I would, at the very outset, like to thank Kobe City, Hyogo Prefecture, the WHO Centre for Health and Development and the Japanese Ministry of Health for their generosity and goodwill in hosting this conference. As governments around the world begin to understand what the tobacco epidemic is all about, I feel particularly encouraged by this early Japanese response to our call for global action against a man-made public health disaster.

It is a long way from Geneva to Kobe. But the cause that brings us together from far corners of the world shrinks any physical distance that might separate us. The tobacco epidemic, ladies and gentlemen, spares no nation and no people. Wherever we come from and whatever we do, we are never truly safe from the long arms of the tobacco industry as they search the world for new markets and victims.

Four million unnecessary deaths per year, 11,000 every day. It is rare – if not impossible – to find examples in history that match tobacco’s programmed trail of death and destruction. I use the word programmed carefully. A cigarette is the only consumer product which when used as desired kills its consumer. That should give us – public health officials – something to think about: how have we allowed things to slip this far?

The good news is that it doesn’t have to continue this way. There is a political solution to tobacco – a solution routed through ministries of finance and agriculture as well as health and education. Three weeks ago, 114 countries representing 93% of the world’s population met in Geneva to begin the preparatory work on the Framework Convention on Tobacco Control. They were joined by 31 international non-governmental organizations, themselves representing hundreds of NGOs around the world, as well as 12 other United Nations agencies and the European Union. They assembled to start work on a legally binding global pact: it is the first time in its 50-year history that WHO has initiated such an undertaking. Among the major countries of this region which were present, China, Indonesia, Australia, India and Japan all joined the world in calls for strict international controls that would stem the tobacco tide.

The world has rules for trade and disarmament, for the environment and human rights. It is about time we had a global set of binding rules devoted entirely to health. It seems only right that this public health endeavour be devoted to tobacco, which, in the first half of the next century, will kill more people than malaria, maternal and major childhood conditions and tuberculosis combined.

The Framework Convention is both a process and a product. We will identify all those areas of governance that we will need to activate if the world is to find a robust solution to the danger of tobacco.

It is our responsibility as the world’s premier health agency to place at the disposal of our Member States the best of science and economics, because both of them are key variables in health. The science is unequivocal: tobacco kills. It does so everywhere it is used, regardless of the mode of use. Recent studies from China mirrored earlier study results from the United States, and work completed this year in India showed how beedis are even more deadly than cigarettes.

The economic evidence is equally solid. A recent World Bank study shows that raising taxes on tobacco brings down consumption and brings money into the state’s coffers. Both the ministers of finance and health are winners. A ten percent increase in prices could lead to an average of seven percent decrease in demand in developing countries and 4% in industrialized countries. It would discourage an onset of addiction and give quitters a greater incentive to stay tobacco-free. It would particularly benefit the poor and the young. The effect is even stronger when a proportion of the excise tax is used to fund health promotion campaigns and to reduce smuggling.

It is rare to consider tax measures as a public health tool. Yet, tobacco demands a multi-sectoral approach. Thus finance, agriculture, trade, education, sports and science all have unique and complementary roles to play in improving those areas of government which have a direct impact on people’s lives and health.

Government action is not sufficient, however. I am urging the private sector to support tobacco control the way they are starting to support other public health programmes. The criteria for inclusion is clear: all who share the mission and the goals are welcome to work with us to advance public health.

The tobacco farmers will not be denied a hearing when the Framework Convention will be negotiated. We are sensitive to their needs and concerns and we are calling for demand-led, not supply-led, interventions. Even as our interventions become increasingly applied, global demand for tobacco will not drop dramatically. We have time to relocate and diversify.

WHO is working closely with FAO and agriculturists at the World Bank to study the possible long-term impact on farmers of a global reduction in the demand for tobacco. We hope to ensure that possible negative economic and social consequences of healthy public policies are identified and minimised.

The task to loosen tobacco’s grip will not be an easy one. Our search for solutions will take us into hitherto uncharted waters and to complex issues relating to setting priorities for policy. A case in point occurs when governments partly or fully own tobacco companies. This is the case in many countries, such as China, Republic of Korea, Japan and France. Experience shows that governments become freer to act for public health when their own dependence on tobacco is reduced.

Governments gathered here and beyond will have to take some very difficult decisions in the months ahead as they search for the right balance between health, tobacco revenue and trade. Public health gains for current and future generations should be the compass to guide our decision-making.

We have learned a lot about the effectiveness of tobacco control. Taxes work. So do advertising bans. I have said to the World Health Assembly that tobacco should not be advertised, glamorized or subsidized. This needs to be repeated. As I travel across the world and see tobacco advertisements selling an addictive substance as a lifestyle, a symbol of success, freedom and – in some countries – the very spirit of democracy, I am truly troubled.

Here in Japan we see western cigarette brands marketed as a kind of "liberation" tool. We see cigarette companies calling on young Japanese women to assert themselves, shed their inhibitions and smoke. Last week a coalition of minority organizations in the United States demanded that a famous cigarette company withdraw cigarette ads that are seen to target the black, Hispanic and the Asian American communities. The ads include glossy images of minority women – including a geisha – smoking a brand destined for women.

In other parts of the world, we find the same tale of deception. For example, in a Sri Lankan disco, crowds of rock music fans line up to get their gold-coloured bags of free cigarettes. Young fashion models known as "golden girls" and dressed in saris hand out samples from a tobacco company. In Africa, many football teams have until recently carried the names of tobacco brands on their shirt-backs. The Indian cricket team still does. This is how cigarettes are marketed in many developing countries - as products for young and healthy people that enhance their modern life styles.

There are now several success stories in the world about how communities have dealt with tobacco advertising. Many have banned all forms of advertising and promotion. They have so despite strong pressure from the tobacco industry. They have found that advertising companies did not collapse and the media continued to flourish.

Another success comes from California, where effective policy interventions, led by strong counter advertising, smoke free policies and grassroots mobilization by the state have led to massive savings in direct and indirect medical costs, 700,000 fewer smokers and – believe it or not – there are smoke-free bars and pubs.

In California, messages to the public depended heavily on truth. Not just the truth about the health impact of tobacco, but most importantly the truth about the way in which the tobacco industry had for years hidden evidence about the addictiveness and harm caused by its products. When the truth about tobacco spoke to people from billboards, television screens and radios, people of all ages responded by quitting. Evidence has also shown that starting rates have been reduced.

In our struggle, ladies and gentlemen, we have scientific truth and economic analysis on our side.

In our efforts to limit the global tobacco epidemic, Asia and especially Asian women, will play a central part. Here, smoking rates are still low but they will not remain that way if the tobacco industry gets its will. In fact, there are worrying indications of increased smoking rates among the young.

This is where the tobacco industry is focusing the might of its advertising and promotion campaigns. And this is from where women will provide a fitting answer to an industry that sells a product that addicts before it kills. Smoking among men in industrialized countries has for several years stagnated or declined. The future growth markets for tobacco lie with women in industrialized countries and with young people in developing countries with rapid economic development. We can preclude this. Asian women can lead the global battle against tobacco.

In the United States, the new battleground is in bars and pubs, places where young adults gather. As tobacco marketing to extreme youth becomes the subject of international scrutiny and censure, the tobacco industry has instead begun to target 18-24 year olds, whose smoking rates are now on the increase. Some say, "So what?" They say advertising just informs about the choices that are available and that this is a question about freedom of choice.

Adults can choose for themselves, if they have full access to information. But 80 percent of smokers in many countries start before the age of 18. Kids often start at the age of 14, 15, 16. What do children know about informed choice at that age? We know that they severely underestimate the long-term health effects and underestimate their ability to overcome the addictive properties of nicotine.

New data compiled by the Japanese Ministry of Health and Welfare, which will be presented for the first time at this conference, shows a drastic increase in the number of Japanese women who have taken up smoking over the past decade. The rise is alarmingly high, especially among young women. Japan is not alone. In Denmark, Poland, Brazil and USA, the rates of smoking among young women are increasing. The same is true in many Asian and Pacific countries. Many, particularly those in poor and rural areas, will not have access to cessation programmes.

As women smoke like men, they will soon die like men. We know this to be the case in many countries where lung cancer now kills more women than breast cancer.

But, there is more bad news. It comes from pioneering work done by the late Tokai Hirayama, who studied the effects of second-hand smoke on Japanese women in their homes. Women who are non-smokers, and whose partners smoke, have a 20 to 50 percent greater risk of developing lung cancer than those whose partners do not smoke. That is a worrisome finding in the Asian and Pacific region, where nearly half the men smoke in most countries.

We know that smokers not only put themselves in danger – they endanger the lives of those around them and those yet unborn. If the non-smoker is a child, that is especially true. Exposure to smoke in a mother’s womb or growing up around smoke handicaps a child’s growth. The latest research on the effects of second-hand smoke on children provides disturbing findings:

• Children of smoking mothers have a much higher risk of getting lower respiratory illnesses, such as bronchitis, croup and pneumonia;
• They are more vulnerable to ear infections;
• The symptoms of asthma and respiratory irritations, such as wheezing and coughs, increase;
• The risk of low birth weight and intra-uterine retardation increases for babies of mothers who smoke. Birth-weights are affected even when mothers are only exposed to passive smoking;
• Infants of mothers who smoke run almost five times the risk of sudden infant death syndrome compared with infants of mothers who don't smoke.
• Parental smoking is associated with learning difficulties, behavioural problems and language impairment.

Smoking during pregnancy should also be a father’s issue. Unless men stop smoking in the home, pregnant women and children will continue to be at risk.

