One Billion Lives

A global initiative aims to keep tobacco from ravaging the developing world.

DISEASES CAUSED by tobacco killed an estimated 100 million people during the 20th century and could kill 1 billion in the 21st if nothing is done to restrain tobacco companies from pushing their products in the developing world. Those companies show no sign of slowing their marketing campaigns on their own; Philip Morris International's sales, for example, were up 18.5 percent this year over the same period last year in Eastern Europe, the Middle East and Africa. Tobacco companies are bringing a new public health disaster to countries that can least afford one.

Last week, the Bill and Melinda Gates Foundation and New York Mayor Michael Bloomberg's Initiative to Reduce Tobacco Use announced a $500 million commitment to combat the global tobacco epidemic. The money will go to MPOWER-- a two-year-old program run in conjunction with the World Health Organization that works to: (M) monitor tobacco use and policies to prevent it; (P) protect nonsmokers from the harmful effects of tobacco smoke; (O) offer help with kicking the tobacco habit; (W) warn about the dangers of tobacco; (E) enforce bans on tobacco advertising, promotion and sponsorship; and (R) raise taxes on tobacco. A sizable portion of the money will be spent on researching patterns of tobacco use in Africa to help governments prevent tobacco companies from establishing the kind of strongholds there that they have in other parts of the developing world.

True to its acronym, the initiative seeks to empower the governments of developing countries to regulate tobacco ads and require warnings on cigarette packages, among other measures. Over the past two years, the program has made substantial progress. Today, if you walk into a Chilean convenience store to buy some Derby cigarettes, a glossy image of a bearded man with sparse white hair stares at you from the package. The photograph occupies half of the pack's front, and it doesn't take long to notice the large, burgundy hole in the man's throat. The image is captioned: "Don Miguel, Chilean, Smoked for 20 years. He lost his larynx to cancer." The back of the pack reads, "Caution! These Cigarettes Are Killing You." Such graphic warnings are especially important in countries with low literacy rates, and they are becoming mandatory parts of cigarette packaging around the world.

Even with this unprecedented grant, MPOWER will not solve the tobacco problem in developing countries. In its efforts to hook new smokers, the tobacco industry continues to outspend the public health community. But thanks to stepped-up public health advocacy, not all the trends are negative; more countries, for example, are banning smoking in public places. A half-billion dollars is a big push in the right direction.