LETTERS

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

Harley Stanton

Secretariat of the Pacific Community, BP D5 98848, Noumea, New Caledonia (email: HarleyS@spc.int)

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 while Sachs points to the "respiratory infections because they breathe wood smoke" his silence on the issues of tobacco and alcohol in the MDG documents is "deafening".

In June 2004, the Economic and Social Council of the United Nations received a report from the Ad Hoc Inter-Agency Task Force on Tobacco Control indicating that unless countries tackled the issue of tobacco control several of the key MDGs were unlikely to be achieved (4). My own sense of this in the Pacific is that we can expect continued poor health outcomes and poverty in a large number of the Pacific Islands unless we give higher profile to the importance of tobacco control and its key role in development at the individual, community and national levels. Tobacco control is a marker for development (5). Inclusion of such an emphasis in some of the writings by Sachs and others on the MDGs would go a long way in support of such efforts. In the Pacific, we have millions of dollars for HIV/AIDS, malaria and TB, but only thousands for tobacco and alcohol. Such resource allocation is fairly typical.

Competing interests: none declared.

References

1. Sachs JD. Health in the developing world: achieving the Millennium Development Goals. Bull World Health Organ 2004:82:947-52.

2. Leeder S. A race against time: the challenge of cardiovascular disease in developing economies. New York: Trustees of Columbia University; 2004.

3. Rodgers A, Ezzati M, Vander Hoorn S, Lopez AD, Lin RB, Murray CJL (Comparative Risk Assessment Collaborating Group). Distribution of major health risks: Findings from the Global Burden of Disease study. PLoS Med 2004; 1(1):e27.

4. United Nations Economic and Social Council Committee. Report from the Ad Hoc Inter-Agency Task Force on Tobacco Control, June–July 2004. New York: ECOSOC; 2004.

5. Stanton H. The social and economic impacts of tobacco in Asia and the Pacific. Develop Bull 2001;54:55-8.