Tobacco use kills one person every eight seconds; almost five million each year. It causes more death and disability than any single disease, including HIV/AIDS. According to the WHO, unless countries adopt tougher anti-tobacco measures, the annual death toll will exceed 10 million by 2020, with 70% of the victims in the developing world.

These grim statistics undoubtedly played a role last week in persuading the 192 member states of the World Health Organization to adopt the momentous Framework Convention on Tobacco Control, an international anti-smoking treaty that aims to reduce smoking-related deaths and disease. The Convention will come into force once it is ratified by 40 countries. It will commit all signatories to stringent curbs on the advertising, marketing and sale of tobacco products within five years, and recommends that at least one third of the space on cigarette packets be devoted to health warnings, including pictures, for example, of diseased lungs, hearts, and gums.

As the new treaty was being endorsed unanimously in Geneva, the World Bank was also there to mark the occasion. Although not an official party to the negotiations, the Bank nonetheless contributed to the successful outcome of four years of negotiations of the Framework Convention by providing the negotiators with factual evidence on the economic impact of tobacco use and tobacco control.

The bulk of that expert evidence came from a Bank report published in 1999, and now translated into 17 different languages, called "Curbing the Epidemic: governments andthe economics of tobacco control,"which has become a standard reference for policymakers, civil society, and the global media, to help disentangle the real economic facts around tobacco control from myths and other misleading information. Much of the report’s wide global dissemination was made possible by a US$300,000 grant from the US Centers for Disease Control (CDC).

For Joy de Beyer and Ayda Yurekli of the HNP group of the Human Development Network, last week’s resounding endorsement in Geneva was cause for celebration. As the Bank’s Tobacco Control team, they have spent years immersed in global and national efforts to lessen the physical and economic toxicity of tobacco.

"I was both relieved and delighted that the Convention passed almost unanimously, but it is sad that so many governments still drag their heels, when a set of proven policies could prevent so many people from dying or being disabled by a completely preventable cause," says de Beyer. "Still, this is a fantastic statement of global action against a global problem, that helps poor countries already battling a raft of other health problems such as HIV/AIDS, tuberculosis, and malaria get a handle on curbing their tobacco epidemic."

On the eve of World No Tobacco Day on Saturday, the Bank has partnered with Research for International Tobacco Control (RITC), an international secretariat based in Canada, to publish a new book, Tobacco Control Policy: Strategies, Successes andSetbacks, which portrays how difficult it can be for anti-smoking groups to counter the political and economic power of the tobacco industry to promote cigarette sales wherever they choose, whether in developing, transition, or industrialized countries. Difficult, but not impossible.

The new book, edited by Joy de Beyer and Linda Waverley Brigden, RITC’s Executive Director, documents the experiences of six countries – Bangladesh, Brazil, Canada, Poland, South Africa, and Thailand in their efforts to establish effective anti-smoking policies. These countries, selected to provide global geographical representation, are in different stages of the tobacco epidemic and the strength and history of their tobacco control policies vary considerably. Each has achieved notable success in tobacco control policy-making, basing advocacy and policies on sound research and evidence.

There are proven highly cost-effective policies and interventions to reduce tobacco use, that some countries are implementing with clear positive effects. But mitigating the devastating health damage caused by tobacco use is made especially difficult by nicotine’s powerfully addictive properties, low prices of tobacco products, and the constant, often subtle reinforcement of social norms and encouragement to smoke through billions of dollars of advertising each year.

Tobacco Control Policy relates the strategies, success stories and setbacks in developing tobacco control policies in order to assist people grappling with similar issues in other countries. The book provides a compelling account of the varied and important roles played by activists, health practitioners, policymakers, researchers, NGOs, politicians, and media, in very different economic, social, and political situations.

De Beyer says the new book makes for inspiring reading. For example, in Poland, she says, the country’s traditional smoking culture has been turned on its head over the last 10 years, as policymakers and the medical community have helped engineer a social revolution that reduced the numbers of Polish men smoking tobacco, and has already sharply reduced lung cancer rates among young men. In Bangladesh, anti-smoking campaigners found that appealing to people to stop smoking for the sake of their health was ineffective. However, when campaigners showed how money spent on cigarettes meant there was less food for poor families to eat, while half of all young Bangladeshi children are malnourished, the impact was dramatic.

"Looking at the unanimous endorsement of the Framework Convention, and how committed policy-makers working with other advocates have been able to prevail over the deep pockets of Big Tobacco in many countries, this is an important time—perhaps a watershed—in the history of tobacco control policy," says de Beyer. "Everyone would say they oppose preventable death, but at what cost? A key virtue of the Convention is that it provides an important process for each of the 165 participating countries to weigh competing national interests carefully and decide how strongly committed they are to reducing tobacco use."

Given that the tobacco epidemic is one of the leading causes of preventable death and disability in the world today, de Beyer says the challenge now for WHO’s member countries is to ratify the Framework Convention, and strengthen their national anti-smoking laws and policies, and also step up their international cooperation to deal with some of the cross-border issues – especially advertising and trade and smuggling.

For more information on tobacco and tobacco control, go to: www.worldbank.org/tobacco.

For more information on tobacco-related literature and upcoming events on tobacco, please visit: http://www1.worldbank.org/hnp/hsd/ViewPoint_Tobacco.asp

To see Canada’s pictorial health warnings for cigarette packets, click here.

The Look That Kills: Indian Man Smoking in Mumbai ( WHO/P.Virot)

New treaty significant accomplishment for outgoing WHO director general, Gro Harlem Brundtland

Tobacco Economist, Joy de Beyer of the HD Network's Health Nutrition and Population group

Manufacturers of cigarettes for sale in Canada are required to print health warnings like this on each pack of cigarettes.

Canadian health warnings on nicotine's addictive properties