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The Battle Against Tobacco

The use of tobacco is referred to by the World Health Organization (WHO) as an epidemic, one that kills over 8 million people annually.1 Promisingly, global tobacco use has dramatically declined over time. In America alone, nearly half of adults smoked in 1965, versus less than 15% in 2018.2 Global initiatives have sought to unite governments in pushing for smoking cessation, and countries have individually implemented various measures that have resulted in lower smoking rates. The tobacco industry, whose interests are in direct opposition to the efforts of the WHO and national governments to lower smoking rates (to prevent smoking-related deaths), continuously seeks out new ways to promote its products. The battle between health agencies and the tobacco industry is ongoing and frequently evolving.

Global initiatives to lower tobacco use began to gain traction in the 2000s. The first international treaty negotiated under the WHO was The WHO Framework Convention on Tobacco Control (WHO FCTC).3 It was adopted by the World Health Assembly in 2003 and “has since become one of the most rapidly and widely embraced treaties in United Nations history.”4 In 2013, a voluntary global target was set for a 30% relative reduction in prevalence of current tobacco use by 2025.5 According to data from 2022, the projected relative reduction is 24.9%, and increased participation during the last couple of years of the initiative could push the world much closer to the intended 30%.6 The WHO notes certain vital measures that several countries have successfully used to lower the rate of tobacco use, including smoke-free public space laws, national smoking cessation services, anti-tobacco ads using pictures to demonstrate the effects of tobacco, banning the advertisement of tobacco products, and a high tobacco tax.7 In the face of these measures, the tobacco industry has found itself in an uncomfortable position.

The Global Center for Good Governance in Tobacco Control is a global watchdog for the tobacco industry. They publish an annual Global Tobacco Industry Interference Index (Global Tobacco Index), a survey on how governments worldwide respond to the tobacco industry’s interference in their nation’s public health policies and how well they protect those policies as required under the WHO FCTC. In 2023, they reported that “the tobacco industry has intensified its interference in public health policy.”8 The Center found that the industry used tactics that had worked well for it in the past. The industry made corporate social responsibility (CSR) contributions to social needs, which improved its access to senior governmental officials and compromised the government’s role as a regulator.9 It also worked to block restrictions and obtain lower taxes for new tobacco products that it framed as less harmful and smoke-free.10 Using modern, clean-living language, cigarette brands such as Natural American Spirit (NAS) market their products using words like “organic,” “natural,” and “additive-free,”— paired with pristine photographs of nature and exploitative Native American imagery— to create the impression that their cigarettes are healthier or less harmful than other cigarettes.11 The conclusion from the Global Tobacco Index in 2023 reads as follows:

“All transnational tobacco companies registered profits for 2021 and 2022. To ensure its business was not interrupted, the TI (Tobacco Industry) continued using its CSR activities and economic investment arguments to persuade governments to believe its exaggerated claims and divert attention away from the harms inflicted on society, and the 8.7 million preventable tobacco deaths that occur each year globally. Governments can and must halt TI interference.”12

Screenshots from the NAS website on April 4, 2021.

“Despite all its smoke and mirrors, the tobacco industry cannot ‘transform’ itself out of the fundamental and irreconcilable conflict between its interests and the public health interest. Its bottom-line remains dependent on shaping our preferences and politics in support of its addiction-, disease- and death-inducing profit.”13

Dr. Douglas William Bettcher, Senior Advisor to

the Director-General, World Health Organization

There are many positive signs that tobacco use is decreasing globally. The WHO and the Global Tobacco Index both provide guidelines and recommendations for countries to utilize that have been proven to reduce the rate of tobacco use and prevent the tobacco industry from interfering with reduction efforts. Still, experts emphasize that we are far from out of the woods as far as tobacco-related deaths are concerned. Because of the long delay between the beginning of a generation’s smoking habit and the resulting increase in smoking-attributed deaths when that generation reaches middle and old age, there is an inevitable “apparently paradoxical period when cigarette consumption is falling yet smoking-attributed mortality is still rising.” Countries can expect a 30-year delay before seeing the results of their efforts, and it is vital not to become discouraged in the meantime.14 The battle against tobacco is far from over.

1. "Tobacco.” World Health Organization, July 31, 2023.

2. “Tobacco.” World Health Organization, July 31, 2023.

3. Secretariat of the WHO FCTC. “WHO Framework Convention on Tobacco Control: Overview.” FCTC, Accessed February 11, 2024.

4. Secretariat, “WHO Framework.”

5. “Global Action Plan for the Prevention and Control of Noncommunicable DIseases 2012-2020.” World Health Organization, 2013.

6. “Global Action Plan.”

7. “Tobacco.”

8. Mary Assunta. “Global Tobacco Industry Interference Index 2023.” Global Center for Good Governance in Tobacco Control (GGTC), November 2023.

9. Assunta, “Global Tobacco Industry.”

10. Assunta, “Global Tobacco Industry.”

11. Jennifer Pearson, Daniel P Giovenco, M Jane Lewis, Meghan Moran, and Ollie Ganz. “Natural American Spirit launches ‘Sky’, the brand’s first commercial organic cigarette with a charcoal filter.”Tobacco Control 32, no. 3 (April 2023): 397-399. doi: 10.1136/tobaccocontrol-2021-056731

12. Assunta, “Global Tobacco Industry.”

13. Assunta, “Global Tobacco Industry.”

14. “Global Action Plan.”


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