Tobacco: A global crisis

The largest tobacco control conference ever meets in Chicago to strike at a worldwide killer.

Editorial. Aug. 21, 2000.

The tobacco industry has suffered some serious and well-deserved blows in this country -- the latest is a $145 billion courtroom judgment in Florida -- and this month it will receive another.

The 11th World Conference on Tobacco OR Health will be held in Chicago, a return of the meeting to the United States for the first time in 25 years. The conference is an important strike at tobacco in the global marketplace, including the developing nations seen as the last refuge of this death-dealing business.

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It will be the biggest tobacco control conference ever. More than 4,000 tobacco control advocates -- including governmental and voluntary agency workers, clinicians, association officials and others -- from more than 130 nations have registered for the event (this editorial goes to press on the eve of the meeting). Co-hosting the event are the AMA, which has worked for most of the 1990s to bring it back to the United States, as well as the American Cancer Society and the Robert Wood Johnson Foundation.

Even for all of America's tobacco use, this country represents only 5% of the world's smokers. Yet it is an appropriate setting for the meeting, especially at this time. Successes in the United States -- including courtroom victories and the Tobacco Settlement Agreement, as well as strides in protecting clean indoor air -- underscore at least some of the results that can come from determined anti-tobacco advocacy.

However, intertwined with such success is a troubling and unintended, but predictable, consequence. Advocacy wins here and in the rest of the developed world have only intensified the tobacco industry's quest to exploit smoking in the developing world.

In those nations, the appetite for all things Western paired with an often poor understanding of health risks -- for example, 40% of Chinese surveyed were unaware of the connection between smoking and cancer -- are among factors that make them a prime target for the tobacco industry. The latest revelations about the tobacco trade have come just this month, in a report by the World Health Organization and based largely on documents released through tobacco litigation in this country. The WHO alleges that for many years tobacco interests backed up their overt marketing tactics with largely secret moves to undermine WHO tobacco control efforts, especially in the developing world.

All told, the WHO estimates 500 million people alive in the world today will die before their time, because of tobacco. As it is, the developing world accounts for half of tobacco deaths; by 2030 that percentage is expected to climb to 70%.

Tobacco is tenacious, both in terms of its nicotine-based addictiveness and the often utter unscrupulousness of the people who sell it. Knowledge of how this product works and is marketed, paired with polished advocacy skills, are powerful weapons in tobacco control. This six-day meeting will place special emphasis on appraising progress in tobacco control, examination of advocacy in action and an understanding of the role of nicotine. It features more than 200 programs on issues such as addiction science, cultural approaches, finding allies, communication and prevention, as well as plenary sessions and major addresses.

It is a big meeting with a lengthy agenda. But then, the problem that it hopes to solve has grown as big as the world we all share.