This week we have been privileged to hear outstanding presentations from colleagues from around the world on a wide range of issues in the tobacco epidemic. Rather than list these out one by one, this Closing Address will describe some major points that emerged and use these to predict the status of the tobacco epidemic in the year 2025. I will come to the issue of the US Settlement at the end of this presentation.

1. DEATHS: THREE TIMES MORE PEOPLE WILL DIE IN 2025

There are only two major causes of premature death that are increasing substantially in the world - HIV and tobacco,[1] and annual HIV deaths will peak at 1.7 million deaths in 2006.[2]

Tobacco deaths will continue to rise from today's 3 million to 10 million a year by 2025.[3,4] China will be the leading country for these deaths.[5,6,7]

Tobacco's share of all death and disability worldwide will increase from the current 3% to 9% by 2025.[8]

Passive smoking will continue to harm a significant number of non-smokers[9] in future.

The good news is that tobacco deaths will continue to fall among males in the small-population developed countries, this trend encouraging developing countries to take firm action and follow suit.

2. DEVELOPING COUNTRIES WILL SUFFER THE MOST

By 2025, the transfer of the tobacco epidemic from rich to poor countries will be well advanced, with only 15% of the world's smokers living in the rich countries. Health care facilities will be hopelessly inadequate to cope with this epidemic.

3. SMOKING PREVALENCE: BAD NEWS FOR WOMEN - GOOD NEWS FOR MEN [10,11]

When searching for predictions for smoking prevalence rates for 2025, I was surprised to find that none existed, nor any predictions for the number of smokers. In collaboration with Dr Alan Lopez from World Health Organisation, I worked out the following as a reasonable scenario:

In developing countries, prevalence of smoking among women will rise from 8% to 20% by 2025. By then, women will be dying from tobacco in substantial and ever-increasing numbers.

The good news is that the prevalence of smoking among men will fall to 25% in developed countries (possibly even as low as 15% in some) and from 60% to 45% in developing countries by 2025.

4. THE NUMBERS OF SMOKERS: WILL GO UP

There are 1.1 billion smokers in the world today. This will increase to over 1.64 billion by 2025 - because the world's population will rise (from the current 6 billion to 8.5 billion), people will live longer,[12] and more women will be smoking.

5. WOMEN: GLOOMY PROSPECTS

The huge increases in the number of women smokers will have enormous consequences on health,[13] income, the foetus and the family.[14]

It was made clear at the conference that women's organisations and women's magazines have singularly failed both to understand that smoking is a feminist issue and to take an appropriate role.[15]

This conference has made an unprecedented effort to involve women at all levels - on committees, as chairs, speakers, discussants and funded delegates. Every invited speaker was asked to include a perspective on tobacco and women in their presentation. And perhaps when women are involved at core decision making level (e.g. in future conferences, on the WHO Expert Panel) the issues of women and tobacco will be properly addressed.

6. ECONOMICS: TOBACCO WILL CAUSE SEVERE ECONOMIC EFFECTS

Already the economic costs of tobacco are at least US$ 200 billion greater than the economic gain, with one third of this loss being incurred by developing countries.[16] This toll can only get worse.[17]

Yet, The World Bank states that tobacco control efforts could contribute to economic development in low and middle-income countries.[18] Before 2025, governments will finally understand that tobacco control is good for the economy,[19] and that no tobacco farmers, retailers or tobacco workers will be out of a job because of tobacco control measures.[20]

7. TREATMENT AND CARE

The conference hardly touched on the possibilities of spectacular advances in diagnosis, investigation and treatment of tobacco diseases, for example in genetics, surgery, nanotechnology, telemedicine, targeted pharmaceuticals and radiotherapy.

In 2025, individuals genetically prone to tobacco-related diseases could be identified at birth. Secondary cancers, currently untreatable, could be treated. Most of this technology will be expensive, but some, for example, automated sputum cytology, will be cheaper.

Medical advances, however, will have almost no impact on global mortality statistics, but will help individual smokers, especially in the rich countries.

8. TOBACCO CONTROL ACTION [21-23]

GLOBALLY:

By 2025, the WHO International Framework Convention on Tobacco Control should have been adopted, ratified and implemented.[24-26] WHO may have a major department on Tobacco or Health at Headquarters, appropriately staffed and financed, with a TOH staff member in each regional office. All other UN agencies may recognise their role.

