Neglected Global Epidemics: three growing threats compares poorly with the growing dominance of commercial and consumer groups who have placed treatment at the centre of health policy debates and funding priorities. Broader alliances of major health professional bodies, consumer groups and others are needed to promote the prevention of major risk factors for CVD and to track progress to agreed na- tional and global goals- perhaps modelled on the Millennium Development Goals(see Box 6.1). Since the determinants of CVD are multisectoral, advocacy and action, too, must extend well beyond the health sector. The involvement of nongovernmental organizations in articu lating the demand for speedy implementation of policies and programmes relevant to CVD control is critical for catalysing policy change and for mobilizing communities to ensure that he benefits flow to the entire population. While the pace of globalization of the major risks for CVDs is increasing, progress towards CVD prevention and control is slow. Sustained progress will occur only when governments, international agencies, nongovernmental organizations and civil society acknowledge that the scope of public health activities must be rapidly broadened to include CVDs and their tors The challenge is to work towards the integration of prevention and control of both commu- nicable diseases and CVDs, while acknowledging the different time scales of these epidemics and the competition for limited resources. a place must be found for the prevention and control of CVD on the agenda of health systems led by primary care At Alma-Ata 25 years ago it was deemed unnecessary. Today, it is indispensable Tobacco control: strengthening national efforts The consumption of cigarettes and other tobacco products and exposure to tobacco smoke are the worlds leading preventable cause of death, responsible for about 5 million deaths a year, mostly in poor countries and poor populations. Latest estimates reveal that, of the nearly 4 million men and l million women who died. over 2 million men and 380 000 w in developing countries (12). The toll will double in 20 years unless available and effective interventions are urgently and widely adopted. Globalization of the tobacco epidemic can undermine even the best national control pro gramme. The epidemic is being spread and reinforced worldwide by a complex mix of factors with cross-border effects, including trade liberalization, foreign direct investment, and other factors such as global marketing, transnational tobacco advertising, promotion and sponsor ship, and the international movement of contraband and counterfeit cigarettes. Recognition of this situation led to the adoption by 192 Member States at the World Health Assembly in May 2003 of the WHO Framework Convention on Tobacco Control(WHO FCTC). This, the first treaty negotiated under the auspices of WHO, constitutes a major turning point in tack- ling a major global killer: it signals a new era in global and national tobacco control activities. The FCTC is an evidence-based treaty that reaffirms the right of all people to the highest standard of health. It represents a paradigm shift in developing a regulatory strategy for ad- dictive substances: in contrast to previous drug control treaties, the FCTC asserts the impor tance of demand reduction strategies as well as supply issues. Major challenges lie ahead as WHO works with Member States to implement the agreement in countries. The process of the FCTC's creation also reveals the price paid for delay between vision and action. It has taken almost 10 years to bring the idea of such an instrument to fruition. During that time, more than 30 million people have died of tobacco-related ill- nesses, 70% of them in low-income and middle-income countries and half before the age of 70Neglected Global Epidemics: three growing threats 91 compares poorly with the growing dominance of commercial and consumer groups who have placed treatment at the centre of health policy debates and funding priorities. Broader alliances of major health professional bodies, consumer groups and others are needed to promote the prevention of major risk factors for CVD and to track progress to agreed na￾tional and global goals – perhaps modelled on the Millennium Development Goals (see Box 6.1). Since the determinants of CVD are multisectoral, advocacy and action, too, must extend well beyond the health sector. The involvement of nongovernmental organizations in articu￾lating the demand for speedy implementation of policies and programmes relevant to CVD control is critical for catalysing policy change and for mobilizing communities to ensure that the benefits flow to the entire population. While the pace of globalization of the major risks for CVDs is increasing, progress towards CVD prevention and control is slow. Sustained progress will occur only when governments, international agencies, nongovernmental organizations and civil society acknowledge that the scope of public health activities must be rapidly broadened to include CVDs and their risk factors. The challenge is to work towards the integration of prevention and control of both commu￾nicable diseases and CVDs, while acknowledging the different time scales of these epidemics and the competition for limited resources. A place must be found for the prevention and control of CVD on the agenda of health systems led by primary care. At Alma-Ata 25 years ago it was deemed unnecessary. Today, it is indispensable. Tobacco control: strengthening national efforts The consumption of cigarettes and other tobacco products and exposure to tobacco smoke are the world’s leading preventable cause of death, responsible for about 5 million deaths a year, mostly in poor countries and poor populations. Latest estimates reveal that, of the nearly 4 million men and 1 million women who died, over 2 million men and 380 000 women were in developing countries (12). The toll will double in 20 years unless available and effective interventions are urgently and widely adopted. Globalization of the tobacco epidemic can undermine even the best national control pro￾gramme. The epidemic is being spread and reinforced worldwide by a complex mix of factors with cross-border effects, including trade liberalization, foreign direct investment, and other factors such as global marketing, transnational tobacco advertising, promotion and sponsor￾ship, and the international movement of contraband and counterfeit cigarettes. Recognition of this situation led to the adoption by 192 Member States at the World Health Assembly in May 2003 of the WHO Framework Convention on Tobacco Control (WHO FCTC). This, the first treaty negotiated under the auspices of WHO, constitutes a major turning point in tack￾ling a major global killer: it signals a new era in global and national tobacco control activities. The FCTC is an evidence-based treaty that reaffirms the right of all people to the highest standard of health. It represents a paradigm shift in developing a regulatory strategy for ad￾dictive substances: in contrast to previous drug control treaties, the FCTC asserts the impor￾tance of demand reduction strategies as well as supply issues. Major challenges lie ahead as WHO works with Member States to implement the agreement in countries. The process of the FCTC’s creation also reveals the price paid for delay between vision and action. It has taken almost 10 years to bring the idea of such an instrument to fruition. During that time, more than 30 million people have died of tobacco-related ill￾nesses, 70% of them in low-income and middle-income countries and half before the age of 70