Every day around the world, tragedies occur that are entirely avoidable: siblings burying siblings, spouses burying spouses, and children burying parents—all of them dying before their time. What is the leading cause of these preventable deaths? Is it tuberculosis? AIDS? Malaria? Each receives a great deal of media coverage along with hundreds of millions of dollars in funding—and rightly so. But there is another deadly epidemic that kills more people than all three diseases combined, and until recently, it received almost no public attention: tobacco use.
Tobacco has become the world's leading cause of death. How many deaths are we talking about? Picture a college basketball arena filled to capacity. Roughly that many people—14,000— die every single day from smoking tobacco. If we do nothing, tobacco may kill 1 billion people by the end of this century.
But only if we do nothing.
In New York, we have seen how effective anti-smoking programs can be. In 2002, I signed a law prohibiting smoking in all workplaces. There was a huge outcry, but then something happened: people loved it. Bars and restaurants saw their business increase. Waitresses kissed me and told me I had saved their lives. And pretty soon, cities and states around the country—along with England, Ireland, France, Italy and other countries with high rates of smoking—began passing similar laws. Along with the smoking ban, we raised cigarette taxes in New York, ran hard-hitting public-education campaigns and provided free nicotine patches. The result? After 10 years of seeing no decline in smoking, we've cut smoking rates by 21 percent—and we've cut teen smoking by more than 50 percent. There are 300,000 fewer smokers in New York City than there were six years ago.
While tobacco use is now declining in New York and some industrialized nations, though, it is growing in countries like Russia and Indonesia. More than 80 percent of tobacco deaths in the coming decades will be in developing countries, including China and India. But in talking to philanthropists and public-health experts, I realized that public-health dollars were tied up fighting other causes of death, and almost no funding existed for fighting tobacco.
Two years ago, I decided to change that. Building on an international tobacco-control treaty, I committed $125 million to a new global effort to reduce tobacco use (since raised to $375 million). Bill and Melinda Gates have joined this effort with their own $125 million commitment. And in partnership with the World Health Organization, we have developed a strategy called MPOWER, which includes six solutions that have been proved to save lives:
Monitor tobacco use and prevention policies. I always say, "If you can't measure a problem, you can't manage it." To determine the effectiveness of our efforts, it's essential to monitor which countries adopt which strategies—and how those policies affect smoking rates.
Protect people from second-hand smoke. Smoke-free environments are the only proven way to protect people—and as we have found in New York, they are popular, they improve health and they're good for business.
Offer to help people quit. Most smokers want to quit but find it hard to stop. Counseling and medicines—such as nicotine patches and gum—can triple the success rate.
Warn about the dangers of tobacco. Despite clear scientific evidence, relatively few tobacco users fully appreciate the extent of the health risk. Together with hard-hitting ad campaigns, large graphic warnings on cigarette packs help smokers quit.
Enforce bans on tobacco advertising, promotion and sponsorship. Such bans can help counter the billions of dollars the tobacco industry spends on marketing activities each year. Partial bans and voluntary restrictions have little or no effect.
Raise taxes on tobacco. This is the most effective single way to reduce smoking, particularly among the young. Besides creating a disincentive, these taxes generate the revenues needed to fund programs and advertising campaigns that help people quit.
Only 5 percent of the world's people are protected by any one of these strategies, and no country has fully implemented them all. But that is starting to change, thanks in part to the local groups we are supporting around the world, and to government officials who are beginning to stand up to the tobacco companies. From Mexico to Turkey to China, governments are starting to adopt MPOWER strategies.
Of course, the skeptics say that the problem of tobacco use is too culturally entrenched to solve. But part of taking on an entrenched problem—whether it's in health or education or public safety—involves challenging people's expectations of what is possible. As we know from our experience in New York City, when people accepted high crime rates, we had high crime rates. When people accepted low high-school graduation rates, we had low graduation rates. And when people accept high smoking rates, we get high smoking rates—and 5 million tobacco deaths a year. But it doesn't have to be that way! And if more people, community groups, international organizations and government officials take action to stop the world's leading cause of preventable death, it won't.
Fighting tobacco use is the single most effective way we can prevent premature deaths in the developing world. A billion lives hang in the balance.
Bloomberg is mayor of New York City.