The reduction of global smoking prevalence has become a Public Health priority in the last decades of the 20th century. As the recent debate over the proposed Update to the EU Tobacco Products Directive has shown some opponents of stricter tobacco regulation, among which many Polish politicians can unfortunately be found, argue that this should no longer be the case. They point out that the proportion of smokers in the European population is now steadily decreasing, and claim that this decrease is sustainable as the harmful effects of smoking have now become widely understood and accepted by the consumers. In their view, the vice of smoking is on the way to becoming extinct, and tobacco should therefore no longer be treated as a major challenge facing Public Health in the 21st century.
It is difficult to agree with the arguments of those who would like to consign smoking to the margins of Public Health, alongside other epidemics that are now well controlled in the developed world, such as polio or smallpox. Smoking cessation treatments are not taken up by enough smokers, and their effectiveness still remains low. While it is true that the percentage of smokers in some countries is decreasing, their absolute numbers are stable due to global demographic growth. This means that the economic and health burdens of smoking-related illnesses have remained largely unchanged in many parts of the world, including developed states such as the UK.
Smoking persists as an even more urgent Public Health challenge in the developing world, where smoking rates have been showing signs of growth among social groups among which they were traditionally very low. This is the case, for instance, of female smokers in China and India. Needless to say, the sheer size of the populations at risk in this countries means that the tobacco epidemic in some parts of the world is a time-bomb waiting to explode. This is exacerbated by the aggressive tactics of the tobacco industry and lobby, which is well aware of the still untapped deposits of potential customers. The industry is tailoring their products to appeal to groups such as women and children – as evidenced by the design and promotional strategies of slim and flavoured cigarettes.
Other reasons for which we should be wary of labeling smoking as a solved Public Health challenge include the persisting problems with implementing and monitoring the provisions outlined in the FCTC, or the rapid growth of the e-cigarette market, whose effects on the perception and consumption of traditional cigarettes are still not clear. Most importantly, however, quitting smoking remains the most effective single health behaviour change in decreasing morbidity and premature mortality from cancers, cardiovascular diseases, and a multitude of other conditions. This sets it apart from other growing areas of interest of Public Health, such as the struggle against obesity or the promotion of physical activity, which do not have such clearly proven and direct positive health effects. Tobacco control must therefore remain a key concern of Public Health professionals as they continue their efforts for a healthier world in the 21st century.