BMJ  2005;331:191-192 (23 July), doi:10.1136/bmj.331.7510.191

Commentary

Making the transition to action

¹ Institute of Hygiene and Epidemiology, Charles University, Prague, Czech Republic, ² Hungarian Medical Chamber, Budapest, Hungary, ³ Polish Chamber of Physicians and Dentists, Warsaw, Poland, ⁴ Department of Tuberculosis and Respiratory Diseases, Martin Faculty Hospital, Martin, Slovak Republic, ⁵ Department of Preventive Medicine, Kaunas University, Kaunas, Lithuania, ⁶ Tobacco Control Resource Centre, BMA, Edinburgh EH2 1LL

The news on smoking from the European Union's eastern frontiers is better than expected, with no evidence of a future gulf in lung cancer mortality between old and new member states.¹ However, the special challenges faced by the eastern transitional economies—such as aggressive tobacco marketing, rapid liberalisation of the tobacco trade, and the political influence of the leading tobacco companies²—remain. And a closer look at the study by Didkowska et al¹ shows just how much work is still needed throughout the EU to reduce deaths from lung cancer and from other tobacco related disease.

The tobacco epidemic cannot be allowed to proceed without active intervention. Tobacco remains Europe's single biggest cause of preventable death. Lung cancer still accounts for more than a quarter of the EU's male cancer deaths and a rising number of deaths in women,³ and tobacco related diseases cause 650 000 unnecessary deaths every year in the EU.⁴ Tobacco control has been identified as a priority in central and eastern Europe,³ but its importance cannot be restricted to these countries.

Throughout Europe, tobacco companies have proved adept at expanding and maintaining their markets, especially among women. Marketing a life shortening addiction as liberation has proved a highly effective strategy in countries as diverse as Hungary, France, and Spain. There is no sign that the women's market has reached saturation point in most countries, and a far greater number of women will die if doctors and governments alike do not act. Despite having declined, tobacco related deaths in males remain frighteningly high.

The unpalatable truth is that both old and new EU states have made very limited progress in reducing tobacco use and its associated diseases in the past 50 years. Despite the evidence that half of all long term smokers will die prematurely as a result of smoking,⁵ both doctors and governments have found it hard to kick their addictions to tobacco. From those doctors whose own smoking stops them advising their patients to quit, to governments in thrall to tobacco companies' wealth, there can be no excuse for inaction.

The medical profession has a key role to play. Treatment for tobacco dependence is a cost effective intervention that will improve the health of patients who smoke; and doctors can advise governments as well as patients. Moreover, because the tobacco industry operates in similar ways throughout the world, much can be achieved through sharing of information across national boundaries. All EU governments are expected to have ratified the WHO Framework Convention on Tobacco Control by the end of 2005. The world's first public health treaty commits governments to take action to reduce the disease, disability, and death caused by tobacco. The evidence based policies that it contains—such as increases in tobacco tax, advertising bans, smoke-free public places, and hard hitting picture warnings—have been proved to work. It's time for Europe's doctors to treat tobacco dependence in their patients. But it's also time to move out of the consulting room and demand that our governments take effective action too.

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Competing interests: None declared.

References

1. Didkowska J, Manczuk M, McNeill A., Powles J, Zatonski W. Lung cancer mortality at ages 35-54 in the European Union: ecological study of evolving tobacco epidemics. BMJ 2005;331: 189-91.[Free Full Text]
2. Gilmore A, McKee M. Tobacco and transition: an overview of industry investments, impact and influence in the former Soviet Union. Tob Control 2004;13: 136-42.[Abstract/Free Full Text]
3. Boyle P, Ferlay J. Cancer incidence and mortality in Europe, 2004. Ann Oncol 2005;16: 481-8.[Abstract/Free Full Text]
4. ASPECT Consortium. Tobacco or health in the European Union—past, present and future. Luxembourg: Office for Official Publications of the European Communities, 2004.
5. Doll R, Peto R, Boreham J, Sutherland S. Mortality in relation to smoking: 50 years' observation on male British doctors. BMJ 2004;328: 1-10.[Abstract/Free Full Text]

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