Rapid Responses to:

NEWS: John Zarocostas WHO report warns deaths from tobacco could rise beyond eight million a year by 2030 BMJ 2008; 336: 299-c [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Is a global anti-smoking strategy feasible?

Irene Hadjimichael, Kostas Zacharias   (11 February 2008)

Beyond a health concern

Takeharu Koga, Toru Rikimaru   (17 February 2008)

Is a global anti-smoking strategy feasible? 11 February 2008
Irene Hadjimichael, ST2 Infectious Diseases Royal Free Hospital, NW3 2QG, Kostas Zacharias Send response to journal: Re: Is a global anti-smoking strategy feasible?	We read with great interest the report by John Zarocostas on behalf of the WHO on the global smoking epidemic and the lack of any real progress. This report coincides with the continuing controversy in the UK on the efficiency of the smoking ban in public places introduced last July. With other European countries, like France, following suit recently we are getting closer to a universal smoking ban in closed public spaces across the Western Europe and North America. The smoking ban in the UK has been met by mixed responses. There is no doubt that non-smokers enjoy the smoke free night life environment. At the same time reports on the news recently chose to focus on the extra amount of rubbish generated outside pubs, restaurants and night clubs in inner city areas and the reduction in business in pubs. Whether the smoking ban has a real impact on the prevalence of smoking is probably too early to tell. Our personal experience however is positive as a few of our friends who were in the past occasional smokers have now given up completely in the wake of the ban. At the same time, as the report states, the global epidemic of smoking remains on the rise. The tobacco industry has found it very easy to adjust to the increasing regulations in the developed world by targeting mass populations in developing countries. Two examples that clearly illustrate this can be found behind two of the most followed global news events of 2008. The Beijing Olympic games this summer should serve, amongst other things, as a reminder that China is one of the greatest consumer of tobacco in the world. An estimated 75% of the adult male population in China are smokers. Surveys performed in the last decade show that ignorance towards the effect of smoking is still high with 60% of people not knowing, for example, about the link of smoking and lung cancer (1). Publicity around the games so far has focused on the Chinese record on human rights. No announcement has been made as to whether the games are going to be smoke free like in Athens and Sydney or as to whether tobacco advertisement will be allowed. The second global event is of course the race to the White House, with tobacco companies still providing a great deal of funding for the candidates through powerful lobbies. Healthcare in the US seems to be one of the big issues of the current campaign but so far the candidates have not been to keen to attack the tobacco industry in the same way as they have pharmaceutical companies. Anti-smoking legislation, as any other piece of legislation in the modern world has first and foremost to make financial sense. The most powerful argument that can be made in favour of ever expanding anti- smoking campaigns has therefore got to be one made by health economists. It is only by persuading governments across the globe that any revenue made by tobacco sales and taxes pales into insignificance when compared to the cost of healthcare created and loss of work days by smoking related illnesses that any real progress can be made. 1) Bo-Qi Liu, Richard Peto, Zheng-Ming Chen, Jillian Boreham, Ya-Ping Wu, Jun-Yao Li, T Colin Campbell, and Jun-Shi Chen Emerging tobacco hazards in China: Retrospective proportional mortality study of one million deaths BMJ, Nov 1998; 317: 1411 – 1422 Competing interests: None declared
Beyond a health concern 17 February 2008
Takeharu Koga, Vice-director Asakura Medical Association Hospital, Toru Rikimaru Send response to journal: Re: Beyond a health concern	As was stated, smoking prevalence tends to be higher in low- and middle- income countries, where burdens of smoking-related illnesses and premature death are significantly higher compared with high-income counterparts. What should be addressed in addition to health problems is the fact that the burden attributable to smoking-related illnesses keeps these countries from development and confines a great number of people to poverty (1), one of the most serious global issues (2). Smoking is no longer merely a health concern but also a significant social and economic burden of the world. Facing with the devastating figures of the WHO report, it is important to address smoking as one of the premier global issues. References 1. Tobacco and poverty. A vicious circle. WHO. Geneva 2004. Website:http://www.who.int/tobacco/communications/events/wntd/2004/en/w ntd2004_brochure_en.pdf 2. Building a better world. Millennium development goals. The World Bank. 2007 Website: http://devdata.worldbank.org/atlas-mdg/ Competing interests: None declared