Tobacco Control in Industrialized Nations: The Limits of Public Health Achievement

In 1999 Gro Harlem Brundtland, Director General of the World Health Organization, painted a stark picture of the global toll in morbidity and mortality that could be expected from tobacco consumption. “Tobacco-related diseases are spreading like an epidemic and are likely to be killing ten million people a year around 2020.”¹ The warning was coterminous with the drafting by the WHO of the Framework Convention on Tobacco Control, a treaty designed to interrupt and reverse the “epidemic’s” course. In the next decades attention to the impact of tobacco will shift to the less developed and rapidly modernizing nation. At this juncture it would be useful to review the almost half-century long public health campaign to confront tobacco in the industrialized nations, where extraordinary achievements in the reduction of tobacco consumption reflect the impacts of persistent public health efforts in the face of powerful commercial resistance.

The five countries we have focused on here France, Germany, Japan, the United Kingdom and the United States share a broad commitment to liberal political values yet they differ in important ways. Two are common law and two are civil law states. Japan is a “mixed” system; The US and Germany are federal systems. France, the United Kingdom and Japan are unitary. Yet despite these differences and those that characterized their first encounters with tobacco they now reflect a broad convergence on the most effective public policy responses to smoking related morbidity and mortality. The experiences and differences of these nations is important to note even though to some careful observers of the global politics of tobacco none would have been classed as pioneers in tobacco control.

This analysis is drawn from a broader examination of the global picture of tobacco control at the end of the first decade of the 21^st century.²