Evaluating Tobacco Control Activities: Experiences and Guiding Principles

In global context of budget restrictions and deflationary policies, public expenditure is more carefully scrutinized than ever. Public and private funds for health promotion, health protection and disease prevention are becoming increasingly scarce and their utilization is closely watched; this is reflected in the search for added efficiency and value for money. Simultaneously, global demands for, and public expectation of, health action are placing added burden on public and private health systems and on health-oriented nongovernmental organizations. Against this somber background, tobacco control programmes have had to establish their niche within political and health systems. Probably more than for other major health problems, the lack of resources for preventing the use of tobacco is striking, especially when compared with the financial turnover of the tobacco industry and related advertising. Indeed, the gross revenue from the international tobacco operations of the largest company is equal to the gross domestic product of Bangladesh, a country of 115 million inhabitants, and represents a hundred times the total health budget of Ecuador. The lack of resources is striking also because tobacco control programmes are different from other health programmes in that they do not work to protect human beings against natural forces such as disease or catastrophe but rather against the ravages of a dangerous drug purveyed by other human beings. Tobacco control activities have to be re-evaluated regularly for effectiveness since the adaptive capacities of the tobacco industry constantly threaten their effectiveness.