Tobacco is one of the deadliest public health menaces that the world has ever faced. If the nature and extent of the harms had been known from the start, tobacco would never have been approved as safe for human consumption. Each year, cigarettes kill 5.4 million smokers from direct use and another 600,000 nonsmokers through secondhand smoke. The problem is particularly acute in the Western Pacific Region, comprising 
one-quarter of the world’s population but more than two-fifths of the world’s smokers. In the Republic of Korea, home to nearly 10 million smokers, an estimated 57,000 people die every year due to tobacco-attributable diseases. Worldwide, tobacco in all its lethal forms stands to claim 1 billion lives in the 21st century ― unless we fight back.
The tobacco industry, employing a sustained campaign of deceit and artifice, has managed to stay in business while manufacturing a product that ultimately kills half of its users when used as designed. Through marketing, the industry continues to replenish the dying consumer base by targeting population segments with false appeals to ideals: men with masculinity and freedom, women with glamor and equality, and children with fun and excitement.
To keep the new consumers hooked, the industry has also added substances such as ammonia to enhance the addictiveness of nicotine. For decades, the industry has concealed data about the harmful effects of tobacco while reassuring consumers with unfounded health claims concerning certain technological gimmicks that may actually aggravate the danger, such as filters or “light” formulations.
One method to hold the industry accountable for such deception is litigation. A powerful tool to promote justice, litigation can reveal the truth about the hazards of smoking and redress the injuries of victims and their families through compensation. The recent lawsuit filed by the National Health Insurance Service of the Republic of Korea against the tobacco companies peddling their poisons in this country demonstrates how litigation can be employed to achieve these objectives.
However, litigation alone will not stop the tobacco epidemic. The impetus created by the lawsuit must be harnessed to strengthen the legislative framework for tobacco control. For example, whereas Korea is one of the more developed countries in the world, cigarette prices remain cheap ― price values have not changed in over 20 years despite inflation, thus making cigarettes here more affordable over time, an effect that should be counteracted by progressively heavier taxation.
Marketing regulations should be expanded to include point-of-sale advertising and displays, a problem in a country with so many convenience stores, where youth often congregate. Graphic health warnings should be required on both the front and back of cigarette packaging. While Seoul has made headlines by creating smoke-free zones along some of the busiest streets in the famous Gangnam district, a complete smoking ban must now be implemented and enforced in all indoor and outdoor public places across the country.
With very deep pockets, the tobacco companies have been highly resourceful in undermining tobacco control efforts. They continue to lobby as well as create and exploit legal loopholes in the system. Recently, they have instigated costly litigations against governments across the world. They provide funding to scientists and experts to contradict, cloud and confuse the public. They exaggerate their importance to the economy with claims about employment, tax revenues and trade obligations, all the while ignoring the developmental, environmental and health costs arising from tobacco use. They invest enormous funds in so-called “corporate social responsibility” causes, such as youth programs, disaster relief or nature conservation, to shift the focus away from their deadly products and gain the impression of respectability.
To paraphrase WHO Director-General Margaret Chan, “if we stand shoulder to shoulder, together, no tobacco industry can survive … the industry sees the writing on the wall.” The WHO congratulates the NHIS for its courage in taking the fight to the industry, our common public health enemy.
By Susan P. Mercado
Dr. Susan P. Mercado is the director of noncommunicable diseases and health through the life course at the World Health Organization Regional Office for the Western Pacific. ― Ed.
