What Will It Take To Create A Tobacco-Free World

Editorial
What will it take to create a tobacco-free world?

Last month, British American Tobacco released their paper, the cause of the tobacco pandemic is the tobacco
preliminary results for 2014. “I am delighted with the industry—lethal but still lawful—and its predatory efforts
excellent progress we have made”, said chief executive, to preserve and grow profits by exploiting markets in
Nicandro Durante. It has been “another strong performance middle-income and low-income countries. The industry
in 2014”, he added. The Group’s revenue continued to grow has vast resources and is undermining and distorting
by 2·8% and its adjusted profit from operations increased tobacco policy in many countries, although its efforts
Imaginechina/Corbis
by 4·4%. Of the 667 billion cigarettes sold in 2014, have been rejected in several high-income settings—for
197 billion were sold in the Asia-Pacific and 227 billion were example, plain packaging legislation in Australia followed
sold in Europe, the Middle East, and Africa—regions known by Ireland’s legislation this month. The authors call for
as “high-growth markets”. An increase in market share monitoring, exposing, and addressing the aggressive See Comment pages 918
and 924
driven by continued growth of leading brands meant the tactics of tobacco companies. Achieving a tobacco-free
See Perspectives pages 937
Group’s cigarette volume decline of 1·4% was less than the world will need concerted and coordinated action at and 938
overall industry decline, estimated at 2·5%. global, regional, and national levels, especially in large See Articles page 966
Contrast this glowing picture with a public health view. countries such as China, where one in three of the See Series pages 1011, 1019,
and 1029
The WHO Framework Convention on Tobacco Control world’s smokers lives. According to Gonghuan Yang and
(FCTC) is often referred to as a landmark treaty in global colleagues, progress is occurring in China with the country
health, ushering in optimism and hope of turning back poised to enforce further legislation, including making
the tobacco tide with its raft of tobacco control measures. indoor public places in Beijing smoke free from
However, despite considerable, although uneven, progress June 1, 2015. Draft proposals to do the same elsewhere in
in reducing the global prevalence of daily smoking in China and ban all forms of tobacco advertising, promotion,
the decade since the FCTC came into being, around and sponsorship are also being considered. However, the
50 million people, mostly men and largely in the poorer very close relationship between industry and the Chinese
countries of the world, have died from using tobacco. FCTC Government must be broken if progress is to be upheld.
implementation has been challenging in many low-income Further cause for concern exists for tobacco control
and middle-income countries, with several countries still efforts globally. In an Article, Ver Bilano and colleagues,
yet to ratify it. A yawning gap exists between global health estimate trends for tobacco use from national smoking
strategies and the way the tobacco industry sees itself and prevalence data from up to 178 countries between
its future. Clearly the FCTC alone will be insufficient to 1990 and 2010, and then extrapolate these trends to
nudge countries to set bold goals and to stop the tobacco assess how many countries will meet the WHO target of
industry actively recruiting new smokers, especially a 30% reduction in prevalence of smoking by 2025. They
women, where they see the real “untapped” growth found that many countries are not on-track to achieve
market. So what is needed to turn the tide on tobacco? their target, with several low-income and middle-income
This week, The Lancet launches a campaign for a countries at risk of worsening their tobacco epidemics,
tobacco-free world by 2040. A three-paper Series marks notably in Africa and the eastern Mediterranean.
the 10-year anniversary of the coming into force of the If tobacco control efforts are not intensified and
FCTC, and is published to coincide with the 16th World accelerated, the authors estimate there will be 1·1 billion
Conference on Tobacco or Health taking place this week tobacco smokers by 2025.
in Abu Dhabi, United Arab Emirates (March 17–21). In the Current global anti-tobacco strategies are failing. We
first paper, Robert Beaglehole and colleagues present the endorse the Series’ call for a UN high-level Summit on
case for an ambitious new global tobacco control goal—a tobacco use to reinvigorate global and national efforts to
world essentially free of tobacco by 2040—and the steps achieve a tobacco-free world by 2040. The time has come
that need to be taken to achieve it. A world where over the for not only greater WHO leadership, but also leadership
next 25 years the sales of tobacco are phased out (although from the UN Secretary-General, because tobacco is not just
not prohibited), and in which fewer than 5% of adults use a threat to health, it is also a threat to sustainable human
tobacco. As Anna Gilmore and colleagues outline in their development. The Lancet
www.thelancet.com Vol 385 March 14, 2015 915

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Editorial

What will it take to create a tobacco-free world?

www.thelancet.com Vol 385 March 14, 2015 915

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