The global fight against tobacco must go on with renewed vigour

Shobha Shukla - CNS
The fourth WHO Report on the Global Tobacco Epidemic 2013, which was released recently in Panama City, shows that one-third of the world’s population – 2.3 billion people (from 92 countries) – are now covered by at least one of the 6 life-saving policy measures to curb tobacco use. This represents an increase of nearly 1.3 billion people (and 48 countries) in the past five years. This year’s report focuses on complete bans on tobacco advertising, promotion and sponsorship (TAPS), which is a highly effective way to reduce or eliminate exposure to cues for tobacco use.

These 6 measures are called the MPOWER measures--with each letter standing for a specific demand-reduction policy that governments can implement in order to protect their citizens from the tobacco epidemic: Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn people about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, and Raise taxes on tobacco) to curb tobacco use.

Although 177 countries, who have signed the WHO Framework Convention on Tobacco Control (FCTC)-- the world’s first public health treaty-- are obligated to implement these measures, but Turkey is the only country in the world which now protects its population of 75 million people with all MPOWER measures at the highest level. Three other countries (Brazil, Iran and Hong Kong) with 278 million people have put in place four measures at the highest level. Unfortunately, till to date, India has not been able to implement fully even one of the measures at the highest level.

Other highlights of the report are:
  • Creation of smoke-free public places and workplaces continues to be the most commonly established tobacco control measure, with 32 countries having passed comprehensive smoking bans in workplaces, public places and public transport between 2007 and 2012, protecting nearly 900 million additional people.
  • In the past five years, a total of 20 countries with 657 million people put strong and effective health warning labels on tobacco packaging in place.
  • Only 24 countries (with 694 million people or just under 10% of the world’s population) have put in place a complete ban on direct and indirect TAPS (tobacco advertising, promotion and sponsorship) activities.
  • Only 14 countries and one territory with 166 million people have raised their tax rates to increase the price of tobacco products sufficiently high levels in the past five years, and only six countries with 29 million people have done so in the past two years.
  • National mass media campaigns have been conducted in the past two years by about one fifth of the countries, which have more than half the world’s population.
  • Adequately staffed national tobacco control government structures have been established by six countries with 413 million people in the past five years.

The International Union Against Tuberculosis and Lung Disease (The Union) works with governments and civil society around the world to support their efforts to develop and pass legislation that corresponds with the MPOWER measures. It contributed to Turkey’s achievement by supporting the Turkish Ministry of Health to enact their smoke free legislation between 2008 and 2010 and by strengthening civil society capacity for monitoring of tobacco control policy implementation. It has also provided grants and technical assistance to 15 countries for smoke free policy implementation. The Union is also working sub-nationally in countries that have not yet achieved comprehensive national smoke free legislations, such as China, Indonesia and India.

‘This report shows quite clearly the progress that we are making as a global tobacco control community,’ said Dr Ehsan Latif, Director of Tobacco Control at The Union. ‘Unfortunately, legislating MPOWER policies is not enough because only effective enforcement of the resulting laws will lead to real reductions in the demand for tobacco. Because of this, in addition to supporting governments to develop tobacco control legislation, The Union is currently focusing on developing capacity for enforcing legislation and preventing the tobacco industry interference that often blocks effective implementation.’

‘It is impressive to see the accelerated progress that has been possible because of the Bloomberg Initiative,’ said José Luis Castro, Interim Executive Director of The Union.  ‘Continued vigilance to ensure that each of the MPOWER measures is introduced in every country will be essential to truly stem the global tobacco epidemic.’

The successes demonstrated by many countries in using demand reduction measures to build capacity to implement the WHO Framework Convention on Tobacco Control show that it is possible to effectively address the tobacco epidemic and save lives, regardless of size or income. However, much more remains to be done to accelerate incorporation of all provisions of the FCTC into national tobacco control programmes in all countries to reduce tobacco use and save the lives of the billion people who may otherwise die from tobacco-related illness worldwide during this century.

Tobacco use and exposure to second-hand smoke still remain serious threats to global health, killing nearly 6 million people every year. Although the number of countries establishing measures to address the tobacco epidemic has increased, more than 50% of them do not yet provide high level protection for their people on any measure. And while the number of people covered by high-level tobacco control measures has increased substantially, 66% of the world’s population is yet to be fully protected even in any one area, let alone all of them. However, more countries need to take the necessary steps to reduce tobacco use and save the lives of the billion people who may otherwise die from tobacco-related illness worldwide during this century.

The road ahead leading to the goal of a tobacco free society is long indeed and the journey is arduous, but by no means insurmountable.

Shobha Shukla, Citizen News Service - CNS
July 2013
(The author is the Managing Editor of Citizen News Service - CNS. She is a J2J Fellow of National Press Foundation (NPF) USA and received her editing training in Singapore. She has earlier worked with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored and edited publications on childhood TB, childhood pneumonia, Hepatitis C Virus and HIV, violence against women and girls, and MDR-TB. Email:, website: