Bloomberg’s Commitment to Curb Tobacco Use Now Totals $1.5 Billion. Here’s the Latest Move

Around the world, cigarette sales continue to decline. Public sentiment has come a long way since the days when social norms for tobacco use included lighting up in crowded restaurants and puffing away in the back rows of planes.

A recent poll shared by the CDC shows that nearly 60% of adults support policies to prohibit the sale of all tobacco products, a number that inches up to 62% for menthol cigarettes. Yet the serious global health impacts continue. Tobacco use claims 8 million lives a year, with over 80% of tobacco users living in low- and middle-income countries.

Michael Bloomberg has long been at the tip of the spear on reducing tobacco use. As mayor, he led the implementation of a 2002 law banning smoking in New York City’s restaurants and bars that was widely adopted in other cities. In 2005, his philanthropies began a commitment to funding tobacco control that now totals more than $1.5 billion.

Roughly a billion of that accrues to the Bloomberg Initiative to Reduce Tobacco Use, a 16-year program aimed at curbing the tobacco epidemic in low- and middle-income countries. Work actively spreads cessation measures around the world, as part of Bloomberg Philanthropies (BP)’s greater global health goal to help lower the rates of preventable deaths.

Recently, BP announced an additional four-year commitment of $420 million aimed at lowering tobacco use in LMICs, and reducing e-cigarette use among U.S. teenagers.

Here are four things to know about the goals for that investment and the data behind the decisions.

Face the data, change the world

The initiative to reduce tobacco use is one plank of Bloomberg Philanthropies’ goal of ensuring better, longer lives for the greatest number of people by facing up to facts that beat a path to avoidable fatalities.

Work centers on addressing preventable death through known intervention strategies in global road safety, drowning prevention, reproductive and maternal health, healthy diets, and noncommunicable diseases (NCDs).

Its global public health program partners with leading organizations like the WHO to apply effective measures and data analysis in LMIC cities where impacts hit hardest.

Empowering behavioral change

Tobacco is the world’s leading cause of preventable death, and according to Bloomberg Philanthropies, has the capacity to kill more than 1 billion people this century.

The Bloomberg Initiative’s work is organized around the World Health Organization MPOWER measures, due to their strong evidence base of lives saved. The acronym MPOWER stands for implementing policies that monitor tobacco use, protect citizens by backing laws for smoke-free public spaces, offer tools to help users quit, warn of dangers through packaging and mass-media public awareness campaigns, enforce advertising bans, and support raising taxes to discourage use.

Policies are carried out in partnership with local and national governments in countries like China, India, Indonesia and Bangladesh.

Dr. Kelly Henning, public health lead at Bloomberg Philanthropies, said that its mission to affect the greatest number of people drove BP to work primarily in the 10 LMICs with the largest number of smokers, based on best-available data. But the tobacco industry’s relentless “pursuit of market expansion in many LMICs drove international partners to provide targeted support to almost 100 additional countries.”

Following the data points

Henning said that the data that drove this latest investment included points showing that a 23% relative reduction in global smoking prevalence between 2007 and 2019 still left 1.3 billion smokers — most of whom live in LMICs.

Still, MPOWER measures can claim significant progress. Between 2007 and 2020, smoke-free laws increased from 3% to 24%. Bans on tobacco advertising, promotion and sponsorship rose from 3% to 22%, and graphic pack warnings increased from 5% to 60%.

There are also numerous examples of progress on the policy level. For example, Turkey implemented a tax increase. Smoke-free policies were adopted in China. Mexico rolled out a comprehensive smoke-free law and ad ban. And both Massachusetts (2019) and California (2022) banned flavored e-cigarettes.

Since 2017, the number of people protected by at least one control measure has increased from 1 billion to approximately 5.3 billion. Nearly 150 countries with almost 5.5 billion people now have at least one MPOWER policy in place, an increase from just 44 countries when its work began in 2007.

If the trajectory continues, MPOWER is projected to save 35 million lives by 2030.

E-cigarettes and teens

Meanwhile, the tobacco industry continues to recruit new life-long customers.

Teen use has climbed dramatically in the U.S. over the past decade, potentially undermining decades of progress in tobacco control. More than a quarter of U.S. high school students used e-cigarettes in 2019. In 2022, 2.5 million middle school and high school students used e-cigarettes. They overwhelmingly favor flavored e-cigarettes. Nearly 85% reported using flavored products. More than half used disposables.

While some see the merits of the relatively low-risk products, Henning said that while “e-cigarettes are almost certainly safer than combustibles, that does not make them safe, especially not for teens.”

“Although e-cigarettes have fewer known cancer-causing contaminants than combustible products, they are not risk-free,” said Henning. “In particular, e-cigarettes contain very high levels of nicotine, which likely harms the developing adolescent brain, and e-cigarettes adversely affect youth lung function. Additionally, significant uncertainty remains about the safety profile of the many thousands of chemicals in e-cigarettes.”

BP believes that evidence continues to support the passage of bans on flavored e-cigarettes. Henning said flavor bans “vastly reduce the appeal of the products to teen users” while still offering adult smokers potentially safer alternatives to combustibles, or stepping-stones to cessation.

The new commitment to tobacco interventions for U.S. teens builds on Bloomberg Philanthropies’ earlier engagement on the issue. In 2019, it partnered with the U.S. Centers for Disease Control and Prevention and the CDC Foundation on the Campaign for Tobacco-Free Kids to counter ballooning e-cigarette use in the U.S.

In 2021, the initiative successfully urged 22 U.S. cities and counties to ban flavored e-cigarettes, bringing the total number of state and local bans it supported to 55.

So what does the data say about the efficacy of BP’s initiative to reduce tobacco use? Henning said the data demonstrates remarkable success, particularly on MPOWER measures. While “considerable work remains, our past 16 years of commitment have shown that progress is possible.”

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