Tobacco use kills about 6 million people per year, and most of the deaths are in Asia. In WHO’s South East Asian region, an estimated 1·3 million people die every year from tobacco-related disease, whereas in the Western Pacific region, two people die every minute. All these premature deaths are preventable.

Tobacco smoking is a commercially driven behaviour, and policies that prevent smoking have been under development for decades. As always in public health, these effective policies operate at population level, and could cost little or nothing to implement—eg, price rises, promotion of bans, smoke-free policies, or media campaigns. However, implementation of these policies, as measured across Europe at country level with the Tobacco Control Scale 2010, remains far from comprehensive. The introduction of effective policies to prevent smoking in European countries could be of profound benefit to the health of millions of people. However, the necessary political, and medical, leadership has been lacking so far.

The UK Government commissioned a systematic review on standardised packaging, launched on April 16, 2012, to inform its own consultation process. The report concluded that standardised packaging increases noticeability and effectiveness of health warnings and messages, and reduces use of designs that mislead consumers about harmfulness of tobacco products. However, as yet there has been no follow-up 8 months since the close of the consultation. Although the UK’s Public Health Minister Anna Soubry recently came out publicly in favour of standardised packaging of tobacco products for the first time, there is no sign that the Health Minister—Jeremy Hunt—has put standardised packaging forward to the Cabinet for discussion. This is despite the fact that Hunt supposedly prioritised reducing premature mortality when he became Health Minister. His call to action published on March 5, 2013, stated clearly that “Tobacco use is the single biggest behavioural risk factor for premature death”, and he committed to make a decision on whether to introduce standardised packaging. To reduce premature mortality, Hunt needs to do more to tackle smoking, and introduction of standardised packaging is essential. There is little time until the Queen’s speech on May 8, 2013, when the UK Government’s legislative programme for the 2013—14 Parliamentary Session is finalised.

In Asia, major challenges also remain in tobacco control. For example, associations between governments and national tobacco monopolies in countries such as China create a conflict of interest—ie, the Chinese Ministry of Industry and Information Technology is responsible for tobacco control, but is also in charge of the State Tobacco Monopoly Administration. Other issues such as scarce funding, continuing legal challenges against governments undertaking tobacco control measures, meeting WHO’s global monitoring target of reduced prevalence by 2025, and obligations within WHO’s Framework Convention on Tobacco Control (FCTC) still remain on the political, social, and economic agenda.

Although difficulties remain, there is some good news worth celebration. In December, 2012, Australia became the first country to introduce standardised tobacco packaging, comprising large and graphic health warnings and limiting brand information to a name and descriptor in standardised font on a plain background. New York City is proposing to raise the legal age at which cigarettes can be bought from 18 years to 21 years, following moves by other US counties and states to raise the age to 19 years or 21 years. Finally, Cancer Research UK has recently won its second victory through the Advertising Standards Authority against Gallaher, leading to a ban on the tobacco company attacking proposals for standardised packaging. This reflects this year’s World No Tobacco Day‘s theme—ban tobacco advertising, promotion, and sponsorship.

All countries should now implement and enforce FCTC smoke-free policies, close exemptions and concessions that many countries provide, and explore extensions that will reduce exposure to children, as seen in New York where smoking is prohibited in parks and other outdoor public areas. Exposure of children to smoke in private vehicles remains a problem and can be addressed through media campaigns and legislation; prevention of smoking in the home is more challenging. The worldwide epidemic of tobacco use causes an enormous burden of morbidity and mortality, one that is entirely preventable. Yet the solution will not only be found in doctors’ clinics and hospitals, but also in the political and legislative arena.

Source: Lancet