Alarming as the statistics are, they do not convey the human suffering and pain. Every child is precious. Every life matters.

Beside the individual suffering, children's involuntary exposure to tobacco smoke has serious economic consequences. By balancing the figures from several studies, we find that the cost of treating afflictions related to children's exposure to tobacco runs at around $1 billion each year in the United States alone.

We can and should protect children and all non-smokers from exposure to tobacco. New evidence makes it clear that tobacco free policies in the workplace, at home and in public places do protect non-smokers and increase the quitting rate of smokers. It is these successes that have led the tobacco industry to so vigorously oppose tobacco-free policies being more widely applied in Europe and Asia, especially in Japan. I have asked my staff to consider giving higher priority to such measures: this is a decision strongly supported by G8 ministers of health and environment.

The impact of tobacco use hits poor women particularly hard. Structural adjustment and the global financial crisis have severely increased health costs for women and children. Poor women in developing and industrialized countries alike have less access to health information and health services.

Working women the world over who have little education, who are unemployed, separated or divorced are at the highest risk to the lure of tobacco images. Many of these women have organized community groups to claim their rights to health information and services. Let us support their efforts by making sure that these women, too, learn the truth about tobacco and its negative impact on their health.

Beyond the science and the economics and the political solutions, there is a crucial lesson for us all: the tobacco industry never gives up.

As successful control is achieved in one country or with one policy, new countries and new approaches are constantly being developed. So we have seen new forms of marketing emerge that extend the visibility of brands. As the Marlboro man has been removed from billboards in the United States, he now rides high across Asia and the Middle East. Clothing, boots and adventure trips carry the Marlboro logo where previously the cowboy stood.

Court cases against tobacco companies in the United States and elsewhere have brought to light over 35 million pages of documents that tell a story of deception. The global scale and precision of the tobacco industry’s plans to subvert political processes, and to obstruct the United Nations – including WHO – is truly astounding.

I have called for an enquiry to determine the nature and extent of tobacco industry attempts to influence our policies and divert budgets. As the world’s top health agency, it is our responsibility to bring this to light. Many of our Member-States are either doing or planning to do the same. To achieve our public health goals, we have to be increasingly innovative, bold and original in our thinking and actions. We have to ensure that public health issues remain in the public’s eye.

We have asked you to come to Kobe so that we can take stock of the latest evidence about the science and economics of tobacco, rethink national policies and identify international strategies. This is a meeting of concerned leaders who support a powerful and important concept - that women and children’s right to health is a basic human right. You are scientists, policy-makers, politicians, journalists, health professionals and NGO leaders. I am pleased to see that over half of you are also women!

We have to work together to ensure the success of the Framework Convention which will be a powerful public health tool. It could encourage State Parties to take appropriate measures to protect children and adolescents from exposure to tobacco by including obligations related to advertising, sponsorships and labelling. Under the Convention, governments could be bound to promote smoke-free environments, build healthy tobacco-free economies and strengthen women’s leadership in tobacco control. It will be especially helpful in protecting vulnerable communities, including indigenous peoples and the poor.

The timing is crucial. Governments all over the world are waking up and their efforts are gaining ground. They have seen that results come only when governments take a combined approach, combining education and legislation.

The European Union has agreed to ban all tobacco advertising within the next few years. South Africa has raised taxes dramatically over the past four years and has initiated strong community programmes to reach young people. China has built a network of smoke-free schools and passed restrictive legislation on tobacco advertising. The United States is taking a bold stance against the tobacco industry in the courts. The United Kingdom has produced an impressive policy document known as the White Paper that gives strong support for a convention to regulate the tobacco industry.

WHO stands firmly behind these efforts. The day I took office, I launched the Tobacco Free Initiative, a special cabinet project to provide global support, build new partnerships, mobilize resources, and accelerate our efforts to bring this epidemic under control. The responses have been very encouraging from the UN system, governments, the private sector and NGOs alike.

It is time to strengthen such initiatives by expanding our outreach to NGOs and women’s organizations. Women leaders can help set our priorities straight and are natural allies in health development. Prevention is a health practice that women know well. Women are the first line of family health workers; they tend to the healthcare of children and the elderly. Women are natural tobacco-control advocates.

When I attended the latest meeting of the Commission on the Status of Women in New York, I learned that women’s groups and governments supported an important recommendation concerning women and tobacco. I would like to congratulate the members of the Committee to Eliminate All Forms of Discrimination Against Women, who have begun to ask governments to report on women and tobacco under Article 12 of the Women’s Convention. This is the kind of co-operation we need within the UN system.

Before I conclude, let me just say this: if we do not act decisively today, a hundred years from now our grandchildren and their children will look back and seriously question how people claiming to be committed to public health and social justice allowed the tobacco epidemic to unfold unchecked. Let this meeting in Japan be the beginning of a series of global responses to big tobacco that we will craft in the months and years to come.