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The editors have organized the subject matter in a logical sequence, making it readily accessible to readers, and relationships are measured in a way that policymakers will surely find useful. Although the emphasis throughout the book is on developing countries, comparisons to smoking patterns and policies in "higher-income" countries are made with regard to virtually every topic. Given the large populations at risk in many of the developing countries and the fact that 8 out of 10 smokers live in these regions, these comparisons certainly give one pause and provide a sense of perspective on the global tobacco epidemic and its projected health consequences.
Many of the topics are introduced with a "devil's advocate" inquiry that brings a certain poignancy and realism to the issues in question, especially as they apply to countries that have limited resources and are less accustomed to government intervention in the choices of consumers. Why should a government interfere with the purchase of cigarettes by an informed consumer? There are sufficient epidemiologic data that demonstrate that the overwhelming majority of adults who smoke began smoking during late childhood and early adolescence. Although it is generally acknowledged that adults should be allowed to make their own informed choices, all societies recognize that there are certain decisions that should not be left up to children -- particularly decisions that are relevant to their long-term health. (Chapter 7 points out that the most effective policy for reducing smoking by young people is increasing the tax on tobacco products.) The economic assumptions behind a free-market economy, which Adam Smith vigorously advanced in his 18th-century book The Wealth of Nations as the "invisible hand" that guides individuals to follow their own self-interest, clearly do not apply to this issue.
A theme that resonates throughout the book is the importance to developing countries of the curtailment of addiction to tobacco -- a prerequisite for tobacco control, as higher-income countries have already discovered. To increase the likelihood that programs will reduce the demand for tobacco products, these programs must be allowed to exert their natural effect over time. As we have seen in the United States, intervention in the epidemic of smoking is a difficult and complex task for any government, but such programs have real economic and public health benefits, as well as incalculable benefits for the quality of individual human lives.
Luis G. Escobedo, M.D., M.P.H.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
--This text refers to the
Hardcover
edition.
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