Message from the Director-General Malaria differs from previous efforts to fight malaria. It will work to create new tools for controlling malaria, and by strengthening health systems for sustainable health improve ment Roll Back Malaria will also act as a pathfinder, helping to set the direction and strat egy for more integrated action in other priority areas, such as tuberculosis control and safe motherhood. Greater reliance on partnerships in fighting malaria will inform WHOs ap proach to other major health challenges and to the development of effective coordinated multipartner action lomentum for action against malaria has been increasing fast. Strong political support has come from the Organization of African Unity and the G8 group of the most industrial- ized countries. Four international agencies with major concerns about malaria and its e fects on health and the economy -UNICEF, the United Nations Development Programme, he World Bank and the World Health Organization-agreed, at a meeting of agency heads in October 1998, jointly to support Roll Back Malaria with WHO leadership Let me now turn to the Tobacco Free Initiative. The tobacco epidemic claims a large and rapidly growing number of premature deaths every year. Our estimates suggest that in 1998 the world suffered about 4 million tobacco-related deaths; to put this slightly differ- ently, about one in twelve adult deaths in 1990 resulted from tobacco use and, by 2020 tobacco will cause as many as one in seven. Perhaps 70% of these will be in the developing world. Millions more suffer from disabling lung or heart disease, impotence or impaired This tobacco toll is now growing most rapidly in developing countries. Can the momen tum of the epidemic be slowed? Have government policies been able to counter the mar- keting strength of the industry and the addictive powers of nicotine? The record here is clear: effective control strategies exist and governments that have adopted them have suc- ceeded in reducing tobacco use. The challenge is to transform ongoing successes into far more comprehensive global efforts At the same time that it is saving lives, tobacco control will also save money. Resources committed to tobacco production will be freed, but as this is at best a gradual process todays producers will suffer few transition costs. Consumer"benefits"from tobacco use accrue substantially to addiction- addiction acquired for most smokers while they were children or young teenagers. A recent and comprehensive World Bank review concludes unequivocally that tobacco control results in net economic as well as health benefits What lessons have we learned concerning the design of effective anti-tobacco strate gies? This report concludes that effective action rests on four principles of control oviding public health information through media and schools, and banning tobacco ing and promotion; using taxes and regulations to reduce consumption encouraging cessation of tobacco use in part by encouraging less harmful and less ex- pensive ways of delivering controlled and diminishing quantities of nicotine building anti-tobacco coalitions and defusing opposition to control measures e These measures cost relatively little and, through tobacco taxes, can more than finance hemselves. Each contributes to the control agenda, and typically each would be included in national control strategies Yet how best to design the implementation of these measures in a national or local ntext is still a puzzle; how to counter the opposition of the multinational tobacco indus- try remains a constant challenge; and how to tap the global moral, intellectual and political commitment to tobacco control for advancing a national agenda is often an unansweredMessage from the Director-General xiii Malaria differs from previous efforts to fight malaria. It will work to create new tools for controlling malaria, and by strengthening health systems for sustainable health improve￾ment. Roll Back Malaria will also act as a pathfinder, helping to set the direction and strat￾egy for more integrated action in other priority areas, such as tuberculosis control and safe motherhood. Greater reliance on partnerships in fighting malaria will inform WHO’s ap￾proach to other major health challenges and to the development of effective coordinated multipartner action. Momentum for action against malaria has been increasing fast. Strong political support has come from the Organization of African Unity and the G8 group of the most industrial￾ized countries. Four international agencies with major concerns about malaria and its ef￾fects on health and the economy – UNICEF, the United Nations Development Programme, the World Bank and the World Health Organization – agreed, at a meeting of agency heads in October 1998, jointly to support Roll Back Malaria with WHO leadership. Let me now turn to the Tobacco Free Initiative. The tobacco epidemic claims a large and rapidly growing number of premature deaths every year. Our estimates suggest that in 1998 the world suffered about 4 million tobacco-related deaths; to put this slightly differ￾ently, about one in twelve adult deaths in 1990 resulted from tobacco use and, by 2020, tobacco will cause as many as one in seven. Perhaps 70% of these will be in the developing world. Millions more suffer from disabling lung or heart disease, impotence or impaired pregnancies. This tobacco toll is now growing most rapidly in developing countries. Can the momen￾tum of the epidemic be slowed? Have government policies been able to counter the mar￾keting strength of the industry and the addictive powers of nicotine? The record here is clear: effective control strategies exist and governments that have adopted them have suc￾ceeded in reducing tobacco use. The challenge is to transform ongoing successes into far more comprehensive global efforts. At the same time that it is saving lives, tobacco control will also save money. Resources committed to tobacco production will be freed, but as this is at best a gradual process today’s producers will suffer few transition costs. Consumer “benefits” from tobacco use accrue substantially to addiction – addiction acquired for most smokers while they were children or young teenagers. A recent and comprehensive World Bank review concludes unequivocally that tobacco control results in net economic as well as health benefits. What lessons have we learned concerning the design of effective anti-tobacco strate￾gies? This report concludes that effective action rests on four principles of control: • providing public health information through media and schools, and banning tobacco advertising and promotion; • using taxes and regulations to reduce consumption; • encouraging cessation of tobacco use in part by encouraging less harmful and less ex￾pensive ways of delivering controlled and diminishing quantities of nicotine; • building anti-tobacco coalitions and defusing opposition to control measures. These measures cost relatively little and, through tobacco taxes, can more than finance themselves. Each contributes to the control agenda, and typically each would be included in national control strategies. Yet how best to design the implementation of these measures in a national or local context is still a puzzle; how to counter the opposition of the multinational tobacco indus￾try remains a constant challenge; and how to tap the global moral, intellectual and political commitment to tobacco control for advancing a national agenda is often an unanswered