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Illustrations by Terry Miura Photos by Additional photos: Todd Shapera, Andrea Fisch, and others
In rural India, people still believe in the magic of tobacco. Villagers think tobacco can rid them of toothaches, sweeten bad breath, or soothe their bowels. In Tirana, Albania, “Marlboro girls” in short skirts stroll the streets handing out free packs of cigarettes. In Japan, the government must by law promote development of its tobacco industry. In Lima, Moscow, Kampala, and Kansas City, advertising links cigarette smoking with vitality, sexiness, slimness, and even health. Myths, misconceptions, and lies about tobacco abound in a world where 1.1 billion people smoke. Global debates over public smoking, advertising bans, and tobacco taxes are clouded by industry influence, politics, and cultural beliefs. Yet the science on the health effects of tobacco has never been more clear. Smoking kills. And in the coming decades, smoking is going to kill in numbers that beggar the imagination. By 2030, health experts estimate that deaths from tobacco will surpass any other cause—more than from AIDS, tuberculosis, car accidents, homicide, suicide, and childbirth combined . Ten million people per year are projected to die from tobacco by then, accounting for one in six deaths worldwide. And if current trends continue, 500 million human beings—half a billion people—now alive will die from tobacco.
The global tragedy spawned by tobacco is only made worse by the epidemic’s evolving nature. The wave of tobacco consumption that surged in the 20th century through the world’s prosperous nations is now breaking where it can least be afforded: in developing countries. By 2030, an estimated 70 percent of smoking-related deaths will occur in the developing world. Beyond the staggering toll on human life, the health care costs and the years of lost productivity will drain already fragile economies. In China alone, there are 300 million male smokers—a number greater than the entire U.S. population. One hundred million Chinese men alive today will die because of tobacco, according to World Bank estimates. To Jonathan Samet, MD, MS, an international authority on tobacco’s effects on health, the question is stark: What should the world’s number one school of public health do about the world’s number one preventable cause of disease? In the mid-1990s, Samet saw that the best way to quickly make a global impact in tobacco control was to work with colleagues abroad. U.S. researchers like Samet had already been tracking the tobacco epidemic for decades and could help international colleagues adapt U.S. research expertise to their own situations. “We need to make certain the knowledge we have is translated to the developing countries—how tobacco companies work, how to count the bodies so we can say what is going on,” says Samet, Epidemiology chair and the Jacob I. and Irene Fabrikant Professor in Health, Risk, and Society (see sidebar). Knowing the scale of a country’s tobacco epidemic, as well as the machinations of tobacco companies there, can give researchers the evidence needed to convince governments to adopt new policies and intervention programs. To realize this vision, the School founded the Johns Hopkins Institute for Global Tobacco Control (IGTC) in May 1998. Initial funding came from Glaxo-SmithKline (then SmithKline Beecham), a maker of smoking cessation products. “It was really this common alignment… of people who had a mission to reduce the ill effects of smoking,” says Catherine Sohn, PharmD, a vice president at GlaxoSmithKline. Just as globalization pried open national markets and flooded economies with cheap goods like TVs and computers, it’s also helped multinational tobacco companies like Philip Morris. “It’s the same players in every country,” says Samet. “They’ve bought up the old national tobacco monopolies. Part of the problem is they take a sleepy national monopoly and remake it into an aggressive multinational.” Ministries of health and nongovernmental organizations (NGOs) realized that they must share data, policy ideas, and programs to form a concerted defense against the multinationals. With its emphasis on international cooperation, IGTC was in a perfect position to help. “We have to work with people in developing countries to better understand how to translate our successes,” says Frances Stillman, EdD, the Institute’s co-director. “It’s not just providing them with the funding but working alongside them to get their programs up and running.” In its first five years, the Institute has launched studies and programs around the world, including:
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