"We've learned a tremendous amount from public health, from epidemiological studies, from studies of interventions about what works for tobacco control, but because we haven't been able to apply it in a universal and multinational way, tobacco morbidity and mortality continue to increase," said Allan Brandt, professor of the history of science and Amalie Moses Kass Professor of the History of Medicine at Harvard University.

The session was dubbed "Curbing the Global Tobacco Epidemic: Regional Opportunities and Challenges." Tobacco control efforts in the U.S. and Europe have shown that higher cigarette prices, public smoking bans, media campaigns, ad bans, prominent label warnings, and support for smoking cessation programs have been effective in reducing smoking rates, said Luk Joossens, advocacy officer, European Cancer Leagues and Tobacco Control Manager, Belgian Foundation Against Cancer. Ireland's ban on smoking in public places has cut consumption by five percent in just one year, he noted. But such policies vary from country to country.

In Poland, an advertising ban and prominent warning labels have caused a decline in lung cancer rates, said Witold Zatonski, director of the Division of Cancer Epidemiology and Prevention, Maria Skodowski-Curie Memorial Cancer Centre, Warsaw.

For example, among young Polish women, the lung cancer rate is down more than 50 percent since the early 1980s, he said. Yet smoking rates are rising sharply in such places as China and India as companies reportedly target those nations to compensate for the loss of sales in the West.

"Now, nearly every adult man in China is smoking," Zatonski said during the session.

U.S. tobacco companies are chomping at the bit to be allowed to sell their products in China, Brandt noted. "Even one percent of the Chinese market would replace the millions who have quit in the West," he said.

He said the best hope for preventing a global pandemic of tobacco-related cancer is the WHO-sponsored Framework Convention on Tobacco Control, which seeks to have countries that sign and ratify it agree to certain tobacco control standards. So far, 168 nations have signed, including 92 that have ratified it. The U.S. has signed, but has not ratified the document. China, the most populous country in the world, has both signed and ratified it.

Each nation is allowed to set its own tobacco control policies under the framework of the agreement. Country-to-country differences in tobacco-use patterns will likely mean different rules in each country.

In India, for example, about 40 percent of tobacco is smoked in "bidis," a cottage industry product made of coarse tobacco rolled in tree leaves, said Prakash Gupta, director of research, Healis-Sekhsaria Institute of Public Health, Navi Mumbai, and president, Action Council Against Tobacco, India.

A smokeless tobacco product called gutka is also particularly popular among children, he said. It causes an incurable and debilitating mouth disease, oral submucous fibrosis, within two years, he noted.

"Several state governments have tried to ban it, but industry always finds a way around the ban," Gupta said.

There are already 930 million smokers in developing countries, said HSPH Dean Barry Bloom, in his opening remarks.

"The WHO projects that by 2030 tobacco will cause 10 million persons to die each year, 70 percent in developing countries," he said. "Smoking has become the single greatest preventable cause of death in the world. We know that. The world knows that. The companies know that. And the numbers are going up. We as a public health community have to do as much as we can."

According to Brandt, the Framework Convention must be successful - or smoking deaths will rise from 100 million in the 20th century to one billion in the 21st century.

"My future colleagues will look back at this moment and see the Framework Convention as either relatively inefficient in addressing this gigantic pandemic or as the beginning of new and creative approaches to global governance committed to equity and justice," he said.

—ML