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Teaming up for tobacco control
Editorial
Teaming up for tobacco control
www.thelancet.com Vol 372 August 2, 2008
with very little public smoking in many African countries. But there is sound reasoning behind the Africa target. According to Michael Eriksen, a professor of public health at Georgia State University, Africa represents an enormous opportunity for early intervention, a place where the tobacco epidemic can be arrested before it really takes off. An out-of-control tobacco epidemic is clearly not something the continent can afford. Here is a public-health problem for which primary prevention can be implemented and where the social unacceptability of tobacco use can be firmly enshrined in law. Furthermore, Africans themselves see tobacco control as important. African leaders were central to the leadership of the Framework Convention on Tobacco Control, and there is strong human capacity both at official levels and in nongovernmental organisations. Africans are ready to act on this issue. But formidable challenges also exist on the continent. The sale of single cigarettes and marketing and promotion of tobacco products, especially to children and sometimes in connection with sporting and cultural events, are common. These practices persist despite industry codes of conduct that forbid them, and despite lawsuits filed against Big Tobacco by some countries, such as Nigeria, to stop them. There are doubtless other obstacles, which the Bloomberg/Gates’ project will attempt to identify early on. A 5-year Gates’ grant to the International Development Research Centre is aimed at gathering evidence from Africa on the prevalence of tobacco use, existing policies, and the economic and political factors that will affect tobacco control. Similarly, Bloomberg is now accepting 4th-round applications for proposals to change tobacco policy in Africa and other low-income and middle-income countries. These data will be added to existing information to delineate the specific steps that are contextually appropriate for tobacco control on the African continent. Africa is also a sensible venue because tobacco control can be added onto existing disease-control efforts. Programmes already in place to combat HIV/AIDS, malaria, tuberculosis, and to improve maternal and child health are well-placed to take advantage of existing resources. The integration of tobacco control into traditional African public-health initiatives is a plan worth watching. ■ The Lancet
The printed journal includes an image merely for illustration Reuters
Last week, two billionaires—Microsoft founder Bill Gates and New York City mayor Michael Bloomberg— announced their latest plan for spending some of their vast fortunes. The pair, through their respective charitable organisations, the Bill & Melinda Gates Foundation and Bloomberg Philanthropies, will contribute a combined total of US$500 million to global tobacco-control programmes. This is not the first time that Bloomberg, who led New York City’s successful anti-smoking legislation in 2002, has contributed his own money to anti-tobacco efforts. In 2005, he set up Bloomberg’s Initiative to Reduce Tobacco Use with $125 million, and his foundation helped fund WHO’s Report on the Global Tobacco Epidemic 2008. That report culminated in the MPOWER package, a group of evidence-based strategies for tobacco control. (The acronym stands for: Monitor tobacco use and policies; Protect people from secondhand smoke; Offer help to quit; Warn about the dangers of tobacco; Enforce bans on advertising, promotion, and tobacco company sponsorship; and Raise taxes on tobacco products.) Bloomberg will now make a further donation of $250 million, to be used over 4 years. The Gates’ contribution is $125 million over 5 years, of which $24 million is designated as a grant to the Bloomberg Initiative. These investments are modest when set against the net worth of the two funders, but the amount vastly exceeds what is now being spent on tobacco control in low-income and middle-income countries. According to the 2008 WHO report, such spending comes to less than half a penny per person per year—against tobacco tax revenues of nearly $66 million. Besides acceleration of the MPOWER strategy, the money will allow the Bloomberg Initiative, in conjunction with WHO and the US Centers for Disease Control and Prevention, to do house-to-house surveys of the prevalence of tobacco use around the world. Data from five of the 15 countries with the highest burden of tobacco use are expected later this year. Perhaps the most intriguing aspect of the partnership is a particular focus on Africa, where smoking rates (20% for men) are relatively low, compared with countries like India and China, which together account for nearly 40% of the world’s smokers. At first glance, Africa seems a rather quirky choice. Tobacco use there is not the norm,
For the WHO Framework Convention on Tobacco Control see http://www.who.int/fctc/en/ index.html For the Report on the Global Tobacco Epidemic 2008 see http://www.who.int/tobacco/ mpower/mpower_report_full_ 2008.pdf For the Bloomberg Initiative see http://www.tobacco controlgrants.org/