There will be the need for:

- Global policies[27] and legislation[28] on supra-national tobacco advertising via satellite and internet,[29] tar and nicotine yields, additives, tax and smuggling.

- Greater regional coordination,[30] such as in the European Community and ASEAN (Association of South East Asian Nations).

- Restriction on trade pressures from one government to another.[31]

- Electronic networking, such as Globalink.[32]

NATIONALLY:

Many conference presentations showed that tobacco control is clearly a low priority for most governments, illustrated by negligible funding. There are few people working on tobacco control - for example, there are less than 10 full-time in the Asia-Pacific region, covering more than half the world's smokers.

In future, a major distinction will evolve between nations which have or have not made the "Koplan transition" to committed and vigorous preventive health measures and practices.[33]

a) "Post-transition" nations will have robust health education programmes/ extremely restrictive tobacco policies/ along with active promotion and increased support for physical activity and a low fat/high fibre/high fruits and mainly vegetarian diet.[34-36]

b) "Pre-transition" nations will be grappling with deteriorating health status, an unabated epidemic of lung cancer/heart disease/ obesity/ industrial and road accidents. They will struggle with deeply entrenched tobacco interests that manipulate their governments, the media and public opinion.

They will have made an extremely costly mistake by missing the opportunity to build significant barriers to tobacco in the late 20th and early 21st century, and will then find it very difficult to expel the powerful foreign tobacco companies and their domestic allies from their midst. They will be doomed to repeat the painful and costly experience of the "post-transition" nations who laboured for 30-50 years to achieve significant gains over tobacco pedlars.

The following will be attained in nations that take serious tobacco control action now:

Establishment of a National Office to coordinate tobacco control efforts.

Licensing of nicotine as an addictive drug with manufacture, promotion and sale under regulatory control by agencies such as the Food and Drug Administration in the USA.[37]

Smoke-free areas in workplaces,[38,39] indoor public areas and public transport. 'Smoking rooms,' popular 100 years ago, will make a comeback.

Bans on all promotion.[40-42] Sports and arts bodies will look back with amazement at the time in history when their predecessors accepted tobacco money.

Cigarette packets will be plain black and white and contain only brand name, tar and nicotine levels and health warnings.

Tar levels will be below 15 mg all over the world, and 10 mgs in "post-transition" countries.

Health education will be carried out by all nations, in some more effectively than in others. The failure of schools programmes in the 20th century will force health educators to turn to social marketers for professional help.

Prices will be higher in real terms in comparison with today.[43] 'Duty Free' tobacco will have long disappeared. Smuggling (currently 30% of all traded cigarettes) will continue to undermine price policy.[44,45] As this smuggling trade expands, tobacco will have become a predominantly illegal product in many markets. The tobacco industry may have been hit by several spectacular legal cases proving their involvement with smuggling their own cigarettes.

Funding: Core funding for tobacco control and health promotion will come from government and tobacco tax,[46-48] although it will become fashionable in future for big business to contribute, in the same way it is beginning to contribute to environmental issues today.

Partners in fighting the tobacco epidemic will include a wide range of youth leaders, environmentalists,[49-52] religious leaders,[53-55] consumer pressure groups,[56] sports bodies,[57] and many others. By 2025, the backlash will be more intense, with smoking firmly entrenched among rebellious youth.

9. CESSATION

Papers presented show that few countries, especially developing countries, are sufficiently energetic about assisting cessation.[58-60]

If efforts concentrate only on preventing children from smoking, there will be no reduction in the up to 200 million smoking-related deaths expected to occur before 2025 in already- smokers.[61]

By 2025, medical schools will have systematically incorporated tobacco issues into the curriculum, and health professionals will be competent and effective in advising patients on quitting smoking.[62-66]

10. THE TOBACCO INDUSTRY

Many papers illustrated how the commercial, transnational companies are expanding their empires, denying the health evidence, advertising and promoting their products in every corner of the earth, obstructing government action, overpowering national monopolies, and selling more and more cigarettes.

Their grip on the big markets in developing countries will become stronger as they move their growing and manufacturing processes out of the USA; by 2025 there may be no tobacco grown in the USA.

The 20th World Conference on Tobacco or Health may be discussing the domination of the world tobacco market by the largest exporter (China) and Japan, and the reversal of fortunes of the American and British tobacco companies.

