Tobacco is an Old Issue

With the increased interest in global health, tobacco control competes in a crowded landscape for funding and attention.  Tobacco control suffers from fatigue as an “old issue” and is sometimes viewed as being about individual choice, thus it’s challenging to sustain interest as other concerns move center stage in the funding arena. Furthermore, unlike many other health issues, tackling smoking moves well beyond medicine and requires complex multifaceted strategies to counter sophisticated, well funded, corporate marketing and lobbying.  As stated in the WHO Zeltner Report, (2000) “Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists.” Tobacco industry tactics mandates strong leadership and sustained government commitment in order to make advances in tobacco control.

Tobacco Control Champions

Tobacco, as a leading cause of death and related health issues, is a global public health crisis but government responses have been varied, and in some cases, limited. South Africa provides an example of how policies and education can successfully drive down tobacco utilization.  Tobacco control efforts began in earnest when post-apartheid policies emphasized tobacco control as part of an overall health promotion strategy.[1] The government’s commitment and the dedication of health professionals such as Nkosazana Zuma, translated into significant progress in reducing tobacco use. [2] There have been many champions for tobacco control on the global scene and Dr. Zuma, South Africa’s Minister of Health from 1994 to 1999, provides an encouraging example of how strong leadership can drive effective policies under the most difficult of circumstances.  In 1993, in the presence of a powerful tobacco industry with strong allies in the apartheid administration, 33% of South Africa’s population aged 18+ smoked.[3]  Despite pressure from the tobacco industry, Dr. Zuma maintained a focus on tobacco and was instrumental in the development of multifaceted tobacco control legislation, education and financial tactics. Following Dr. Zuma’s efforts, South Africa made great strides with comprehensive tobacco control measures.  Unfortunately, there are suggestions that South Africa’s attention has stagnated [4] and notably, tobacco control is not currently listed as a priority on the government’s health web site.

Sustained Efforts a Must

Tobacco control requires sustained efforts, yet has not received levels of attention and financial support commensurate with the disease burden and unfortunately, the Millennium Development Goals do not specifically address tobacco. Without ongoing pressure from champions like Dr. Zuma, we are at risk for reversing gains made in the tobacco wars as industry takes advantage of waning interest. As the new era of global health unfolds, tobacco control must remain a global priority.  Health professionals should continue to build anti-tobacco coalitions, pursue innovations in tobacco control and celebrate those who champion this difficult cause.


[1] A. Bitton, Tobacco Control in South Africa. Harvard Business Publishing; 2011.

[2] K. Steyn, et al. (eds). Chronic Diseases of Lifestyle in South Africa: 1995 – 2005. Technical Report. Cape Town:South African Medical Research Council, 2006.

[3] Abedian, I, et al. The Economics of Tobacco Control. Towards an optimal policy mix. Cape Town, South Africa: Applied Fiscal Research Centre;1998.

[4] Bitton, A. et al. Improving the Delivery of Global Tobacco Control. Mount Sinai Journal of Medicine; 78:382-393,2011.


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