Global tobacco consumption is slowing. This is largely due to many countries implementing successful tobacco control programs. Slowly, the tobacco control community is “normalizing” its interventions. For example, a decade ago, just 10 countries had comprehensive smoke-free policies whereas today it is 55, with 23 more almost there. For those fortunate enough to live in smoke-free environments, it is thanks to these efforts that encountering smoking in a restaurant today feels so jarring. Once a society has adjusted to a smoke-free norm, it becomes difficult to understand why smoking was ever tolerated. But more work remains to be done.

Many tobacco control proponents aspire to a so-called “end game” for tobacco, and such visions vary considerably, from complete eradication of tobacco use to declines in prevalence to 5% or less. While it is important to aspire, we emphasize that vigorous implementation and enforcement of the proven strategies would undoubtedly drive tobacco prevalence down significantly and just as importantly keep low prevalence low. The largest obstacle in many countries remains a lack of will. Some government officials are still unwilling to follow through on commitments to the WHO FCTC, and more broadly, to commit sufficient resources to promoting societal well-being through comprehensive tobacco control.

Though there were small victories at the Seventh Conference of Parties of the WHO FCTC in late 2016, there were also disturbing signs of governments indifferent to tobacco control. Even worse, some official delegates promoted messages remarkably similar to those of the tobacco industry. These dynamics reinforce that the industry remains a powerful and ubiquitous force globally and must not be underestimated. However, an emerging global orientation toward preventing non-communicable diseases, and tobacco control’s increasing place on the development agenda, are helping to challenge the industry’s power.


Tobacco Control Policy Implementation

Average performance across five major tobacco control policies (smoke-free, warning labels, cessation, marketing bans and taxes).

There is considerable discussion in the public health community about the role of potentially less harmful tobacco products. This issue is complex. We implore readers to be open-minded but also skeptical, and to always turn to science – tobacco control must be grounded in facts. There may be no one-size-fits-all solution to this new challenge, but we must work together as a public health community, find or rigorously generate the necessary evidence, interpret it thoughtfully, and avoid dogmatism that serves to divide and potentially obfuscate important truths. While we must address new developments, we also cannot let them distract from the key tasks at hand, particularly implementing evidence-based measures such as high excise taxes on cigarettes. New approaches to reducing tobacco-related disease will almost certainly work better in concert with proven measures to motivate quitting and discourage initiation. Moreover, there is no substitute for the weight of government action when it comes to implementing these proven measures.

As a modest start, we can set our sights on the established goal of a 30% relative reduction in prevalence by 2025 (from a 2010 baseline) with far more ambitious goals immediately thereafter. But governments must make a larger effort to implement these interventions and proponents working within government must raise their voices for change. And those outside of government, including civil society and researchers, must pressure governments to redouble their efforts, and provide assistance necessary to realizing these goals. We hope you will commit seriously to be part of this effort to save millions of lives from the scourge of tobacco use.