Towards a tobacco-free world

Many barriers must be tackled for controlling the tobacco epidemic responsible for completely preventable mortality. Tobacco addiction is presently considered as the central element in smoking. The mechanisms of action of drugs of abuse (including nicotine) and the current techniques for their study in animals and in humans are briefly reviewed. Cigarettes are manipulated by the tobacco industry to increase the level of dependence. The transnational tobacco companies use a global tactic to expand their sales, particularly in the third world, so that the mean world cigarette consumption per adult remains unchanged at approximately 1500 per year. Nevertheless, it is hoped that control of the epidemic will be gained in the 21st century, since the awareness of tobacco risks and costs is increasing, an antismoking climate is developing and the tobacco lobby has lost its credibility. On the other hand, improved behavioural and pharmacological methods increase the cessation rate. Health professionals are progressively more involved in the smoking cessation problems, while international control measures are applied by the European Commission. The World Health Organization is preparing a "Framework Convention on Tobacco Control" with binding mechanisms for governments. A larger involvement of the community is needed to promote an international policy based on health values, rather than on trade considerations, and addressing the specific problems of the third world. Nevertheless, since a latency of approximately 30 yrs exists between the increase in tobacco consumption in a population and the rise in tobacco mortality, past trends in consumption will continue to influence health status during the next 30 yrs. Present, urgently needed, radical health measures are expected to have their major impact only after that period.