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Can We Really Achieve a "Tobacco-Free World"?

by Alison Hudson

March 16, 2015

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Donate The Lancet is celebrating the ten-year anniversary of the WHO Framework Convention on Tobacco Control, the global health treaty aimed at worldwide smoking cessation. Accusing the tobacco industry of using "a business model of peddling an addictive product to children and young people, and sustained by practices that prioritise corporate profit over health," the Lancet's collectionof articles are all dedicated to examining one idea: achieving "a world where over the next 25 years the sales of tobacco are phased out (although not prohibited), and in which fewer than 5% of adults use tobacco." Or as the headlines are putting it: a tobacco-free world.

I was aware that groupsaround the world have been engaged in smoking cessation programs for years, but the notion that a tobacco-free world was not only possible but within reach waived a skeptical flag for me. Smoking is such a huge industry, and there are well-documented efforts to push back against any efforts at smoking cessation. Is it possible to do it in twenty-five years? Is it possible to do it at all?

There is no need for one to be skeptical about the health risks. The damage that smoking can cause -- lung cancer, emphysema, COPD, strokes, and more -- are so well documented that the industry itself was forced to admit so in a United States court of law. The Lancet cites a figure of 100 million lives lost to smoking-related health issues in the 20th century with the prospect of even more in the 21st. There's no doubt: if one is concerned about the overall health of the global population, smoking cessation is a noble and practical effort.

But canwe achieve a tobacco-free world? I would argue that it's possible, but not likely. In the recent past, many countries, especially in North America and Europe, have taken great strides towards smoking cessation for better public health. In the United States, for example,smoking rates among adults have gone from nearly 50% down to 17.8% in 2013. These gains have been countered globally, however,by increases in places like Indonesia (home of the infamous "Smoking Baby") where nearly 70% of adult males light up on a regular basis. Ultimately, though global smoking percentageshave dropped, population growth in some of the highest-smoking areas means there are actually more people smoking now than there were in 1980. So, despite the best efforts of the WHO and many countries thus far, the fight for smoking cessation is far from over

I should note at this point that personally, I am not "anti-smoking." I have never smoked habitually; I dislike both the acrid smell and the burning sensation it caused in my throat the few time I've tried it. On the other hand, I have no problem with others enjoying the habit in their own homes if they do so fully informed, that is, understanding the health risks. Call it the "freedom of informed choice."

And there are people out there who, fully cognizant of the dangers of smoking, continue to smoke. WHO puts the total number of worldwide smokers at 1 billion currently. So long as there are people out there willing to smoke despite the risks, and a tobacco industry activelyencouragingthem to continue, all the hopes and efforts of the WHO can only do so much. All the hideous packaging pictures and dire block-print warnings in the world aren't convincing them to quit, and many governments are either made complicit by money from, or kowtowed by bullying from, the industry.

There comes a point where people use that freedom of informed choice, and despite the best efforts of the WHO and other groups, they're choosing to smoke. Especially in this age of the Internet, there are fewer and fewer places in the world where access to information about the adverse effects of smoking is an issue. What will the WHO's strategy be to combat this sort of willful ignorance? That remains to be seen.

Still, more power to the WHO and the combined efforts of the various national health services seeking towatch out for the health of the world population's lungs, even if the population itself is sometimes disturbingly blase about the whole thing. Even a partial success on this front can only be seen by rational, science-based minds as a victory for public health in the long run.

by Alison Hudson

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