Ten years ago, the world was a different place when it came to tobacco. Fewer than twenty developing countries in the world had even one strong tobacco control policy in place. The tobacco industry was beginning an aggressive ramping up of nefarious activities to grow their market share in vulnerable developing countries. And although advocates for tobacco control measures had a major public health victory in passing the Framework Convention on Tobacco Control, the world's first public health treaty, little financial or technical help was available to support countries that wanted to put life-saving, proven tobacco control policies in place.
Early in 2007, the tobacco control landscape was changed dramatically when Michael R. Bloomberg, then in his second term as mayor of the City of New York, donated $125 million through his foundation, Bloomberg Philanthropies, for a two-year commitment to reducing global tobacco use. Now ten years and a total of $600 million later, Bloomberg recently committed another $360 million over six years to this life-saving work, bringing his total financial commitment to nearly $1 billion.
In the ten years since Bloomberg's first commitment, Bloomberg Philanthropies has been pleased to partner with more than 110 countries and five international partner organizations to tirelessly fight to end the global tobacco epidemic. The decade-long fight has shown that progress is indeed possible. In that time, nearly 100 countries worldwide with a total of more than four billion people have passed at least one strong tobacco control law—and fifty-nine of these countries with nearly 3.5 billion people have received Bloomberg support.
Urgent Need
The need for these tobacco control policies is urgent: tobacco is among the leading public health scourges. Noncommunicable diseases (NCDs) are persistent killers, representing 80 percent of deaths in middle- and lower-income countries. Tobacco contributes to six of the ten leading causes of death globally, including heart attack; stroke; chronic lower respiratory disease; lower respiratory infections; lung, bronchial, and throat cancers; and diabetes.
NCDs are preventable, but together they receive a mere 1 percent of global health funding. As the WHO works to achieve the United Nations' goal of reducing premature NCD deaths by one-third, Big Tobacco spends heavily to fight against effective regulation of its products.
Here's one way tobacco companies do it: litigation. In 2010, Philip Morris International filed a challenge to prevent Uruguay from enforcing its tobacco laws—which mandate large, graphic health warning labels on cigarette packs and restrict what is known as "brand usage to a single presentation." In other words, this means no longer allowing tobacco companies to market a cigarette with various representations such a "light," "red," "blue," and so forth. On July 8, 2016, after a six-year lawsuit, the International Centre for the Settlement of Investment Disputes, a World Bank arbitration panel, determined that Philip Morris's suit had no merit. Uruguay's laws were designed according to evidence demonstrating that strong warning labels spur smokers to quit, and they stop nonsmokers—especially youth—from starting. In 2014 youth smoking in Uruguay was at 8 percent, down from 23 percent in 2006, according to the Uruguay Ministry of Public Health.
Uruguay won, as did the rest of the world. Many groups rallied around Uruguay in its fight, including the Campaign for Tobacco-Free Kids, the CDC Foundation, Johns Hopkins Bloomberg School of Public Health, the International Union Against Tuberculosis and Lung Disease, the WHO, Vital Strategies, and others.
The Bloomberg partner network has worked closely with country-level advocates and governments in low- and middle-income countries, where nearly 80 percent of the world's smokers live and where smoking is ingrained in the culture. Of the 110 countries that have received support from the Bloomberg network, fifty-nine countries—with nearly 3.5 billion people—have passed a strong tobacco control law, saving an estimated 30 million lives. Just in the past two years, Bloomberg Philanthropies and our partners collaborated with the city governments of Beijing and Shanghai, China, to provide technical support aimed at achieving new smoke-free laws. Together, smoke-free laws in those cities now protect more than 30 million residents.
WHO Creates MPOWER
To further support countries and public health officials in their battle against the tobacco epidemic, WHO created the technical package called MPOWER. The acronym stands for a group of policies proven to reduce tobacco use: Monitor tobacco use; Protect people from second-hand smoke; Offer help to quit; Warn about dangers of tobacco use; Enforce advertising bans; and Raise tobacco taxes. MPOWER has, since 2007, spurred action to improve tobacco-control policies through strategies completely in line with the guidelines of the Framework Convention on Tobacco Control.
Bloomberg Philanthropies has provided support for the country-level implementation of MPOWER, for instance, by supporting thirty-four countries representing nearly four billion people to conduct household surveys to track tobacco use—the M in MPOWER. Similarly, the Bloomberg Initiative to Reduce Tobacco Use has supported, through our partners, 168 hard-hitting mass-media campaigns in thirty-one countries. The campaigns were created and adapted for global use—the W in MPOWER.
In Turkey—a country that has made a strong commitment to reducing tobacco use—the establishment of tobacco pack warnings, smoke-free zones, tobacco taxes, and tobacco advertising bans have had a huge impact. From 2008 to 2012, the number of smokers in Turkey declined by 1.2 million. Exposure to second-hand smoke in restaurants there declined from 55.9 percent in 2008 to 12.9 percent in 2012. And Turkey is on track to save 5.2 million lives by 2030.
To continue the momentum, we must build on MPOWER and the work of the global partnership, boldly communicate the importance of tobacco control to keep it on the global public health agenda, deepen support for tobacco taxes in vulnerable countries, ensure long-term funding for tobacco control as well as NCDs, and hold Big Tobacco accountable for its actions and the impact of its products. By remaining focused on programs proven to reduce use of tobacco and expanding successful programs, we can reach the Bloomberg Philanthropies initiative's ambitious goal of saving 100 million lives by 2050.
Related Reading:
"Addressing Tobacco And Secondhand Smoke Exposure In Maternal And Child Health Survival Programs," by Karen Wilson of Children's Hospital Colorado and the University of Colorado School of Medicine (Aurora) and coauthors, Health Affairs Blog, November 24, 2015.
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