"We all know that tobacco kills," Brundtland told an anti-tobacco rally in Geneva, Switzerland. "This year, we want to tell everyone that tobacco kills non-smokers as well. We have a right to breathe clean air. We have a right to good health and to protect our friends and family. We need to clear the air of second-hand smoke, and — we are calling for a ban on smoking in public places."

WHO employs World No Tobacco Day to focus public attention on the health and economic dangers of tobacco use. The agency estimates that tobacco will cause 8.4 million deaths worldwide in 2020 and 10 million annual deaths in 2030, up from just over 4 million deaths this year. If the estimates are correct, the United Nations agency warns, tobacco will become the world’s largest single health problem.

Brundtland issued a warning published in the June 9 issue of the British Medical Journal that "Women everywhere are exposed to second-hand smoke and suffer serious health consequences because of it. In the Asian region, where on average more than 60% of men are smokers, this means millions of women and children suffer from second-hand smoke. We must do everything we can to protect women and children’s rights to a safe and healthy environment." The BMJ article states that in many countries, tobacco companies are aggressively targeting women in their advertising campaigns, sponsoring beauty pageants, sports and arts events, and even women’s organizations to influence young women to use tobacco.

However, in Canada, blatant tobacco warnings are placed prominently on cigarette packages, such as the one pictured above: "Children See, Children Do. Your children are twice as likely to smoke if you do. Half of all premature deaths among life-long smokers result from tobacco use."

"The main goal of World No Tobacco Day is to promote tobacco control," emphasizes Vera Luiza Da Costa e Silva, MD, PhD, product manager for WHO’s Tobacco Free Initiative, "and to be a tool for advocacy, to raise awareness for tobacco control — especially in developing countries."

Tobacco control is a well-established concept in the developed world, she said, but much of the developing world is either unaware of the dangers of tobacco or unable to fight the economic and political clout of international tobacco companies.

In China, where two-thirds of adult males smoke, WHO estimates that 100 million of the 300 million men who are now younger than 29 will be killed by tobacco. Most will die in middle age, depriving China of valuable human resources.

However, Sweden was a leader in tobacco consumption in the 1960s but now has the lowest smoking rates in the developed world, less than 20%.

"Success against tobacco can be replicated," says Michael Thun, MD, vice president of epidemiology and surveillance research for the American Cancer Society (ACS). "It’s not a magic trick, it just takes political will."

WHO is trying to bolster political will by pushing the Framework Convention on Tobacco Control, the first international treaty on health. Backed by a unanimous resolution of the 199-nation World Health Assembly, the FCTC would create the first uniform international controls on the production, manufacture, advertising, taxation, and smuggling of tobacco products. WHO wants to see the treaty adopted by May, 2003.

"The United States is seen as a leader in educational campaigns against tobacco," said Terry Pechacek, PhD, associate director for science in the Center for Disease Control and Prevention’s Office on Smoking and Health. "But we have a long way to go in terms of universal access to proven treatments for nicotine addiction. And we need to be spending at much higher levels to counter industry programs that encourage smoking."

The Scandinavian countries, Great Britain, Canada, and other countries have tougher restrictions on tobacco advertising and promotion than the US, Pechacek adds, and better access to stop-smoking programs. However, according to an article in the New York Times, David Byrne, the European Union health commissioner, says Europe lags behind, with smokers accounting for 30% of all adults, compared to 20% in the US.

"We need universal access to smoking cessation programs just like we have universal access to childhood immunizations," Pechacek says." It’s the integration of proven strategies into standard medical practice that makes the difference in smoking rates between countries."