Global tobacco consumption is slowing. This is largely due to many countries implementing successful tobacco control programs. Slowly, the tobacco control community is “normalizing” its interventions. For example, a decade ago, just 10 countries had comprehensive smoke-free policies whereas today it is 55, with 23 more almost there. For those fortunate enough to live in smoke-free environments, it is thanks to these efforts that encountering smoking in a restaurant today feels so jarring. Once a society has adjusted to a smoke-free norm, it becomes difficult to understand why smoking was ever tolerated. But more work remains to be done.
Many tobacco control proponents aspire to a so-called “end game” for tobacco, and such visions vary considerably, from complete eradication of tobacco use to declines in prevalence to 5% or less. While it is important to aspire, we emphasize that vigorous implementation and enforcement of the proven strategies would undoubtedly drive tobacco prevalence down significantly and just as importantly keep low prevalence low. The largest obstacle in many countries remains a lack of will. Some government officials are still unwilling to follow through on commitments to the WHO FCTC, and more broadly, to commit sufficient resources to promoting societal well-being through comprehensive tobacco control.
Though there were small victories at the Seventh Conference of Parties of the WHO FCTC in late 2016, there were also disturbing signs of governments indifferent to tobacco control. Even worse, some official delegates promoted messages remarkably similar to those of the tobacco industry. These dynamics reinforce that the industry remains a powerful and ubiquitous force globally and must not be underestimated. However, an emerging global orientation toward preventing non-communicable diseases, and tobacco control’s increasing place on the development agenda, are helping to challenge the industry’s power.