Through my 20 years in tobacco control, I have often been asked, “What is the main challenge faced by the tobacco control movement?” I’ve heard the question so many times, the answer has become reflexive: “Tobacco industry interference.” Industry interference is often blamed for tobacco control woes – and rightly so. But I wonder if something else is impeding progress, something that is often overlooked. What if the tobacco control movement is inadvertently holding itself back?
To truly help the world’s smokers quit, we need to look inwards to the challenges we have created for ourselves. During negotiations of World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC), FCTC articles were consciously discussed, negotiated and added to a final document. This includes articles relating to cessation, research and tobacco agriculture. But over the past two decades, these particular articles have not received the attention they deserve.
Certainly, there have been advances in policy formulation on demand-reduction strategies supported by Bloomberg Philanthropies, the Bill and Melinda Gates Foundation and others. And this support has been important in developing tobacco control policies that have been effective to some degree. But visit any low- or middle-income country or tobacco growing farm, and you’ll wonder if the benefits of well-intended policy are reaching the people most affected – the smokers and the growers.
Over the last two decades, we have created smoke-free environments, mandated bigger health warnings, made cigarettes more expensive, and restricted advertising and marketing. Yet still, one billion people continue to smoke, and a similar number are projected to die prematurely from tobacco use by the end of this century.
There seems to be a disconnect between the development of policy and the benefit many smokers receive from policy. This, in my opinion, is due to a rigid attitude adopted by many tobacco control advocates, including myself.
We have not fully involved smokers in the debate around policy formulation and implementation. Health services are not tuned to best assist smokers who want to quit. Research has not answered the questions that are most relevant to helping us understand which advances and technological innovations can improve quit rates the fastest.
Moving forward, we need to rethink our approach to tobacco control. It is imperative we push ourselves to discover innovative, new methods to save the lives of people who would otherwise be killed by smoking. This new way forward must be collaborative, grounded in high-quality research, and inclusive of all the innovative thinkers across the world who exist inside and outside public health.
