Call to eliminate tobacco use worldwide by 2040 Friday, 13 March 2015

New Zealand health experts are at the forefront of a new international effort to make the world tobacco-free by 2040.

University of Auckland professors Robert Beaglehole and Ruth Bonita, with the backing of health and addiction experts from around the world, are calling on the United Nations to lead a "turbo-charged" effort against the tobacco industry.

It's timed to coincide with the next World Conference on Tobacco or Health, which will be held in Abu Dhabi next week.

In perhaps a nod to the difficulties of wiping out use of one of the world's most popular addictive substances, the experts are defining tobacco-free as being used by under 5 percent of all adults - and they're not calling for prohibition.

Writing in the latest issue of medical journal The Lancet, the Kiwi pair - along with Derek Yach of the Vitality Institute of New York, Judith Mackay of the World Lung Foundation in Hong Kong, and K Srinath Reddy of the Public Health Foundation of India - present a four-step approach they believe could tobacco could be "out of sight, out of mind, and out of fashion - yet not prohibited".

"The justification for the endgame is the uniquely hazardous and highly addictive nature of tobacco products and the need for more radical solutions to address the failure to achieve rapid and substantial reductions in the prevalence of tobacco use," they claim.

Firstly, and most urgently, the researchers want "the inclusion of an ambitious tobacco target in the post-2015 sustainable development health goal"; secondly an "accelerated implementation of the WHO Framework Convention on Tobacco Control (FCTC) policies in all countries, with full engagement from all sectors including the private sector - from workplaces to pharmacies - and with increased national and global investment"; thirdly, "an amendment of the FCTC to include an ambitious global tobacco reduction goal"; and lastly, a "UN high-level meeting on tobacco use to galvanise global action towards the 2040 tobacco-free world goal on the basis of new strategies, new resources, and new players".

"Decisive and strategic action on this bold vision will prevent hundreds of millions of unnecessary deaths during the remainder of this century and safeguard future generations from the ravages of tobacco use," they write.

In 1980, it was estimated 41 percent of adult men and 11 percent of adult women smoked. In 2012, that had fallen to 31 percent and 6 percent respectively.

But the tobacco industry hasn't seen a corresponding fall in income, because population growth pushed the number of smokers up from 720 million to almost 1 billion.

The Lancet estimates only 10 percent of the world's population live in countries with adequate control measures - for example, hefty taxes on cigarettes - and only 15 percent have access to smoking cessation programmes.

The 2040 goal lags 15 years behind the New Zealand Government's aim of making the country smokefree by 2025.

Prof Richard Edwards, co-head of the University of Otago's Department of Public Health, says both are ambitious targets that won't be achieved without making drastic changes.

"Business as usual using current interventions is unlikely to be sufficient to achieve Smokefree 2025, particularly among Maori communities.

"There are no major new tobacco control interventions in the pipeline (although standardised packaging and refreshed pack health warnings are hopefully still on track). More fundamentally, the lack of any comprehensive Government plan as to how Smokefree 2025 will be achieved suggests a lack of rigorous planning and of political will and momentum."

Assoc Prof Nick Wilson of the University of Otago agrees the target is ambitious, but the world's managed similar feats before, eradicating diseases like smallpox and dramatically reducing the impact of polio and HIV.

"We need to plan for ongoing tobacco tax increases after the current series ends in January 2016. We need [plain] packaging passed into law. We also need new laws on expanded smoke-free areas to protect children from secondhand smoke in cars and playgrounds.

"But more importantly we really need one or more major new strategies to ensure success with the tobacco endgame. These might include phasing down of retail outlets or possibly phasing down nicotine levels in smoked tobacco."

A potential roadblock for the WHO could be international trade treaties, which give tobacco companies the right to sue countries that threaten their revenue. The Lancet article focuses on Finland, which has a stated objective to eliminate tobacco use by 2040 - going so far as banning e-cigarettes.

"The major danger to Finland's strong stance could ironically come from their membership of the European Union and its Tobacco Products Directive, which could interfere with individual governments' right to enact stricter legislation," the authors write.

Australia has been challenged in court over its plain packaging ban, and the UK seems to be heading for a similar fight.

Former Maori Party co-leader Tariana Turia, who spearheaded much of the Government's recent efforts to curb smoking, will be honoured at next week's conference for or her efforts.

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