Bring tobacco and alcohol control to the fore to achieve the health MDGs.

Editor – I refer to the Round Table in the December 2004 issue of the Bulletin on achieving the Millennium Development Goals (MDGs) for health, with the main article by Jeffrey Sachs (1). The Secretariat of the Pacific Community has recently produced a 160-page document on the Pacific Islands Regional MDGs, with statistical indexes for the various goals. Few people know the extent of the work of the Secretariat in this area and I would be happy to arrange for a copy of this report to be sent to WHO. The report was circulated to governments at the 34th Meeting of the Committee of Governments and Administrations, held in Noumea on 16–19 November 2004, with input from Mr Greg Urwin, Secretary General of the Pacific Islands Forum Secretariat. Much of this work contributes significantly to our understanding of the various goals and efforts to redress poverty and ensure more equitable outcomes in a range of social, health, environmental and economic indicators. I was struck by what was missing from the Bulletin’s Round Table. Dr Sachs recently supported a report from Professor Stephen Leeder on the challenge that cardiovascular disease poses in developing countries (2), and other recent publications point to the importance of noncommunicable disease risk factors in developing country situations. This is very evident in the Pacific Islands. The Comparative Risk Assessment Collaborating Group points out in the most recent burden of disease publication that some 5 million people die annually from tobacco use, with the majority now in developing countries, and just under 2 million die from alcohol use, with a comparatively greater burden of DALYs from alcohol when compared with tobacco (3). So