“If only our country’s health minister could have heard that discussion!”—how often have frustrated tobacco control advocates said something like this after a particularly rich session at a conference where all too many of the participants were recognised experts in the field, and none at all were politicians or their advisory officials. Most important, how often have such sentiments been expressed when a conference has yet again agreed that prevention of tobacco use is essentially a political struggle; getting the health ministers and other senior lawmakers to sit down and hear why and how to enact effective tobacco control legislation has seemed fine in theory, but almost as difficult to achieve as the legislation itself.

At last there has been a major conference to try to remedy this. The first international policy conference on children and tobacco took place in the United States in Washington, DC, in March. Funded by, among others, the Robert Wood Johnson foundation (and the Campaign for Tobacco-Free Kids, which it sponsors), and the American Cancer Society, the two day conference brought together health ministers, other leading parliamentarians, senior health ministry officials, and other political leaders representing more than two dozen countries who together, as the organising panel pointed out (and largely thanks to the inclusion of China and India, it must be said), represented about three quarters of the world’s population. The sessions were held in the dignified and splendid setting of the Hall of the Americas, the headquarters of the Organisation of American States, and were opened by a dynamic trio of senators (Richard Durbin—Democrat, Illinois; Roy Wyden—Democrat, Oregon; and Susan Collins—Republican, Maine), aided by an equally dynamic and encouraging address from Dr Gro Harlem Brundtland, director general of the World Health Organisation (WHO).

To seasoned conference goers in this field, the most palpable difference from other tobacco control meetings was that, with a few carefully chosen exceptions, very few of the world’s leading tobacco control advocates were on the programme, and many were not even in the building. Many of them had been consulted, of course, and had in some cases spent hours on the telephone talking through the geopolitics of need, achievement, and expertise in tobacco control, and many were present as observers. But first and foremost this was a conference for those who have the power to try to introduce legislation and commit funds, to learn from those who have succeeded.

In the carefully constructed panel discussions and the working group sessions, actual testimonies by those who have faced up to their responsibilities were the most impressive and instructive material to which the newcomers could be exposed. For example, on the question of being sure to carry your traditional supporters with you, could any advocate have been more helpful than South Africa’s health minister, Dr Nkosazana Zuma, when she related with a quiet dignity a significant error she had made? When her battle against some of the fiercest and nastiest opposition yet seen from tobacco interests was already well under way, she realised that she had not explained the policy in detail to her country’s trade unions. Finding that some of them were actively lobbying against it, she realised the significance of overlooking this influential sector, and had to make the time to sit down with them to explain it, and ask for their support, an effort which was rewarded in due course.

Among the many discussions in the lobbies, where the advocates and other occupants of the observers’ seats made up for their enforced silence during the sessions, there was much talk, and a fair amount of evidence, of a growing political and organisational support for applying far greater American resources to international tobacco control. One area already receiving attention, with cooperation from WHO and a wide array of other institutions, is exploring the potential for litigation. The millions of tobacco industry documents released as a result of the Minnesota lawsuit already hold great potential, and the Brown and Williamson (B&W) repository in the United Kingdom is likely to add to this resource, especially as B&W’s parent company, BAT, has been more involved for longer in developing countries. One health minister from a developing country which has legislation covering most aspects of tobacco control policy, on leaving a session that included presentations from lawyers active in American litigation, was heard vowing to start a similar process back home.