Tobacco and Public Health - TCSC Indonesia

dramatically. Once more, I am not satisfied with a goal of 50% reduction of initiation,
because I think we can do better. If we look at the results of tobacco prevention and cessation
efforts in California and Massachusetts during the 1990s, we see that smoking
initiation and prevalence can be reduced, and it is reasonable to predict even stronger
results if the efforts and expenditures were more commensurate with the magnitude of
the health problem caused by tobacco (CDC 1999b, 2000). I would also point out that
Fig. 1 shows only premature mortality; it does not include the important, and more
rapid, benefits of preventing initiation in terms of projected missed days of school, and
lost work productivity due to diseases that may not be life threatening, but can be debilitating
and account for unnecessary suffering. Of course, the greatest effect on smoking
prevalence in the near and long term would be from the simultaneous reduction of initiation
and increase in cessation, which could have synergistic effects (Farkas et al. 1999).
I believe that my vision is possible because we already have the science foundation to
support substantial progress. We know enough to predict significant reductions in risk
through substantial increases in smoking cessation (US DHHS 1989; World Bank
1999). We have treatments, both behavioral and pharmacological, that can help people
quit smoking at far less cost per person and far greater cost benefit than treatment
costs of many of the diseases caused by tobacco (Cromwell et al. 1997; World Bank
1999). We know that the prevention of initiation of tobacco use can be accomplished
by comprehensive educational programs that increase awareness of the harms inherent
in smoking, and by decreased access and increased costs at the point of purchase
through increased tobacco taxes (Kessler et al. 1997; Chaloupka et al. 2001; Bachman
et al. 2002). We have a solid scientific foundation that will allow us to move forward
and make considerable progress in the US and globally (WHO 2001).
Realizing the vision
PREFACE ix
I have already touched upon some of the elements that will be critical to the realization
of my vision for the twenty-first century, and many other potential features are discussed
in this volume. At this point, I would like to make some general observations
that I think are particularly important for focusing our efforts, so that we may achieve
our goals.
First, we have to understand that we are fighting disease and Big Tobacco, not cigarette
smokers. We have to isolate and contain Big Tobacco interests in the interest of
health. We have to fight for the resources to support the science that is yet needed, and
to support the application of its lessons in order to protect those who do not use
tobacco products, and to serve those who are addicted and those who will yet become
addicted. We need to work to keep our political leaders on the right path, or the powerful
interests of Big Tobacco will surely deliberately lead them astray.
As I have written before, we will have to channel outrage to ensure that, from local
communities to the global community, we do not become complacent. Our tasks will