Smoking-Related Epidemic Is Foreseen : Health: Surgeon general’s report says aggressive action is needed to prevent widespread death, disease in Latin America, the Caribbean.

U.S. and international health officials on Thursday predicted an epidemic of smoking-related death and disease in Latin American and Caribbean countries within the next two to three decades unless aggressive anti-tobacco programs are launched quickly.

“Public health threats do not respect borders,” said Surgeon General Antonia Coello Novello, speaking at a press conference. “There is a critical need for concerted action against such threats.”

The grim prognosis was among the major conclusions of the 1992 surgeon general’s report on smoking, prepared in collaboration with the Pan American Health Organization, which examines consequences of smoking in the Americas.

Although smoking has declined significantly in North America, the United States and Canada are in the throes of a major epidemic of smoking-related disease, the result of the smoking habits of 20 to 30 years ago, Novello said.

“It is our hope that hemisphere neighbors, poised to follow the same path, can avert the death and disease that inevitably result,” she said.

By the mid-1980s, an estimated 526,000 deaths each year throughout the Americas were caused by smoking, of which 100,000 were in Latin America and the Caribbean, the report said.

In the past, smoking-related deaths and cigarette use in Latin America and the Caribbean were far below those in North America, but the equation is changing, the report said. After smoking began to decline in the United States, there was “a period of rapid international expansion by the tobacco companies,” the report said.

The prevalence of smoking in some urban areas of Latin America and the Caribbean, for example, is 50% or more among young people, according to the report. In addition, “significant numbers” of women have taken up smoking in recent years, the report said. The current structure of the tobacco industry, which is dominated by transnational corporations, “presents a formidable obstacle to smoking-control efforts” in these countries, according to the report.

The report was immediately condemned by the tobacco industry.

Walker Merryman, vice president of the Tobacco Institute, said Novello had “substituted caustic rhetoric for factual analysis” and noted that virtually all the countries of the Americas have imposed advertising and other restrictions on smoking.

“Yet this report makes it appear as though residents of Latin America are helpless to chart their own destiny with respect to tobacco issues,” Merryman said. “To presume . . . that these governments are somehow backward and inept is not only offensive but contrary to their right to self-determination.”

The report acknowledged that most of the countries of the Americas have legislation that restricts cigarette advertising and promotion, requires health warnings on cigarette packages, restricts smoking in public places and attempts to control smoking by young people.

But it said these actions did not go far enough. In most countries of the Americas, smoking cessation services were available only through church and community organizations, and private and government-sponsored programs were rare, the report said.

“Tobacco and health education programs are not a major feature of control activities” in Latin America and the Caribbean, the report said.

Stronger prevention, control and cessation programs were needed and, “in most cases, existing legislation needs to be enforced,” said Dr. Carlyle Guerra de Macedo, director of the Pan American Health Organization.