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“Asia cannot afford to repeat the North American cycle of tragedy from tobacco company aggression. In truth, hundreds of millions of Asians alive today depend on what you do today . . . against tobacco.” These were the words of Dr Prakit Vateesatokit of Thailand, as he received one of the first Luther Terry Awards for outstanding achievements in tobacco control, at the world conference in Chicago in August.
One response to the challenge is being provided by the Rockefeller Foundation, which has pledged up to US$10 million to support proven approaches to tobacco control in Thailand, Malaysia, Cambodia, and Vietnam. The “Trading Tobacco for Health” initiative comes just over 10 years after several Asian markets, including Thailand's, were forced open to US cigarette imports.
By passing strong tobacco control policies and by active non-governmental efforts to reduce smoking, Thailand has lowered smoking prevalence over the past decade. Campaigns to raise public awareness of the damage to health from smoking, increased excise taxes on tobacco, and the establishment of a Health Promotion Foundation have set an example for the developing world. The Rockefeller programme will benefit from the regional expertise this experience has developed.
While it is reassuring that Thailand's expertise will be utilised, the juggernaut of “free trade” is descending on Asia as China enters the World Trade Organisation and a number of free trade agreements, such as the ASEAN agreement, come into play. The Rockefeller Foundation recognises the need to invent new strategies, not just globalise those tested in developed countries. Further, it says: “the challenges . . .include maintaining sustained commitments over a long time horizon, developing programming that bridges public health with other sectors, and investing in low cost interventions appropriate to the context of developing countries.”
Thailand and South East Asia are at a crossroads. Proven local programmes can be expanded and improved if funds are used in a timely manner. Tobacco control resources are very low in Asia, where countries' economies are still weak from the 1997 financial crisis. There is a need to accelerate resource mobilisation and boldness of innovation in tobacco control programmes, especially in view of the expected impact of trade agreements, tobacco industry spending and tobacco industry “consolidation”. Hence the great potential of the Rockefeller initiative. The hope is that Asian tobacco control advocates will be able to prevent the repetition of some of the western cycle of tragedy by not repeating failed tobacco control approaches, thus preventing millions of deaths from the brown plague.