- The Washington Times - Monday, February 18, 2008

The Geneva-based U.N. World Health Organization is warning of a global tobacco epidemic, in which women in developing nations are especially vulnerable. The WHO Report on the Global Tobacco Epidemic 2008, released earlier this month, criticizes increased advertising by the tobacco industry in nations such as India and China as anti-smoking efforts gain traction in the United States and Western Europe. The following are excerpts from an interview with Dr. Douglas Bettcher, director of the WHO Tobacco Free Initiative, conducted by John Zaracostas, The Washington Times’ special correspondent in Geneva.

Question: Your report on the tobacco epidemic rings alarm bells on the increasing incidence of smoking prevalence in developing countries and the increasing incidence among young women. What is causing this concern? What are you seeing in the new figures?

Answer: 100 million people lost their lives to tobacco use in the last century. If we continue on this collision course, 1 billion people could lose their lives needlessly due to tobacco use in this century. At least 70 percent of the current [tobacco-related] deaths are occurring in developing countries.

With the relentless marketing strategies and profit motives of the tobacco companies, who lost market share due to tobacco users in developed countries in Europe and North America quitting over the last couple of decades, in many cases dying, tobacco companies have been offshoring their activities and moving in to developing markets, targeting populations where there’s low prevalence [of smokers] such as women, youth, etc. As a result of this, the estimates and predictions that we have for 2030 are that the number of deaths will almost double to 8.3 million deaths [per year] with around 82 [percent] to 83 percent of those deaths in developing countries.

In Asia, the sad reality of the epidemic is that it’s an epidemic of the poorest of the poor. Tobacco consumption kills through over 25 deadly diseases from a whole range of cancers, cardiovascular diseases, respiratory diseases, reproductive diseases, and also through exposure to secondhand smoke as well.

What we’re seeing in the world is that about two-thirds of the world’s smokers are clustered in about 10 countries. Forty percent of the world’s smokers reside in China and India. Our World Health Organization survey data show almost a double rate of daily smokers and old smokers in the poorest groups, compared to the richest groups in India. Various studies in developing countries have shown that up to 15 percent of family income is used to support this deadly habit. Moreover, contrary to what tobacco companies say, a recent study in China showed that only 25 percent of the population thought that smoking was harmful.

Q: On China, the report is projecting a sharp increase in tobacco-related deaths by 2030. What’s driving this?

A: One million Chinese are estimated to lose their lives [each year] due to tobacco consumption. There are over 350 million Chinese smokers, mostly males. But there’s concerning increases among female populations as well. By 2050, the number of smoking-related deaths in China will increase threefold, to 3 million on an annual basis.

Tobacco companies are targeting populations that are vulnerable and have low smoking rates. In a survey of 13- to 15-year-olds in more than 160 countries, we saw some troubling storm clouds. In Southeast Asia, male smoking rates are usually 10 times higher than female smoking rates. In some recent snap global youth tobacco surveys data, we see in 13- to 15-year-olds a difference between males and females is only 2.5 times. That’s a fourfold increase.

Q: How long has the smoking prevalence been on the increase among young women?

A: We don’t have trend data for that. We have trend data for the difference between adult female and male smoking. Usually smoking rates among men are 10 times higher than women. But the snapshots we have received in the last couple of years shows a compression among young women, where the difference is only 2.5 times now. So this means we could be sitting on a huge, huge problem.

Q: The study highlights that although there’s a lot of tax revenue from tobacco, the amount that’s plowed back into tobacco-prevention policies or health support is minuscule compared to the revenues received, with the ratio of 341 to 1 in rich countries and middle-income developing countries about 4,100 to 1. The study also highlights some good examples, like Thailand. What are they doing right?

A: These figures are astounding. The fact that low-income countries, you have 9,000 times the rate of tax-revenue generation versus the amount spent on tobacco control. The tobacco epidemic is certainly a major priority, and certainly funding has increased recently, with some new donors like the [New York Mayor Michael R.] Bloomberg philanthropy coming on the horizon, a catalyst for more resource mobilization.

Thailand is really one of the best. Thailand puts aside about 2 percent of the tobacco-tax revenue and deposits that into a health-promotion fund, which supports a number of health-promotion activities, but primarily tobacco control is one of those. There are other countries that are looking at doing this.

Q: What’s your message to policy-makers trying to deal with the epidemic?

A: The stark reality is that only 5 percent of the world’s population is covered fully by any one of these five cost-effective interventions in our strategy.

One of the five interventions is to protect people from tobacco smoke. We want to see complete bans on all forms of smoking in public places and workplaces. Some of the best practices are in Uruguay, the United Kingdom, New York City, California, and Ireland — where they said pub culture would not allow a complete ban. The message here is they are very popular. Another recommendation is to offer help to smokers who quit tobacco use, and other recommendations involve public health strategies.

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