How will the tobacco companies behave in 2025? Who would have imagined 30 years ago that they would engage in settlement talks with governments today?[67]

An ex-tobacco industry executive, who was invited to the conference, but who at the last minute did not appear, made the interesting prediction ahead of the conference that tobacco production could be reduced by the global demand for food, brought about by increasing population and a century of ecological abuse and mismanagement of the planet's food and water supply. He pointed out that as many of the tobacco companies are involved with the transnational food business, their corporate and personal pockets, previously lined with tobacco gold, will now likewise be lined with gold from wheat, corn and rice.[68]

The litigation flurry[69-71] will have run its course. Much of the developed world will have moved to a managed tobacco industry, with liability automatically paid for tobacco-attributable health care costs and to individual smokers who have been harmed by tobacco.

The US Settlement

The US Settlement Agreement with the tobacco industry produced unique interest at this meeting. The Resolutions Committee received more submissions on this topic than on any other. These submissions differed quite considerably on specific recommendations for the US Settlement. There was, however, a broad consensus on the principles as they should apply to all countries, and these are reflected in the resolutions. The Resolutions Committee believes that these apply not only to the USA, but also to the UK, Japan, Indonesia and other large exporting countries.

We hope that delegates with specific ideas will be able to draw on these principles for their own campaigns, for example, the current US Settlement. Letters are circulating if delegates wish to address specific points to those involved with the US Settlement.

I was asked by a journalist as I entered the Hall if there had been any pressure from the government to water down any of the proposals. I can truthfully say that there has not been any political pressure from the Chinese government for us to modify these resolutions in any way.

CONCLUSION

It has been clearly shown at this conference that the global tobacco epidemic is worse today than it was 30 years ago. The extraordinary effort needed to prevent the epidemic being even worse in another 30 years is not being made.[72]

Several countries have already shown that smoking rates can be reduced. These successes can be reproduced by any responsible nation only by determined, immediate and sustained governmental and community action.[73] This requires encouragement and guidance by the delegates at this conference and our colleagues from around the world.

We know it can be done...[74]

1. The Bellagio statement on tobacco and sustainable development. The Rockefeller Foundation's Bellagio Study and Conference Centre, Italy, 26-30 June 1995.

2. WHO Christopher J.L. Murray, Alan D. Lopez. The global burden of disease. World Health Organisation, Harvard School of Public Health, World Bank. World Health Organisation, 1996:4,35.

3. Peto R, Lopez AD, Liu B. Global tobacco mortality. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

4. Zatonski W, Peto R, Lopez AD. Lung cancer trends and overall mortality from smoking in developed countries. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

5. Shiru N, Yang G, Wang G, He X, Chen ZM, Peto R. The Chinese national prospective study of mortality. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

6. Gao YT, Dent J, Xiang YB, Yuan ZX. Smoking, related cancers and other diseases - result of a 10 year follow-up of 210 thousand adults in Shanghai. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

7. Lam TH, He Y. A review of case control studies on smoking and lung cancer in China. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

8. WHO Christopher J.L. Murray, Alan D. Lopez. The global burden of disease. World Health Organisation, Harvard School of Public Health, World Bank. World Health Organisation, 1996:38.

9. Samet JM. Foetal and childhood exposure. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

10. Yang G, Fan L, Huan ZJ, Li F, Aiping C, Zhang Y, Qi G. The 1996 national survey of smoking prevalence in China. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

11. Mochizuki-Kobayashi Y. Impact of cigarette marketing on female smoking. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

12. United Nations. World Population Prospects 1990. Department of International Economic and Social Affairs. Population Studies No 120. United Nations, New York, 1991.

13. Sasco AJ. Health effects of tobacco use for women. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

14. Haglund M. Discussant, Plenary: Women and tobacco. 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

15. Amos A. Involving women's organisations in tobacco control - what are the challenges? Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

16. The Bellagio statement on tobacco and sustainable development. The Rockefeller Foundation's Bellagio Study and Conference Centre, Italy, 26-30 June 1995.

