This study demonstrates the relevance of tobacco control in achieving the Millennium Development Goals (MDGs). It outlines the occurrence of high and increasing prevalence of tobacco use in the developing world, and documents the negative health and economic effects associated with tobacco cultivation and use. It introduces affordable and effective strategies that developing countries can employ to reduce tobacco use and promote sustainable development. Drawing on data from the poorest nations, and from the poor within nations, it illustrates how tobacco control measures will significantly enhance the effectiveness of investments in health, poverty reduction and development. The MDGs derive from the United Nations Millennium Declaration 2000. They call on Member States to work together to eliminate extreme poverty and hunger, to improve health, and to promote human development and sustainable economic progress in the world’s poorest nations. The World Health Organization (WHO) Commission on Macroeconomics and Health (CMH) in 2001 highlighted the link between poor health and lack of economic progress. It identified tobacco as a major avoidable cause of illness and premature death in low income countries, and urged that tobacco control be enacted to improve the prospects of the world’s poorest billion people. Specifically, it supported the adoption of WHO’s first international treaty, the WHO Framework Convention on Tobacco Control (WHO FCTC), which includes comprehensive measures to reduce demand, minimize harm, and control cross-border tobacco promotion and illicit trade. Tobacco control as envisioned in the WHO FCTC has often been omitted from economic development agendas. Tobacco use has been simplistically portrayed as a personal choice rather than an addiction. Inaction has been excused because data on tobacco use are lacking in many very poor countries, lower tobacco use rates and fewer long-term health effects are evident in some of the poorest nations, and tobacco cultivation is assumed to be economically positive. Tobacco control, in contrast, is presented as a luxury that is too costly, given other urgent needs. Each of these arguments is seriously flawed. However, while the MDGs explicitly link health and economic progress, they do not currently address all relevant health issues, including tobacco use. In this summary, “tobacco use†is used where possible, although sometimes “smoking†and “tobacco use†are used interchangeably. Forms of tobacco use other than smoking (such as chewing) are very common in a number of countries.
