All it takes is a quick glance at the cover of “The Tobacco Atlas” to see that Atlanta is central to the fight against a public health crisis that researchers say kills more than 6 million people globally each year.
Walk around downtown long enough, and you might run into two of the three authors of the landmark book, which went into print a decade ago and has been updated three times.
Michael Eriksen, dean of Georgia State University‘s Institute of Public Health and a renowned expert on tobacco control, and Hana Ross, head of the American Cancer Society‘s research arm focused on the economics of fighting it, work just a few miles apart.
That’s just one example of Atlanta’s key position in the fight against tobacco, which springs naturally from its role as a health hub, Dr. Eriksen said.
“Atlanta is a mecca for global health,” he said, rattling off names like the Centers for Disease Control and Prevention, CARE, Emory University, the Carter Center and others.
But with so many institutions competing for the same funds, mostly from the Bill & Melinda Gates Foundation and Bloomberg Philanthropies, they might be tempted not to cooperate.
Collaboration could be better but Atlanta groups have largely been able to overcome differences to work toward the common goal of extinguishing smoking around the world, Dr. Eriksen said.
“It’s not really competitive. That’s what public health people do; they work more collaboratively together,” he said.
Each country has its own challenges, but sharing of data and resources has helped the tobacco-control community identify many policies that work across borders, Dr. Eriksen said in an interview the week of World No Tobacco Day, which is observed May 31 each year.
Organizations operate in a web of information and overlapping impact. For instance, the CDC puts out data on smoking prevalence that American Cancer Society will use to inform its independent research and its prevention programs in places like Africa and Southeast Asia. The society often works with the World Health Organization or other non-government organizations for on-the-ground implementation.
That spirit of unity has helped turn the tide in recent years.
“We are definitely winning, but the progress is too slow,” Dr. Eriksen said.
Though 43 trillion cigarettes have been smoked in the past decade, the number of cigarettes manufactured across the world has started to flatten out, and smoking rates among adults in developed nations have declined significantly. Much of the fight will be in poor countries, and it’s tough to define “winning” when so many people are still dying of preventable diseases he said.
During the interview, Dr. Eriksen sat under a map of China, where 40 percent of the world’s cigarettes are made and where 100 million people could die this century from smoking-related illnesses if something doesn’t change. The map was adorned with pushpins, colorful representations of collaboration in action.
Dr. Eriksen is working alongside Jeffrey Koplan, director of the Emory Global Health Institute, in administering a $14 million, five-year grant from the Gates Foundation to reduce smoking in China. Emory’s China Tobacco Partnership brought together four Chinese universities (white pins) to craft culturally specific smoking reduction plans in a variety of cities (red and blue pins).
Dr. Ross of the American Cancer Society also works with Emory, hiring interns from its economics department, and she believes “it’s only a matter of time” before her team of economists also works with Dr. Koplan.
Atlanta has been a refreshing place to work, in part because it’s easier for organizations to garner big donations from philanthropies like the Bloomberg Initiative if they demonstrate that they can work together.
“If you work with your competitors and put the proposal together, you eliminate your competition. This is the way we tend to do it,” Dr. Ross said.
Still, there is plenty of work to go around, even though “huge progress” is being made globally, she said. Smoking increases have been stemmed in Southeast Asia for the most part. Importantly, that trend has included women, who are seen as a vast untapped market by tobacco companies. She added that there are signs that the tobacco industry is diversifying, meaning that it’s preparing for life after cigarettes.
But the interconnection between the tobacco industry and governments continues to thwart prevention efforts in many countries. China’s government gets 7-10 percent of its revenues from taxes and sales generated by the state-run tobacco monopoly, according to a Brookings Institution study. American state governments are heavily targeted by tobacco lobbies. Even as they take a stand against smoking’s health risks, governments find themselves trying to strike the right balance among a variety of factors: freedom, responsibility, public health costs and the need for tax revenues.
Dr. Ross’ International Tobacco Control Research unit at the American Cancer Society is fast becoming a go-to resource on tobacco tax policies. One of her staff members will be in Geneva next week to help craft new WHO guidelines for countries on cigarette taxes. She will soon travel to Chile and Egypt for launches of Spanish and Arabic editions of “The Tobacco Atlas”.
The team has also been working in Poland to develop a new model for estimating the presence of illicit cigarettes in each country. This is a major policy issue, since tobacco companies argue that higher taxes won’t cull smoking because people will just switch to cheaper smuggled cigarettes. Dr. Ross argues that this isn’t the case.
“There will be many more people who actually quit smoking because of a tax increase as opposed to switching to illicit cigarettes,” she told Global Atlanta.
In Turkey, another Atlanta-based organization is seeing the fruits of the government’s commitment to smoking reduction.
The CDC Foundation, which works to connect the CDC with corporate and nonprofit partners on collaborative efforts, on May 31 joined Prime Minister Recep Tayyip ErdoÄŸan for the release of the second Global Adult Tobacco Survey in Turkey.
Initial surveys have been conducted for benchmarking in more than 30 countries, but Turkey is the first one where a followup is providing a basis for comparison, said Brandon Talley, the foundation’s deputy chief operating officer for tobacco control.
The results showed that a strong commitment by the Turkish Ministry of Health made a crucial difference. In four years, the number of smokers dropped by 1.2 million, amounting to a decrease in prevalence to 27.1 percent from 32.1 percent, Mr. Talley told Global Atlanta by phone from Turkey.
He agreed that Atlanta has been a rewarding place from which to forge partnerships on programs like this.
“You have this whole kind of synergistic effect because you have a variety of different sectors that are all working together towards a kind of purpose,” he said of Atlanta. “It’s a very tight family in a lot of respects.”
Learn more about the American Cancer Society’s Africa Tobacco Control Consortium here or see CDC maps and data on global tobacco control here.
The second edition of the Tobacco Atlas can be downloaded here, or visit www.tobaccoatlas.org.
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