17. Jin S, Jiang Y. Estimation of smoking related direct costs in China. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

18. Jha P, Feachem R, Klingen N. Economic development and tobacco use. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

19. Warner KE. Economics of consumption. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

20. Stamps TJ. The growers perspective. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

21. Weng XZ. Tobacco control campaign in China. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

22. Muna WFT. Challenges for tobacco control in Africa. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

23. Robinson RG. Tobacco control networks in Latin America, Sub-Saharan Africa and communities of color in the United States. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

24. Collishaw NE. An international framework convention for tobacco control. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

25. Roemer R. International action for tobacco control. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

26. Taylor AL. Towards a Framework Convention on Tobacco Control. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

27. Gray N. Global tobacco policy. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

28. LeGresley E. International law and covenants. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

29. Pasnik S. The tobacco industry assault: billboards to cyberspace. Workshop, 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

30. Saloojee Yussuf. The African experience: present difficulties, future possibilities. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

31. Chaloupka FJ. Do trade pressures lead to market expansion? Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

32. Israel R, Cannon J. Workshop on Electronic Networking. 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

33. Koplan J. Global trends in health and health care. Paper presented at "Healthcare - the next millennium", 12 March 1997, London; and Discussant, Plenary Session 3 on developing countries, 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

34. Chng CY. The Singapore experience. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

35. Tan D. Health promotion in tobacco control. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

36. Terborg J. Cost benefits of health promotion. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

37. Borland R. Dedicated regulation of nicotine use: is it time? Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

38. Chapman S. The impact of workplace smoking bans on declining cigarette consumption in Australia and the USA. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

39. Burton R. Persuading employers to introduce smoke-free workplaces. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

40. Zain ZM, Assunta M. Circumvention of bans on direct advertising. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

41. Pierce JP. Effects of targeted advertising. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

42. Pandey MR. Tobacco Promotion: Nepal. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

43. Townsend J. Price and consumption. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

44. Joossens L. Europe: subsides, trade and smuggling. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

45. Godfrey AA. Investigation and prosecution of smuggling. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

46. Sweanor D. Discussant, Plenary: Financing tobacco control. 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

47. Galbally R. Financing tobacco control - the VicHealth experience. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

48. Cook J, Bal DG, Todd R, Morra M, Lins N, Seffrin J. Money against tobacco v/s money for tobacco: the US experience. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

49. Parkin S. Discussant at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

50. Kweyuh P. Environmental damage of tobacco growing in Africa. Abstract, 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

51. Loh C. Environmentalism and Health. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

52. Du Melle F. Tobacco growing and the ozone layer. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

53. Dagli E. Islamic beliefs and practices in tobacco control. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

54. Crosby M. Religious influences on tobacco investments. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

55. Prado L. Milk or tobacco: the struggle for land in the south of Brazil. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

56. Wykle-Rosenberg L, Hastings G. Workshop on countermeasures against tobacco promotion. 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

57. Forbes R, Thompson P. Workshop on freeing sports from tobacco. 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

58. Slama K. Behavioural approaches to smoking cessation. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

59. Jarvis M. Pharmacological approaches to smoking cessation. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

60. Glynn TJ. Tobacco use cessation among children and youth. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

61. Ramstrom L. Disease prevention before 2025. Discussant, Plenary: Approaches to Cessation. 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

62. Richmond R. Teaching on tobacco in medical schools. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

63. Masironi R. Role of health professionals. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

64. Akerberg O. World dentistry against tobacco. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

65. Bass F, Lai L, Abrams D. Workshop on assisting cessation. 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

66. Gitchell J et al. Workshop on pharmaceutical approaches to cessation. 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

67. Connolly G. The $360 billion 'Global' Settlement. Will the women and children of Asia pay the bill? Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

68. Cornejo G. The tobacco industry assault: billboards to cyberspace. Cancelled Facilitator at Workshop, 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

69. Daynard RA. Litigation against the tobacco industry by states. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

70. Woodward S. Litigation as an intimidatory tactic. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

71. Banzhaf III JF. Litigation against the tobacco industry by individuals. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

72. Mahood G. Legislation: a key component of effective tobacco control plans. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

73. Ritthiphakdee BO. Community approach. Paper presented at 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

74. Bjartveit K. Discussant, Plenary: Tobacco control programmes. 10th World Conference on Tobacco or Health, 1997 24-28 Aug; Beijing, China.

This information from the 10th WCTOH is originally published
by UICC GLOBALink - http://www.globalink.org

		The Non-Smokers' Movement of Australia Inc. Box K860, Haymarket NSW 1240.
This page was last updated on Friday, 19th December 2014