Tobacco and Public Health - TCSC Indonesia

Introduction
Chapter 37
Global tobacco control policy
Nigel Gray
Tobacco control policy has evolved over time and will continue to do so. To every
action by the tobacco industry there has been a reaction by public health authorities
and vice versa. As a result there has been a continuing struggle between those committed
to market expansion (the industry) and those committed to market shrinkage
(public health authorities). As a result the market is shrinking in most developed countries
while it expands in many, but not all, developing countries. Between 1997 and
1999 world tobacco leaf sales went from 7 975 360 tonnes to 6 341 430 tonnes (United
States Department of Agriculture 2001), while world cigarette production went from
5614 830 million pieces in 1996 to 5 573 464 million pieces in 2000 (United States
Department of Agriculture 2001). If public health is winning, it is winning very slowly.
Fifty years of obstruction and obfuscation has maintained industry profits and has
seen a steady increase in global mortality (Peto 1994). To be effective, tobacco control
policy must be comprehensive and global.
Making tobacco policy is not the same as implementing it and the time lag between
the two processes is often decades. Tobacco use is, and will remain, one of the most difficult
health issues facing society in the twenty-first century. It is worth reflecting on
the history of the major infectious diseases and the disappearance from developed
countries within a decade or less of smallpox, measles, diphtheria, tetanus, whooping
cough, rubella, and scarlet fever. These diseases were conquered by the discovery, and
use, of penicillin and vaccines that both worked and were used. Some of these diseases
persist in developing countries for reasons related to social organisation and money
but NOT to organized opposition, which explains the slow progress against the
tobacco epidemic. The single reason for the dominance of the tobacco problem is that
someone is selling it, whereas no one is selling diphtheria or tuberculosis. This fact
is unique to tobacco which has been, until very recently, the subject of a 50-year
campaign of denial. There was never a serious suggestion that asbestos did not cause
asbestosis or that drunken driving was merely a pleasurable habit.
That the environment has changed is due to the effects of litigation, mainly
within the United States, which has led to the arrival in the public domain of over
33 million documents which revealed what the tobacco industry knew and when