69 san francisco created another notable ex ample of

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69 San Francisco created another notable ex- ample of a government program aimed at reducing disparities by making health care services accessible and affordable for unin- sured residents. Although it does not provide FRAMING HEALTH MATTERS S76 | Framing Health Matters | Peer Reviewed | Koh et al. American Journal of Public Health | Supplement 1, 2010, Vol 100, No. S1
health insurance, the Healthy San Francisco initiative offers universal access to primary and preventive care to uninsured residents through a clinic network with a sliding-fee scale. 70 Tobacco Dependence With 5 million preventable deaths world- wide attributed to tobacco use each year, tobacco control deserves our highest commit- ment. The tobacco industry has profited over many decades from its comprehensive mar- keting efforts targeting youths, lower-SEP pop- ulations, minorities, and developing countries, thereby creating broad societal and global in- equities. 71 The burden of tobacco addiction and to- bacco-related deaths falls heavily on develop- ing nations especially. Worldwide, 1 billion men smoke; 50% of men living in developing countries compared with 35% of men living in developed countries are among them. 68,69 China, where nearly 70% of men smoke, consumes more than 30% of the world’s cigarettes. 72,73 To counter this global public health chal- lenge, the WHO launched the Framework Convention on Tobacco Control, the first and only international public health treaty. To date, 166 countries have both signed and ratified this treaty, committing their governments to adopting a comprehensive range of measures to combat the health and economic effects of tobacco. 74 The United States, along with only 25 other countries, has not signed and ratified the treaty. 74 If implemented aggressively, the treaty articles should address worldwide tobacco dis- parities. As the first effort of its kind, however, the treaty faces challenges in implementation in the diverse political climates throughout the world, with their competing economic incentives and priorities and their resource scarcities. It is imperative that those involved in implemen- tation of this historic international agreement take the issue of disparities into explicit con- sideration. Previous analyses of data from the Global Youth Tobacco Survey (of children aged 13–15 years in developing countries) showed that more than 75% of youths support smoke- free policies despite reports from the majority that they are exposed to smoke in public places. 75 Further attention to reducing global disparities in tobacco use and its consequences should focus on establishing smoke-free policies in public places to protect children and to establish smoke-free norms for the next genera- tion. In the United States, effective statewide prevention and cessation programs, starting with those created in California and Massa- chusetts, have used a comprehensive social determinants approach that integrates media campaigns, policies, price increases, and other tactics to aid communities, schools, families, and individuals.

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