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World Health Organization Takes on Tobacco

DEBBIE ELLIOTT, host:

Tobacco use is considered the leading preventable cause of death in the world. According to the World Health Organization, tobacco related illnesses kill an estimated five million people every year, and health officials predict the annual death toll will double by 2020 if current smoking trends continue. This past week the International Tobacco Control Community met in Washington for the first time since a landmark public health treaty went into effect last year. The agreement seeks to curb tobacco use worldwide through higher cigarette taxes and limits on tobacco advertising and promotion, among other things. We decided to check in with Dr. Armando Peruga of the World Health Organization about the global impact of smoking today. He said the so-called tobacco epidemic is increasing rapidly.

Dr. ARMANDO PERUGA (World Health Organization): Right now there's more than one billion people all over the world that smoke, and as you well said, there are a number of people, five million right now that die every year, and it's increasing and by the end of this century if we do nothing we will have one billion people killed by it, this epidemic caused by a legal product. Basically because the developing world is beginning to smoke, and also there is an increase in population, so we are seeing that in poor countries the number of people that smoke is increasing very, very rapidly.

ELLIOTT: Smoking rates have actually gone down in the U.S. and Europe.

Dr. PERUGA: Yeah, the prevalence, I mean the proportion of people that smoke. And if you look at the number of cigarettes smoked in the United States and Europe, you will see a stable number of cigarettes consumed. But if you look at countries that are poor, you will see numbers that are skyrocketing in terms of number of cigarettes.

ELLIOTT: What's behind that rise?

Dr. PERUGA: The tobacco industry. There is a very simple explanation. Tobacco industry is marketing with force their product to the Third World. In many countries, not only Latin America, governments are taking very proactive action in terms of passing legislation and we've seen now countries are losing fear of the tobacco industry. And we have the example of Uruguay that just turned in March completely smoke free. The first country in Latin America that turned completely smoke free.

ELLIOTT: Uruguay.

Dr. PERUGA: Uruguay, yeah. It's not a big country, two million people, but is a start, and any news that people are not allowed to smoke in any indoor places, whether restaurants, bars or government offices, whatever.

ELLIOTT: When you look at all of the health problems facing the world today, how do you rank tobacco? Where does it sit?

Dr. PERUGA: Well, tobacco is one of the main problems countries are facing. And you see that in the developed world, tobacco is the leading risk factor. In other countries it's ranked second, third and fourth, but still one of the first five risk factors along with sometimes malnutrition. It is very strange to see a country, a poor country which is sharing a so-called poor country problem such as malnutrition with a so-called rich problem, rich country problem such as tobacco. But you are seeing that right now in many countries. Kind of a double burden.

ELLIOTT: So smoking is no longer only accessible to people who have wealth?

Dr. PERUGA: That's true. You have to remember that tobacco is marketed at very, very, low prices. Not only that, it creates addiction and we see in countries like Bangladesh in which families that have smokers are spending a sizeable amount of money that would be equivalent to about 800 calories of food per day, which could save the lives of many people.

ELLIOTT: The World Conference on Tobacco or Health meets every three years. And I notice on this year's agenda there was an actual, you know, agenda item called the end game. What is the end game? What do tobacco control advocates want to see? A world with no cigarettes?

Dr. PERUGA: Well, we want to see basically a reduction of mortality or morbidity due to tobacco. We have seen that once the smokers of the world, asked if tobacco is bad, they will say, yes, it's bad. But when you ask them why, very few are able to tell you what are exactly the impact they're having on their health. About 60 percent will mention lung cancer, but after that it drops to 30 or 20 percent of smokers that can mention something, for example, a heart attack.

So we still have this myth that smokers know that tobacco is bad, and it's not true because they cannot relate to a specific problem. And health warnings are gonna accomplish that goal, relating their general idea that tobacco causes some harm to the specific harm so they can personalize that.

ELLIOTT: Dr. Armando Peruga is a tobacco control expert with the World Health Organization. Thanks for coming in.

Dr. PERUGA: Oh, thank you. Transcript provided by NPR, Copyright NPR.