Tobacco control: present and future

The history of tobacco control in the twentieth century can be summed up by the phrase 'too little, too late'. The century saw the proliferation of the most deadly form of tobacco use: cigarette smoking. Until the 1970s, no government took serious action to protect its citizens. In fact, probably the most effective global tobacco control 'strategies' to date have not been motivated by health concerns: they have been inaccessible or uneconomic markets for tobacco companies and a cultural taboo on women smoking. Economic development has led to massive increases in male cigarette smoking in developing countries but even now <10% of women in non-Western countries such as China, Russia and India smoke. With 'westernization', this picture is changing. Without drastic action to get current smokers to stop, the annual rate of tobacco-related deaths will grow from 5 million in 2006 to 10 million in 2025. Without further action to prevent take up of smoking, the subsequent death toll will be even higher. The recently enacted World Health Organization (WHO)-initiated Framework Convention on Tobacco Control (FCTC) can mitigate this impending disaster but only if it is implemented according to the spirit and not just the letter of the articles contained therein. Specific tobacco levies in every country should be the primary means of kick-starting the process, with the proceeds being used exclusively to fund other tobacco control initiatives, including product regulation.