Ten Years On, America has Dropped the Ball on the Global Tobacco Epidemic

We want to stop American kids from smoking; why don’t we have the same concern for Asian or African kids? Senator John McCain asked that question on the floor of the U.S. Senate fifteen years ago. And, this week, on the ten-year anniversary of President Bill Clinton’s executive order instructing U.S. agencies to take “strong action to address the potential global epidemic of diseases caused by tobacco use,” that same question is still being asked about U.S. policy.

President Clinton’s order, which remains in effect, requires U.S. agencies to support global tobacco prevention and control efforts, deter youth smoking globally, and coordinate U.S. trade and public health policies on tobacco. Nevertheless, as I describe in Foreign Policy, U.S. efforts in these areas have remained modest while, in contrast, tobacco companies have aggressively expanded markets for their products and opposed tobacco control and prevention programs in low- and middle-income countries. According to the WHO, tobacco use and secondhand smoke now kill more people globally than HIV/AIDS, malaria, and tuberculosis combined. It will kill hundreds of millions more in the coming decades, mostly in developing countries, unless urgent action is taken.The last decade, however, has also brought some reasons for optimism. Tobacco control strategies are cost-effective and evidence-based. The WHO Framework Convention on Tobacco Control is among the most widely subscribed treaties in the world and provides a platform for effective tobacco control efforts. The Bloomberg Initiative, the Bill & Melinda Gates Foundation, and anti-smoking NGOs like the Tobacco-Free Kids Initiative are providing new resources and energy to the cause. Low- and middle-income countries like Poland, South Africa, and Uruguay are implementing successful tobacco control programs despite industry pressure. Where the United States has engaged on international tobacco control, such as CDC’s programs on global tobacco use surveillance, it has made a big difference.Cost-effective and comprehensive U.S. engagement on international tobacco control would serve U.S. interests and improve the prospects for the world’s poorest people. By implementing the strategies I outline with my co-author Larry Gostin in the Journal of the American Medical Association, the United States would go a long way toward helping the world’s poorest countries ensure that their kids have the same protections against tobacco industry marketing and products as we have for our own.