WHO Unveils Global Effort to Fight Smoking

One billion people may die of tobacco-related illness this century, almost all of them in developing countries, the World Health Organization warned    yesterday as it rolled out an unprecedented global campaign to limit the spread of smoking.
   The effort provides the first comprehensive look at tobacco use, as well as smoking control and taxation policies, in 179 countries. It also lays out six strategies to reduce tobacco use, many used by rich countries in recent decades, although far from fully deployed even there.
   Tobacco use is a risk factor for six of the world's eight leading causes of death and causes about one in every 10 deaths of adults now. That toll is expected to rise steeply as tobacco companies target new customers, particularly women, in low-income countries, WHO officials said.
   "What we're saying is that we don't want to let that happen," said Douglas Bettcher, director of the WHO Tobacco Free Initiative. "We want to see the operating environment of the tobacco companies become as difficult as possible in the near future."
While WHO cannot force countries to make stringent tobacco control a priority, it hopes to convince them such efforts are cheap, proven, and especially beneficial to their poorest citizens.
   "In many countries, money spent by the poor on cigarettes is taken away from what they could spend on health and education," said Patrick Petit, a WHO economist who helped produce the 329-page report accompanying the initiative's launch in New York.
   Margaret Chan, WHO's director-general, said the compilation of data is itself a powerful tool for change. "I truly believe that what gets measured gets done," she said.
   WHO is using marketing techniques reminiscent of the tobacco companies'. It has branded the campaign MPOWER -- each letter represents one of six strategies -- and is eschewing scare tactics in favor of the theme "fresh and alive." Press materials came with a box that looks like a pack of cigarettes and contains a pad and pens describing the elements of the campaign.
   The six strategies are: monitoring tobacco use and control policy; protecting people by enforcing "smoke-free" laws; offering smokers nicotine replacement and counseling programs; warning on cigarette packs about smoking's hazards; enforcing bans on tobacco advertising and promotion; and raising the price of tobacco through taxes.
   By packaging them together "we are saving the countries of fishing around for the most cost-effective measures," Chan said.
   Numerous studies have shown that raising the price of cigarettes is by far the most powerful strategy. For every 10 percent increase in price, cigarette consumption drops about 4 percent overall and about 8 percent in young people.
   While some cities, states and provinces employ the strategies in a coordinated fashion, no countries do so, the WHO report said. Uruguay employs the most of any nation -- three: graphic pack warnings, a ban on smoking in public buildings and free smoking-cessation help. The United States employs two, at least to a degree: national monitoring and a national ban on many forms of tobacco advertising.
   Only 5 percent of the global population is protected by laws to curb smoking; only 5 percent live in countries that completely ban tobacco advertising and event sponsorship; and only 6 percent live in places where cigarette packs carry pictorial warnings of smoking's hazards. (In Brazil, some packs feature a man with a tracheotomy, a breathing hole created in the front of the neck after treatment for throat cancer).
   The report sketches a picture of huge diversity between countries and regions in current tobacco use.
   In Greece, 59 percent of men smoke cigarettes every day; in Sweden, 15 percent do. Thirty-eight percent of Serbian women smoke, but only 1 percent of women in Kyrgyzstan do. In Indonesia, 65 percent of men are smokers, but only 4 percent of women.
   Nearly two-thirds of the world's smokers live in 10 countries, with China accounting for nearly 30 percent. About 100 million Chinese men now under 30 will die from tobacco use unless they quit, the report said.
   In India, which is second to China in the number of smokers, tobacco control is complicated by the fact there are two types of cigarettes that are priced and taxed differently.
   In 2006, Indians smoked about 106 billion conventional cigarettes and 1 trillion "biris." The latter are loosely packed combinations of tobacco and flavorings such as chocolate or clove, wrapped in a leaf of the tendu tree.
   Biris are made in thousands of small factories and home workshops and cost about 10 cents for a pack of 25. They are taxed at a lower rate than normal cigarettes, ostensibly to protect the poor, who are their main consumers.
   WHO's campaign was put together with financial help from a philanthropy run by New York Mayor Michael R. Bloomberg, a billionaire businessman. He is giving $125 million over two years for global tobacco control and helped pay for the country-by-country survey that provided baseline data for the campaign.
In New York, he created one of the most comprehensive anti-smoking programs in the country. His advocacy of higher tobacco taxes has pushed the average price of a pack of cigarettes there to $6.20, and he is seeking another 50-cent increase.
   The U.S. Centers for Disease Control and Prevention reported in June that the percentage of adult New Yorkers who smoke fell from 22 to 18 from 2002 to 2006, with the steepest drop in people 18 to 24 years old.
   The campaign organizers held two news conferences in New York yesterday, one at the United Nations, WHO's parent organization. U.N. headquarters is about the only place in the city where a smoking ban is not enforced, because the U.N. campus is autonomous territory.
   The Vienna Cafe there is packed with smokers all day long. It used to have signs saying "Smoking Discouraged," but they haven't been in evidence recently.