Tobacco and Public Health - TCSC Indonesia

Introduction
Chapter 42
Effective interventions to reduce
smoking
Prabhat Jha, Hana Ross, Marlo A. Corrao and
Frank J. Chaloupka
Cigarette smoking and other tobacco use currently accounts for one of every ten adult
deaths world wide. Given current trends, about 500 million people alive today will die
prematurely as a result of tobacco use, with one billion deaths from tobacco expected
during this century (WHO 1997; Peto and Lopez 2001). Future tobacco mortality
depends largely on current smoking patterns. The increase in tobacco deaths is the
result of both increases in the susceptible population size and increases in age-specific
disease rates. Low-income countries will pay the biggest toll in this respect, accounting
for 87 per cent of the increase in tobacco-attributable deaths between 1990 and 2020
(Murray and Lopez 1997). Even though reducing smoking initiation will reduce the
burden associated with smoking in the long run, the most immediate reduction in
tobacco related mortality would be achieved by encouraging cessation among current
smokers (Peto and Lopez 2001; Donald et al. 2002).
Given the public health consequences of smoking, governments have a strong
incentive for intervening to reduce tobacco use. However, many governments have
resisted taking strong action because of concerns that effective interventions would
have harmful economic consequences. Recent efforts by the World Bank, in partnership
with the World Health Organization (WHO), have addressed these concerns. A team of
over 40 economists, epidemiologists, and other tobacco control experts examined the
state of knowledge about tobacco use and tobacco control strategies. A summary of this
work was published in 1999 (Jha and Chaloupka 1999), and the background papers
contributing to this work were published in 2000 (Jha and Chaloupka 2000a, b).
This chapter reviews and updates the findings from these global analyses. It begins
with an overview of trends in global tobacco use and its consequences, followed by
a review of the evidence for the effectiveness of tobacco control policies and their
impact on smoking initiation and cessation. A description of the types and comprehensiveness
of policies currently in place and a discussion of some of the factors
correlated with the strength and comprehensiveness of these policies follows. Finally,
the constraints against implementing tobacco control policies and global efforts to
overcome these constraints are discussed.