How science improved the health of millions worldwide

The tobacco industry pulls in hundreds of billions of dollars in profits every quarter, at the cost of more than 8.3 million lives annually. The World Health Organization (WHO) estimates the economic cost of tobacco is US$1.4 trillion a year —1.8 per cent of global GDP.

In response to these sobering statistics, the WHO Framework Convention on Tobacco Control (FCTC) was created to turn the tide against the number one preventable cause of death in the world: smoking.

When the first WHO treaty was being negotiated, psychology professor Geoffrey Fong realized a research program would be needed to evaluate the impact of tobacco control policies that would be implemented globally because of the FCTC.

Assembling an interdisciplinary team

Geoffrey Fong

Geoffrey Fong
Professor, Faculty of Arts
> Founder and Chief Principal Investigator of the International Tobacco Control Project

In 2002, three years before the FCTC came into force, Fong, who is cross-appointed to the School of Public Health Sciences, gathered an interdisciplinary team of experts from Waterloo and around the world, creating the International Tobacco Control (ITC) Project.

With Mary Thompson from Statistics and Actuarial Science in the Faculty of Math, and David Hammond, then a doctoral student and now a professor in the School of Public Health Sciences, the ITC team began its global research to evaluate FCTC policies.

Their aim was to develop a deep understanding of global smoking habits and trends that would support and defend effective tobacco control policies.

Although it began in Canada, the U.S., the U.K. and Australia, the ITC Project now includes 31 countries, with a team of more than 150 researchers. It is the world’s largest tobacco research program. ITC researchers have conducted more than 180 surveys, involving more than 300,000 people and built a global data set of 150 million data points.

Recent policies include plain packaging and bans on additives and flavourings such as menthol. The research has led to positive changes, both nationally and internationally. Last year, the U.S. FDA announced it would ban menthol cigarettes, highlighting the ITC study and Fong’s estimates based on Canadian findings that the ban would lead to an increase in more than 900,000 U.S. smokers quitting.

Science is the antidote

With more than 600 published articles, the ITC Project has shown that policies, such as higher taxation, comprehensive smoke-free laws, large graphic-warning labels, bans on tobacco marketing and support for cessation programs are effective and save lives.

The ITC studies, which are widely known for their scientific rigour, have bolstered global implementation of the treaty. But the tobacco industry is projected to hit revenue targets of more than US$888 billion by 2025, so the ITC Project’s path to improving global health has met with resistance. Hammond and Fong have been expert witnesses in many trials and government inquiries, called to present ITC evidence to counteract false or misleading industry claims.

David Hammond

David Hammond
> Professor, Faculty of Health
> School of Public Health Sciences

“Good, timely and well-communicated science is the antidote to this misinformation,” Hammond says. “People said it could never happen — that we’d never get rid of logos or put graphic images on packages. But the power of evidence and perseverance has made one of the most powerful industries bend to public health measures. That’s very rewarding.”

Distinguished awards

ITC research has led Canada and other countries to strengthen their tobacco-control efforts, improving the health of millions. In 2021, the ITC Project received a prestigious Governor General’s Innovation Award, which celebrates innovations that have a positive impact on quality of life in Canada.

Mary Thompson

Mary Thompson
> Distinguished Professor Emerita, Faculty of Mathematics
> Statistics and Actuarial Science

Thompson, co-founder of Waterloo’s Survey Research Centre, remembers when Fong approached her to help create the ITC Project. After 20 years, hundreds of studies, millions of dollars in research grants and a long list of awards, Thompson reflects with gratitude on how much they’ve accomplished.

“The ITC Project has done amazing things — it’s a Canadian research project that has global influence. I’m grateful to Waterloo for its support and proud of the role our institution has played in addressing a public health crisis that requires an interdisciplinary approach to solve.”

Because of his relentless work, Geoffrey Fong was recently appointed as an officer of the Order of Canada. Officers of the Order of Canada are recognized for an outstanding level of talent and service to Canadians or humanity at large.

Looking to the future

Until recently, cigarettes were the dominant nicotine product, but in the past decade e-cigarettes have risen in popularity. There is debate among researchers, advocates and governments about the potential for e-cigarettes to help smokers quit, which may be counteracted by their negative potential for addicting young people.

“We are conducting multi-country studies of e-cigarettes and other new nicotine products,” Fong says. “We are measuring the effects of these products, and policies on them, on both youth and adults. The objective is to inform and support evidence-based policies on these new products in Canada and globally. In this sense, we are continuing down the path we began 20 years ago.”