VOICES FOR CHANGE

After days of travel-- some originating in smoke-free airports, others not-- more than 70 of the world's leading public health officials and advocates gather this week at the Bloomberg School for the third annual Global Tobacco Control Leadership Program. Their voices are varied-- with stories from China, Mexico, India, the Philippines, elsewhere. Their question is the same: Can the world prevent 1 billion deaths from tobacco over the next century, by putting in place strategies already known by health professionals around the globe?

The lively debate will carry on for a fortnight, regarding everything from cigarette filters to tax hikes to smoking cessation. "I applaud your interest and commitment to tobacco control," says Bloomberg Dean Michael J. Klag, MD, MPH. "And I want you to know how committed we are as a school to tobacco control as well."

INDIA

Bhavna Mukhopadhyay
Director
Health Promotion & Development Communications
Voluntary Health Association of India
New Delhi, India

"In India, we have statistics that tell us we will have as many as 1 million people dying from tobacco use each year, starting in 2010. That's nearly double what we had in the last decade. That is a lot of people. And the most important thing: I see evidence that young people are getting into tobacco even younger. The tobacco industry is finding new ways to market to our children. We have people selling chewing tobacco for 1/40th of a U.S. dollar outside the schools, despite legislation. We are talking school children -- 12-years-old or 13-years-old."

"In certain areas of India, in the northeast, 8 out of 10 people are into tobacco use. Over 80% of the population is into tobacco in certain pockets. We have been pushing for picture warnings, smoke-free legislation and higher taxes. We have had mixed success. Our picture warnings aren't strong enough yet. On October 2, we will have smoke-free workplaces. But that's not enforcement. Our work has begun, but our work is not complete."


THE PHILIPPINES

Debby Sy
Legal Consultant for Health Justice Foundation

UP College of Law, Faculty Development Foundation, and FCTC Alliance - Philippines
Manila, Philippines

"In the Philippines, one of the more alarming statistics is the prevalence of tobacco use in children, aged 13 years to 15 years. The rate has increased 30 percent in two years, up from 20% of that population in 2005 to 27% of that population in 2007."

"That is despite tobacco regulation passed in 2003. Those provisions-- which are quite weak-- will be phased in. And it is only this year that we have a total advertising ban. Right now, we are working on legislation for picture warnings. We are working on smoke-free enforcement programs. So everything we learn will be helpful in moving these policies forward. In general, we are trying to build broader coalitions to help us with these efforts."


MEXICO

Alejandro Madrazo
Legal Expert
Mexican Office of the Inter-American Heart Foundation
Mexico City, Mexico

"In Mexico, it is quite complicated. In 2004, 53,000 Mexicans died of tobacco related illnesses. That estimate is now 60,000 deaths a year. The amount the government spends on tobacco related health care costs exceeds the amount spent on higher education."

"In 2006, Mexico City established a 100% ban on smoking in enclosed spaces. At the national level, the government passed comprehensive tobacco control legislation. But the federal legislation has major flaws. I am hoping to return to Mexico with a good idea about how to tighten that federal legislation, whether through litigation, lobbying. My first hope is to tighten that very loose legislation. My second hope is to move Mexico City's program to the country's 31 states. We need to push a national strategy, but in Mexico, we have to fight state by state."

CHINA

Jiang Yuan
Deputy Director
National Tobacco Control Office
Chinese Center for Disease Control and Prevention
Bejing, China

"In China, the situation is very different. In our country, the tobacco company belongs to the government. It is not like the United States, where it is easy to separate. We heard someone from Indonesia who talked about how tobacco is controlling decision-making in that country. In China, we almost have the same situation...."

"We have many leading people in the country who smoke. It is not just the young people. We have the leading people-- the teachers, the physicians. We have statistics where 50% of male doctors are smokers. It is not uncommon for a doctor to do a treatment, and he is also smoking."

"It is very difficult to change policies. It is very difficult to put in place a ban on smoking in public places. We have a comprehensive ban on advertising. But in China, that means a partial ban. The right priority now is to change the social norm. The right priority is to change the smoking behavior of the leading people-- our teachers, our doctors."