Around 100 million lives could be saved if every country around the world reduced its adult smoking rate to below 20% or by 5% if already below 20%. The proposal is published in a Viewpoint co-authored by Mayor of New York Michael Bloomberg in this week'

Around 100 million lives could be saved if every country around the world reduced its adult smoking rate to below 20% or by 5% if already below 20%. The proposal is published in a Viewpoint co-authored by Mayor of New York Michael Bloomberg in this week's edition of The Lancet. The Viewpoint, also co-authored by Dr Thomas Frieden, New York City Department of Health and Mental Hygiene, New York, USA, states that tobacco will kill 1000 million people prematurely throughout the whole of the 21st century if current trends continue. The authors say: "Despite this enormous and growing burden of premature illness and death, and despite evidence showing the effectiveness of anti-tobacco initiatives, few countries use most of these public health interventions and none use them all." Countries that have implemented some effective anti-tobacco policies include Australia, Brazil, Canada, South Africa and Sweden-all of which have lowered their adult smoking rates to below 20%. The authors say: "If the world reduces absolute adult smoking prevalence by 2020, at least 100 million fewer tobacco related premature deaths would occur in people alive today, and another 50 million deaths would be prevented in infants born between now and 2030." The Viewpoint refers to the comprehensive tobacco control programme introduced in New York in 2002, which included raising cigarette tax by 32% to increase the price of retails cigarettes and making virtually all indoor workplaces smoke free. Within two years the proportion of adult smokers in the city dropped from 21·4% to 18·4%. It says: "Taxation is the most effective way to reduce tobacco use, and it accounted for more than half the decline attributed to New York's comprehensive programme." The effects of smuggling, anti-tobacco advertising, marketing tactics by tobacco companies, direct and indirect advertising bans and smoking cessation services are also discussed. The Viewpoint concludes: "Government economic interests in tobacco manufacturing and revenues, and tobacco industry opposition, will make implementation of these [tobacco control] strategies challenging. But if global adult smoking prevalence declines to 20% by 2020, at least 100 million fewer people currently alive will be killed prematurely by tobacco."

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