Moving beyond global tobacco control to global disease control.

INTRODUCTION More than 60 years have now passed since epidemiological studies first linked tobacco smoking to lung cancer; the 50-year anniversaries of the 1962 Royal College of Physicians of London and 1964 US Surgeon General’s reports, which indicted smoking as causing lung cancer, are approaching. 2 While millions of people have since died prematurely from smoking, the policy and prevention initiatives that were motivated by the scientific evidence in these and subsequent reports have finally led to a decline in smoking-caused diseases in many high-income and a few lowand middle-income countries. Will 2011 become the start of a similar pivotal era for non-communicable diseases (NCDs), as was the 1960s for tobacco control? There are parallels including the powerful descriptive evidence for multiple epidemics of NCDsddiabetes, cardiovascular diseases, chronic lung disease and cancerdand some avoidable causes are obvious to alldphysical inactivity, poor diet, the persistence of tobacco smoking and harmful alcohol consumption. These epidemics have now received political attention at the highest level possible. The UN High-Level Meeting on Prevention and Control of NCDs was held on 19e20 September 2011 in New York, the first UN General Assembly summit involving heads of state to address the threat of NCDs and only the second special summit to take on a health issue directly. The first special summit was held on HIV/AIDS in 2001. Such high-level governmental attention to NCDs worldwide is long overdue. Rates of obesity have risen precipitously in recent decades and predictably, higher rates of diabetes and cardiovascular disease will follow. There is well-grounded concern that the strategies of the multinational tobacco companies will continue to increase tobacco use in lowand middle-income countries as well. While HIV/AIDS, tuberculosis and malaria, have been central in the global health agenda, epidemics of NCDs already represent 60% of the global disease burden and 80% of these deaths occur in lowand middleincome countries. The largest percentage rise in NCDs over the next 10 years is projected for Africa, a continent still struggling to address infectious diseases. This double disease burden threatens future development in many lowand middle-income countries, particularly in those of Africa. Despite the growing global burden, there has been a sustained and regrettable lack of emphasis on NCD control by multiple sectors at national and global levels on such matters as funding by governments and by non-governmental organisations for research and prevention, development of coordinated strategies and diplomatic initiatives to address the multinational dimensions of the problem. With regard to NCDs, tobacco control stands as the only domain where significant progress has been made at the global level. Many factors have contributed to this progress: the rise of a global tobacco control network, leadership by the WHO, completion and dissemination of policyrelevant economic studies illustrating the cost effectiveness of tobacco control interventions, the successful adoption, entry into force and initial implementation of the Framework Convention on Tobacco Control (FCTC), significant funding through the Bloomberg Initiative, and a global surveillance programme led by the WHO and the US Centers for Disease Control and Prevention. Here, we look to the mounting challenge of NCD control and the roles that the tobacco control community can play in the burgeoning global NCD movement. Central to this commentary is whether ‘lessons learnt’ from tobacco control can foreshorten the NCD pandemic and whether the global tobacco control community can become a platform for broader global NCD activity. While our experience in tobacco control provides some lessons that extend to NCD control, there are distinct challenges in bringing approaches from the more focused domain of tobacco control to the diffuse and poorly bounded domain of NCD control. Nonetheless, we propose that in many places the tobacco control community needs to engage more broadly in disease prevention and bring its strategies, experience and enthusiastic advocacy to encompass a broader global NCD movement. Such engagement could become a ‘win’ for the tobacco control community and a ‘win’ for NCD control.