The WHO wants governments to encourage people to stop smoking

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7095.1688 (Published 07 June 1997) Cite this as: BMJ 1997;314:1688
  1. Jo E Asvall, Regional directora
  1. a WHO Regional Office for Europe, DK-2100 Copenhagen, Denmark

    Dear Prime Minister,

    All the really difficult problems in your country's development land on your desk. From morning to night your schedule overflows with burning issues that claim your attention. Setting priorities is a constant challenge. There are times, however, when a small effort on your part can make a large contribution to the quality of life of the people of your country. This is one of those times, because you alone can orchestrate the concerted action of many ministries. I am addressing you today on such a matter, to ask for your support. Help your people by reducing the awful threats to their life and health that smoking inflicts on them.

    Tobacco is one of the greatest public health challenges facing the 51 member states of the WHO European region. Every year over 1.2 million deaths in the region are caused by tobacco. By 2020, unless we really change things, that number will rise to two million deaths. This will represent a fifth of all deaths, the single greatest killer in the European region. Many of these deaths occur among the economically active segment of the population.

    The facts are simple. Manufactured tobacco products deliver regulated doses of the addictive drug nicotine. Tobacco products cause one third of all cancers and a large proportion of heart disease, as well as many other health problems, and half of all regular smokers die of a condition caused by smoking. Over one third of adults in the region are regular daily smokers, and smoking is increasing in two fifths of the countries in the region, particularly among young people and women. Although there are some notable exceptions, why are we failing so miserably to deal with this problem when we so clearly know what to do?

    Almost every minister of health in our member states now sees this as a major challenge to health–both for this and for future generations–and many have taken vigorous action to deal with the issue. I am also proud to report that we have strong support from virtually every national medical association, national pharmaceutical association, and pharmacy-owner association in the region, for an all out effort to help young people to stop smoking and actively support those smokers who want to “kick the habit.”

    Such action cannot, however, be carried out by ministries of health alone; they need support and active cooperation from a number of other ministries–and for that they need your personal commitment. As the leader of the country, you have the power, if your country has not already done so:

    • To appoint an intersectoral coordinating committee for tobacco control, responsible for drawing up effective and comprehensive action plans on tobacco, with clear timetables for implementation and specific targets for reductions in the use of tobacco, and adequately funded commensurate with the burden of disease caused by tobacco, possibly from tobacco tax or a special levy on tobacco products

    • To persuade colleagues in the ministries of finance that regular increases in tobacco tax can raise revenue, correct for externalities such as health costs, and deter tobacco consumption;

    • To persuade colleagues in government that there is a causal relation between advertising and smoking behaviour, particularly in young people, and that effective action requires a total ban on tobacco advertising and the prohibition of sponsorship associated with a tobacco brand name or product

    • To persuade colleagues in government that restricting the access of people younger than 18 to tobacco products is effective in reducing the number of adolescents and young adults who become daily smokers

    • To ensure that all health related premises and particularly those within the jurisdiction of the ministries of health are smoke free environments

    • To ensure that support for smoking cessation is made widely available, particularly through primary healthcare professionals, including doctors, nurses, pharmacists, and dentists

    • To persuade colleagues in the ministries of customs and excise that failure to control tobacco smuggling is costing the country revenue and lives.

    It is time to take a stand and say things that may not be popular. During the next decade over 12 million men and women will die an agonising death from diseases caused by smoking, leaving in their wake countless family tragedies and great economic loss to our societies. Unless we take strong action now, future generations will condemn us for failure to control one of the worst scourges facing our people today.

    Yours sincerely,


    • We have received the following open letter from the regional director for Europe of the World Health Organisation. It is addressed to the heads of government of the 51 European member states of the WHO.

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