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Teaming up for tobacco control
www.thelancet.com Vol 372 August 2, 2008
with very little public smoking in many African countries. But there is sound reasoning behind the Africa target. According to Michael Eriksen, a professor of public health at Georgia State University, Africa represents an enormous opportunity for early intervention, a place where the tobacco epidemic can be arrested before it really takes off. An out-of-control tobacco epidemic is clearly not something the continent can afford. Here is a public-health problem for which primary prevention can be implemented and where the social unacceptability of tobacco use can be firmly enshrined in law. Furthermore, Africans themselves see tobacco control as important. African leaders were central to the leadership of the Framework Convention on Tobacco Control, and there is strong human capacity both at official levels and in nongovernmental organisations. Africans are ready to act on this issue. But formidable challenges also exist on the continent. The sale of single cigarettes and marketing and promotion of tobacco products, especially to children and sometimes in connection with sporting and cultural events, are common. These practices persist despite industry codes of conduct that forbid them, and despite lawsuits filed against Big Tobacco by some countries, such as Nigeria, to stop them. There are doubtless other obstacles, which the Bloomberg/Gates’ project will attempt to identify early on. A 5-year Gates’ grant to the International Development Research Centre is aimed at gathering evidence from Africa on the prevalence of tobacco use, existing policies, and the economic and political factors that will affect tobacco control. Similarly, Bloomberg is now accepting 4th-round applications for proposals to change tobacco policy in Africa and other low-income and middle-income countries. These data will be added to existing information to delineate the specific steps that are contextually appropriate for tobacco control on the African continent. Africa is also a sensible venue because tobacco control can be added onto existing disease-control efforts. Programmes already in place to combat HIV/AIDS, malaria, tuberculosis, and to improve maternal and child health are well-placed to take advantage of existing resources. The integration of tobacco control into traditional African public-health initiatives is a plan worth watching. ■ The Lancet
The printed journal includes an image merely for illustration Reuters
Last week, two billionaires—Microsoft founder Bill Gates and New York City mayor Michael Bloomberg— announced their latest plan for spending some of their vast fortunes. The pair, through their respective charitable organisations, the Bill & Melinda Gates Foundation and Bloomberg Philanthropies, will contribute a combined total of US$500 million to global tobacco-control programmes. This is not the first time that Bloomberg, who led New York City’s successful anti-smoking legislation in 2002, has contributed his own money to anti-tobacco efforts. In 2005, he set up Bloomberg’s Initiative to Reduce Tobacco Use with $125 million, and his foundation helped fund WHO’s Report on the Global Tobacco Epidemic 2008. That report culminated in the MPOWER package, a group of evidence-based strategies for tobacco control. (The acronym stands for: Monitor tobacco use and policies; Protect people from secondhand smoke; Offer help to quit; Warn about the dangers of tobacco; Enforce bans on advertising, promotion, and tobacco company sponsorship; and Raise taxes on tobacco products.) Bloomberg will now make a further donation of $250 million, to be used over 4 years. The Gates’ contribution is $125 million over 5 years, of which $24 million is designated as a grant to the Bloomberg Initiative. These investments are modest when set against the net worth of the two funders, but the amount vastly exceeds what is now being spent on tobacco control in low-income and middle-income countries. According to the 2008 WHO report, such spending comes to less than half a penny per person per year—against tobacco tax revenues of nearly $66 million. Besides acceleration of the MPOWER strategy, the money will allow the Bloomberg Initiative, in conjunction with WHO and the US Centers for Disease Control and Prevention, to do house-to-house surveys of the prevalence of tobacco use around the world. Data from five of the 15 countries with the highest burden of tobacco use are expected later this year. Perhaps the most intriguing aspect of the partnership is a particular focus on Africa, where smoking rates (20% for men) are relatively low, compared with countries like India and China, which together account for nearly 40% of the world’s smokers. At first glance, Africa seems a rather quirky choice. Tobacco use there is not the norm,
For the WHO Framework Convention on Tobacco Control see http://www.who.int/fctc/en/ index.html For the Report on the Global Tobacco Epidemic 2008 see http://www.who.int/tobacco/ mpower/mpower_report_full_ 2008.pdf For the Bloomberg Initiative see http://www.tobacco controlgrants.org/
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