Intended for healthcare professionals

Observations On the Contrary

Letter to an unknown health minister

BMJ 2011; 343 doi: (Published 21 September 2011) Cite this as: BMJ 2011;343:d6004
  1. Tony Delamothe, deputy editor, BMJ
  1. tdelamothe{at}

Legislation, regulation, and taxation are the best ways to change behaviour

Dear Minister

I imagine you in your suite at the Millennium UN Plaza Hotel, pondering how to justify your entourage’s trip to the United Nations summit on non-communicable diseases this week. You already knew that heart disease, lung disease, cancer, and diabetes together kill more than half the people in your country. The summit recognised that prevention must be the cornerstone of global and national responses to non-communicable diseases (BMJ 2011;343:d6034, doi:10.1136/bmj.d6034). So what have you decided to do about the risk factors targeted by the summit: tobacco use, unhealthy diet, lack of physical activity, and alcohol misuse?

I wasn’t at the summit, but the participants I’ve talked to were disappointed that food and alcohol companies got off so lightly. But don’t despair: so much was published in the run up to the summit that a consensus about future action is emerging.

But firstly I need to get a few apologies out of the way. I’m sorry that some Western countries with antismoking policies to protect their own citizenry lobbied against imposing fiscal penalties on tobacco elsewhere. And that they resisted …

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