Author: Ulysses Dorotheo, MD, FPAO, Executive Director of Southeast Asia Tobacco Control Alliance
20 years: Learning from the past to achieve a tobacco-free future
The WHO FCTC has been a global health game changer since its entry into force in 2005. Smoking prevalence has declined globally in these past 20 years, even dropping below 10% in some countries. However, we still count 8 million tobacco-caused deaths annually, because declines in tobacco use haven’t been uniform within and among countries, particularly in low- and middle-income countries. Given that tobacco-caused diseases are completely preventable, these deaths are 8 million too many.
If governments are serious about preventing NCDs and promoting the highest standard of health for all people, it’s essential to fully denormalize the tobacco industry tobacco products, and tobacco use, because it’s completely unacceptable that harmful and addictive products–that kill millions—are allowed for sale and use as normal consumer products.
This is why standardized (plain) packaging, which very effectively denormalizes tobacco products, must be implemented as a core tobacco control measure. It’s a key ingredient of the continuing success of countries such as Australia and Singapore that have reduced smoking prevalence to 10% or less. Similarly, a tobacco/nicotine-free generation policy vaccinates the youth against the tobacco pandemic.
Tobacco industry denormalization is the only way that the world can finally put an end to the tobacco pandemic and ensure that truly no one is left behind as the world strives to achieve the UN Sustainable Development Goals.
It won’t be easy. Industry interference is why it took more than 25 years from the time that plain packaging was first proposed in Canada in 1986 until Australia was first to legislate this best practice in 2012. It’s also why, even if the WHO Western Pacific Region is proudly the only WHO region where all Member States are Parties to the WHO FCTC, only five other countries (New Zealand, Cook Island, Niue, Singapore, Lao PDR) have adopted it since 2012.
In these past 20 years, the tobacco industry has not only opposed and undermined effective tobacco control measures but also expanded its product portfolio so as to continue profiting from nicotine addiction, including by co-opting public health’s harm reduction strategy by promoting e-cigarettes and nicotine pouches as supposedly less harmful solutions to the tobacco pandemic it created.
Fully implementing all supply and demand reduction measures in the WHO FCTC is important, but it’s time to recalibrate and convince ourselves that a 30% relative reduction in tobacco use is no longer an acceptable target. We should collectively be targeting a tobacco use prevalence that’s as low as possible, and the lowest possible is zero.
How do we know it’s possible? We can learn from history. Leaded fuel was invented in 1921, and in 2021, Algeria became the last country to ban leaded fuel after a 20-year campaign by the UN Environment Programme. In the case of the Montreal Protocol, it also took 20 years to ban CFCs in all countries.
Governments say that strong political leadership is necessary for climate resilience. If governments can stand up to Mother Nature, why not the tobacco industry? We owe it to future generations. We can begin phasing out tobacco products today to achieve a tobacco-free generation tomorrow.
