Less than 5% of the world's smokers live in the USA; nevertheless America plays a vital role in reducing the global tobacco epidemic. This is particularly important because the US, along with the United Kingdom, Japan and now China, is home to the global tobacco industry. Also, as markets have declined in the west, these transnational companies have looked towards developing countries for their future expansion and profits, with tactics including denial of the health evidence, pervasive promotion, and political and commercial pressures on governments in developing countries.

 

Along with other western countries, American governmental and non-governmental organisations, academic institutions and foundations, have offered assistance and expertise on a global scale, for example, the establishment of a science base, training, serving on international committees, funding world and regional conferences, and grants. The US-based international media have played an important role. The US has offered leadership in areas such as tobacco economics; some aspects of legislation like smoke-free areas in restaurants and bars; litigation; smoke-free movies; and publicising tobacco industry documents exposing information on industry tactics around the globe.

However, and importantly, the USA has not yet ratified the WHO Framework Convention on Tobacco Control (FCTC), now ratified by 149 countries.

Worldwide, systems are slowly being put into place that will eventually reduce the tobacco epidemic -- data are being collected, legislation and price policies implemented, and health education and cessation programmes introduced. Examples will be given of countries which have now implemented stronger tobacco control policies and programmes than those found in the USA.