Tobacco and Public Health - TCSC Indonesia

Introduction
The publication of this book is timely. Over fifty years after the establishment of the
substantial evidence that tobacco caused a great deal of serious disease we are about
halfway through the global tobacco epidemic. Declines in consumption and mortality
in (some) developed countries are being matched by increases in the developing world,
but it seems likely that global tobacco consumption may have reached its peak and be
starting to decline.
The severity and social costs of this epidemic are defined clearly now and are covered
in the relevant chapters. The reader will probably come to share the editors’ wonder
that such a controllable man-made epidemic, of complex diseases but simple aetiology,
has resisted public health attempts to control it for so long.
The scientific understanding of tobacco, tobacco smoke, and the relationships with
disease are now well understood and new factual knowledge in these fields is unlikely
to change this greatly. The major toxic and carcinogenic components of smoke are
known and the mechanisms by which these substances cause disease is becoming clear.
Knowledge exists which, if applied, could reduce the disease-causing potential of
tobacco. Although it is clear that no safe cigarette will ever be manufactured, less dangerous
variants and other forms of nicotine delivery systems are either here or on the
horizon, albeit not at the stage where they can compete with current tobacco products
for the global nicotine addiction market.
The chemistry and physiology of nicotine are well documented and the addictive
properties of the drug well delineated. The mechanism of addiction is reasonably well
understood even though there remains much to learn about methods of treatment and
whether there is a substantial genetic contribution towards susceptibility to addiction.
Why, then, is progress against tobacco use and mortality so slow?
The answer lies in the sections devoted to prevalence, policy, and tobacco-related
behaviour. A further component of the answer lies in the societal failings of our political
systems to deal with the corrupting effects of tobacco industry’s behaviour, and to
focus on preventing what is preventable about the factors contributing to initiation of
the habit. Another failure is the lack of effort committed to stimulating cessation
efforts which offer the greatest promise of early (i.e. within one to two decades) mortality
decreases, associated with consideration of better sources of competitive nicotine
delivery products.
This book sets out to cover the known levers which could be pulled to reduce
tobacco’s death toll. The information in it will be useful to any student or practitioner
of medicine and other health sciences who will gain an understanding of the crucial