by Anthony Robbins, MD, MPA
Can we really consider “end game strategies” for tobacco? An Op-Ed in the New York Times makes a strong case for ending tobacco use. Let me begin with some history.
The World Health Organization’s (WHO) Framework Convention on Tobacco Control, adopted in 2003, was developed in response to globalization of the tobacco epidemic. The Framework’s objective is to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke. Unlike previous drug control regulatory strategies, it recognizes the need to address both demand and supply issues.
The Journal of Public Health Policy, where I am co-editor, has been encouraging public health leaders to report on “end game strategies” for tobacco control, especially in the developing world. In our call for papers we note:
As anti-tobacco groups pressed for the WHO FCTC, they challenged the global tobacco industry’s most deadly strategies for addicting children. Anti-tobacco advocacy was centered in rich or industrial countries and these countries adopted the strongest anti-smoking measures. Can these countries move into a new phase? … Today the tobacco industry is spreading its plague to the world’s poorest and most populous countries, employing the same tactics they used in the industrial world before the Framework Convention was in place. As the number of smokers continues to grow, can new efforts and strategies stem this tide?
Northeastern University law professor Richard Daynard brought the end game challenge home to the U.S. In the recent New York Times Op-Ed “Two Paths to the Gradual Abolition of Smoking,” Daynard spells out just what the Food and Drug Administration can do and what states and localities should do. He writes the FDA should limit nicotine in cigarettes (and other tobacco products), so that they are no longer addictive. Research shows that when people are smoking very low nicotine cigarettes, further lowering of nicotine content does not lead the smokers to compensate by smoking more cigarettes. States and localities should ban sales of tobacco to anyone born after 2000 (or another chosen starting point). Thus fewer and fewer people could buy tobacco each year. This would use the same controls used to restrict alcohol purchases by age.
“Some antismoking advocates who support existing approaches (smoking-cessation programs, higher taxes) fear that pushing for an “end game” — a smoking rate below 10 percent — is too ambitious. But then, banning smoking in restaurants, workplaces and bars was once seen as crazy, too. Sometimes, a little crazy goes a long way.”
Anthony Robbins, MD, MPA is co-Editor of the Journal of Public Health Policy.