & Schooley, 1993). More than a third of current cessation attempts in the United States involve the use of medication (Hughes, in press), a sizeable increase that has coincided with the availability of new treatment medications. The likelihood of long-term abstinence among quitting smokers increases with the addition of behavioural treatment and nonprescription and prescription medication (see Fiore et al., 1996).

Scientists and clinicians have learned much about how to help tobacco users quit. Even so, many key questions remain, including:

  • How can tobacco dependence treatment be more accessible and successful?
  • How can effective treatment be implemented worldwide, considering the many cultural and legal differences among nations and regions?
  • How can treatment work in concert with other tobacco control measures to reduce morbidity and mortality from tobacco-related causes on a worldwide scale?