Lessons for the world 50 years after the US Surgeon-General’s report

13 Feb 2014

The original report, so ground-breaking that its release 50 years ago was held on a Saturday to minimize the impact on the stock market, revealed to the world the scientific fact that smoking causes disease and death.

This public stance from a governmental body raised awareness about the tobacco epidemic both in the US and abroad, and was one of the steps that led to the world’s first modern-day public health treaty, the World Health Organization Framework Convention on Tobacco Control (FCTC).

The world listened

While the 1964 report examined the impact of tobacco on Americans, the rest of the world was listening. As well, much of the scientific data analysed by the expert committee came from non-US scientists.

The new Surgeon General’s report also includes data from around the world. “Enough is enough,” said Acting Surgeon General Boris D. Lushniak at the White House, urging renewed efforts to end tobacco use in our lifetime. The rest of the world agrees. Asked for her priorities to improve global health, World Health Organization Director Margaret Chan answered: “Tobacco, tobacco, tobacco. We must fight it.”

There is one key lesson from the US experience for rest of the world: if we want to reach global health targets, which include a 30 percent reduction in smoking, countries need to implement the evidence-based measures in the FCTC, and ensure that they are fully funded.

While the FCTC should be implemented in its entirety, Art 6 of the treaty (on price and taxes) should be given particular attention. Not only is raising the price of tobacco one of the most effective measures to decrease consumption, doing it by increasing taxes can help governments raise revenues that could fund priorities such as implementing the FCTC and attaining other health goals and objectives.  

The epidemic has shifted

While tobacco remains the number one cause of preventable death in the US, causing one in five deaths, the epidemic has shifted dramatically in the 50 years since the 1964 report. At the time, it was a disease of the rich world. Today it is a particular burden for the poor, especially in developing countries.

By 2030, 80 percent of global deaths from tobacco will be in the poorest countries in Asia, Africa and South America. Other global statistics are equally sobering:

  • 100 million people died from tobacco-related disease in the 20th century. Unless we take action, 1 billion will die in the 21st century.
  • The vector of the disease, the multinational tobacco industry, is richer than ever. Its annual revenue is comparable to the gross domestic product of some of the richest countries in the world.
  • In the poorest countries, some families spend 30 percent of their income on their nicotine addiction, taking money away from food, housing, education and healthcare.Fortunately, many countries are taking action, by implementing the FCTC. 

The treaty’s other evidence-based measures, which can help prevent millions of premature deaths, include:

  • Impose complete marketing bans, including advertising, promotion and sponsorship;
  • Protect everyone from exposure to tobacco smoke;
  • Implement public education campaigns;
  • Provide comprehensive help for smokers who want to quit;
  • Affix large, graphic warning labels, and if possible institute standardized packaging for cigarettes, as Australia has already done;
  • Ban flavourings that make tobacco more attractive.

Two countries, New Zealand and Finland, have drafted national plans aimed at ending tobacco use by the mid-point of this century. However, the entire world will have to accelerate implementation of the FCTC if we are to achieve the target adopted by the World Health Assembly in May 2013: a 30 percent relative reduction in smoking prevalence by 2025. Only if they do, can we hope to celebrate a smoke-free world on the next big anniversary of the Surgeon-General’s report.

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