The Potential for Prevention
This issue of Health Education Research is dedicated to global tobacco control and is being released in conjunction with the 13th World Conference on Tobacco or Health being held in Washington, DC, 12–15 July 2006. As Health Education Research strives to become a truly global journal, the Editorial Board has encouraged more thematic issues that address global public health concerns. In addition to this issue on global tobacco control, Associate Editor Jenny O'Dea is preparing another thematic issue on the prevention of childhood obesity. Please let me know your ideas about themes for possible future issues.In terms of global health threats, it is appropriate that we turn our attention to the prevention and control of tobacco use. The accumulated global health and economic burden of tobacco use is virtually incomprehensible, and at the same time, the potential for prevention has never been greater. The World Health Organization estimates that 5 million people die each year due to tobacco use and that this figure will increase to 10 million deaths a year by 2020. Not only will the global toll increase but also it will shift from the developed world to developing countries, where >70% of the deaths are expected to occur. These are the very countries that will be continuing to deal with the burden of infectious diseases and will now be confronted with the additional burden of heart disease, lung disease and cancer caused by tobacco. This is truly a double burden of disease, but one that has the potential for prevention.
The potential for prevention is perhaps best represented by the Framework Convention for Tobacco Control (FCTC), which was unanimously adopted by the World Health Assembly in 2003, signed by 168 countries, and entered into force in February of 2005. As of the beginning of June 2006, 129 countries have ratified the FCTC. While the FCTC is one of the most rapidly enacted treaties in history and countries continue to ratify, some of the largest countries in the world have not yet ratified the FCTC, most notably the United States, Indonesia and the Russian Federation—the third, fourth and seventh largest countries in the world, respectively. Ratifying countries have 3 years to put into place strong health warnings and 5 years to ban or severely restrict (in accordance with its constitution or constitutional principles) tobacco advertising, promotion and sponsorship. In addition, the FCTC obligates ratifying countries to enact other tobacco-control measures, including education, training, public awareness, and perhaps most importantly, global cooperation and information exchange. The full text of the FCTC (in English) can be found at http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf.
While the FCTC provides the potential for prevention, progress will be limited to the extent that member states implement the provisions of the FCTC and that compliance with the treaty obligations is closely monitored and enforced. To this end, the creation and funding of a strong and accountable ‘Conference of the Parties’, the entity assigned the responsibility for overseeing the implementation of the FCTC, is essential. While tobacco use causes hundreds of billions of dollars in unnecessary medical expenditures and lost productivity, the countries that have ratified the FCTC are finding it difficult to commit to the few million dollars necessary to support the Conference of the Parties and the operations of the secretariat. Hopefully, the FCTC's potential for prevention will not be handicapped by a short-sighted lack of investment by member states.
This lack of investment not only may affect the FCTC but is also characteristic of the entirety of tobacco control. The scientific evidence is clear that there is a direct relationship between money spent on implementing evidence-based tobacco control programs and reduction in tobacco use, however, garnering and maintaining financial support for tobacco control efforts continues to be a global challenge. Many of the most effective state-based programs in the United States have had their funding dramatically cut or totally eliminated. It almost seems that the programs most likely to be financially cut are also those that were most successful in reducing tobacco use. Could there be a relationship? In any case, there is a clear and compelling need for enhanced and sustained funding for global tobacco control efforts. The burden is vast, the interventions are proven and the potential for prevention is incalculable.
Let me close by reiterating that it is a distinct privilege to release the current issue of Health Education Research in conjunction with the 13th World Conference on Tobacco or Health. These World Conferences have been held for the past 40 years and have served to advance and coalesce global efforts to reduce the burden of tobacco use. The first World Conference was held in New York City in September 1967, and US Senator Robert Kennedy addressed the conference participants. His remarks nearly 40 years ago presage the subsequent war on tobacco that has continued to this day:
The cigarette industry is peddling a deadly weapon. It is dealing in people's lives for financial gain ... The industry we seek to regulate is powerful and resourceful. Each new effort to regulate will bring new ways to evade ... Still, we must be equal to the task. For the stakes involved are nothing less than the lives and health of millions all over the world. But this is a battle which can be won ... I know it is a battle which will be won.
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