A new American Cancer Society report outlines 21 challenges and needs for global tobaccocontrol, covering the wide range of issues to be addressed and expertise needed to reduce the rising tide of tobacco use worldwide, particularly in the low- and middle-income nations that are the target of the multinational tobacco industry.

The report's authors, led by Thomas Glynn, PhD, American Cancer Society director of Cancer Science and Trends, point out that the globalization of tobacco began with the European exploration of the New World more than 500 years ago. But it is only in the past 50 years that public health has responded to the death, disease, and economic disruption caused by tobacco use. Tobacco now has at least 1.3 billion users and kills more than 14,500 people every day, while debilitating and sickening many times that number. The report lists activities, policies, and interventions that must be increased or in some cases decreased in order to be successful in reducing the rising tide of tobacco use.

Increase challenges

• Increase support for and adherence to the Framework Convention on Tobacco Control (FCTC): The report calls this the single most important action in the effort to eliminate tobacco-related death and disease, saying all governments should be encouraged to join the more than 165 nations who already have ratified the treaty, and that those who have joined the Framework should faithfully implement it.
• Increase tobacco taxes: Raising tobacco taxes is considered perhaps the most effective intervention to reduce tobacco use.
• Increase access to comprehensive treatment for tobacco dependence: With more than 1.3 billion tobacco users in the world today, if only half of them wished to stop their tobacco use, there would be need for access to tobacco dependence treatment for greater than 650 million tobacco users. Furthermore, the World Bank has estimated that more than 180 million lives could be saved in just the first half of this century if the prevalence of current tobacco users were cut in half by 2020, and providing access to adequate treatment would be a cornerstone of that approach.
• Increase media-based tobacco counter-marketing campaigns: Although the tobacco industry will always far outspend tobacco control advocates, novel, entertaining, cutting-edge tobacco counter-marketing campaigns have been shown to attract attention and support far beyond the amount of funds spent and to have a direct effect on reducing tobacco use.
• Increase regulation of all tobacco products: Tobacco is the most unregulated consumer product on the market today, exempt from important basic consumer protections, such as ingredient disclosure, product testing, accurate labeling, and restrictions on marketing to children.
• Increase health warnings on tobacco packaging: As warnings become more graphic, tobacco users are more likely to pay attention to them.
• Increase availability of tobacco health/economic information to the general public: Many tobacco users, policymakers, and even health care professionals are largely unaware, or only vaguely aware, of the other cancers, heart disease, lung disease, pre- and postnatal conditions, etc that are caused by tobacco use.
• Increase primacy of health over commerce in trade agreements: Successful arguments have been made that excluding tobacco from trade agreements is compatible with international law, which provides for other harmful products such as landmines to be exempted. In addition, the World Trade Organization (WTO) has declared that human health is an important consideration and that if necessary, governments may "put aside WTO commitments" to protect human life.
• Increase basic biomedical and applied tobacco control research
• Increase the extent and accuracy of tobacco epidemiologic and surveillance data
• Increase litigation aimed at the tobacco industry

Decrease challenges

• Decrease tobacco use by physicians and other health care providers: Many physicians and health care providers continue to use tobacco, with use reported to be as high as 50% or more in some countries
• Decrease targeting of women: The WHO has estimated that the prevalence of smoking among women worldwide will be 20% by 2025, compared with the 12% of the world's women who currently smoke.
• Decrease exposure to secondhand smoke: Providing smoke-free environments has been proven to not only protect nonsmokers, but also encourage smokers to quit and focus greater attention on the need for tobacco control measures.
• Decrease illicit trade and smuggling
• Decrease duty-free and reduced-cost sales of tobacco
• Decrease tobacco advertising, promotion, and sponsorship
• Decrease misleading tobacco product claims/descriptors
• Decrease targeting of youth
• Decrease subsidies for tobacco production
• Decrease youth access to tobacco

The report says there are certainly many other challenges not discussed in the report and that,while "resources … will never be enough to address all of these challenges," actions taken with the resources currently available will have a significant effect on global health. Finally, the report points to an issue it says rises above all others when considering the potential to reverse the global tobacco epidemic: the need for skilled, dedicated people to address the issues outlined in the report.

For more information on the American Cancer Society, visit www.cancer.org.