I really appreciate that the greatest number of you have stayed over, close to six o'clock. And I must guarantee that I do not look like Flavier, and I really don't know what to keep it more likely, but I do appreciate that all of you are here on such a special day for me. Today is my 25th Wedding Anniversary and I am here rather than home, so you better stay rather than me. It seems to me that today I want to do in a very short while what you are going learn tomorrow. And I don't know if I'm going to listened to while I make very good sense of tobacco. Or if I will be the typical Puerto Rican that will speak very fast and everything will be covered in five minutes. I have not decided the course of action. But I must tell you that one thing I want to do is cover with you some of the things that I thought as Surgeon General I learned. And see if by tomorrow you will be able to help the people put into context what we need to do in the next four years and a half when the year 2000 hits us. One of the things I believe has changed since the last time is many, but one that has not changed is the issue that the children are increasingly being targeted by the tobacco companies with propaganda and influence. But more importantly I have to tell you that 23 surgeon generals reports have gone into the world. And with it 60 000 instruments of proof that continuously show that if tobacco is utilized in the way that it is advertised, it will absolutely cause you death and disability. I can tell you that people continue to believe that the problems of tobacco are only lung cancer. I have to tell you that with the world-wide use of tobacco in the last twenty-five years, 70% is already increasing in developing countries and the prevalence is increasing at least 2% per year. With this I have to realize that there is much more than tobacco and problems of health. There are problems of the economic aspect as well. When you realize that in the United States alone, the utilization of tobacco costs us 50 billion dollars each year, the equivalent of $2.00 per pack or the equivalent of 7% of the total cost of health care per year.
Emerging evidence shows that many cigarettes are being sold in the developing countries, and with it many children are smoking. I can also tell you that even though we don't have many facts relating to how many children are smoking in developing countries, it has been shown with the little data we have that 10% of youth are already regular smokers and 30% have already smoked at least once by the age of sixteen. In the presence of these statistics, why is it that only twenty countries in the world have legislation prohibiting the sale of tobacco products to minors and even more important when there is a law it is not abided by or totally weak. In the presence of what WHO has said recently, that it will be close to ten million people in the next thirty to forty years that will be hit by tobacco and its consequences from three million today. I am sure that you are asking me, what are we going to do, what have we achieved and what are the challenges of the future. I can tell you that thirty years ago many things were said about tobacco when the first surgeon general report was made. We were very naive then and sometimes health presented in a way by which it does not touch me, it does not make me conducive to change. But I can tell you that thirty years ago, we did not know that 82% of kids would start smoking before the age of 18. Hardly anyone starts smoking past the age of 20. We didn't know thirty years ago that adolescents are addicted to nicotine. They want to quit but they cannot. Thirty years ago we did not know that if your son or daughter has a friend who smokes, he or she will become a smoker more frequently than not having a smoking friend. Thirty years ago we didn't know that adolescent with lower school achievement, fewer skills and low self-esteem were more likely to utilize tobacco. Thirty years ago, we didn't know that cigarette advertising appears to increase the teens risk of smoking by making believe that many more people smoke than what they see in the advertisement.
We didn't know that adolescent smokers are four times more likely to use marijuana and five times more likely to use cocaine than people who do not smoke. And we didn't know that still births and early neo-natal deaths are increased by 33% in mothers that smoke. We just didn't know. But today, thirty years after we do know that the industry spends 4.6 billion dollars per year on advertising. Something that is equivalent to 12 million dollars a day or 8 thousand dollars per minute. Now we know that cigarette advertisement uses images rather than information to portray the attractiveness of smoking. Now we know that the three main elements that the industry utilizes for advertisement, and include my children, are the fun and play characteristics, the promise of social acceptance and an appeal to the physical senses. No doubt the old Joe and the old Josephine made an impact on the children so when the industry tells me that their share continues to be stable, I tell them please do explain to me how come your share was 1% in 1988 before Old Joe and now in 1993 it is 30%. Now we know that even though the industry says I only advertise so that you keep your brand loyalty, the children continue to smoke in the largest numbers those cigarettes that are more advertised. Marlboro, Camel, and Nuport in the African American group of adolescents. And now we know that when you increase the price you have an impact in diminishing the prevalence of smoking in youths.
We know that children who become addicted to cigarettes will smoke for an average of 23 years at a cost of 30 thousand dollars over that time. But more importantly we know too that the toll of this attributable to tobacco is greater than the total deaths than AIDS, car accidents, alcohol, suicide, homicide, fire and illegal drugs. But the most important thing that we have learned in the thirty years past, is that when communities want to get involved there is success. We've seen it in tobacco price increases. We've seen it in the enforcement of minors access laws. We've seen it in the use oriented mass media campaigns in the prohibition of vending machines, in the restriction of point of sale and in non-smoking in government buildings. We have even seen it in school based tobacco. We've seen that communities can work. But I can tell you that currently, the concerns about tobacco have prompted some nations to do something extremely important. In 1975 Norway banned all tobacco advertising, sponsorship and indirect forms of tobacco advertising. Canada introduced a ban in 1989 on all tobacco advertisement, sponsorship and indirect advertising of Canadian origin. And New Zealand, introduced a ban in December of 1990, on advertisement in print media. The same is being said now in Brazil and Russia. All of us, are forever thankful for Canada for having done that long time ago when it was truly necessary. And it seems to me very sad that the substantial price increases between the two countries, made Canada to diminish this when it was doing Canada so good for health policy. All of you and all of me and all the companies, just like any parent are extremely cognizant of what children like. And for that I can tell you that whatever knowledge the companies have about your child and mine, allows them to access your home, the school and lends acceptance to the things they sell. Whenever we do not pay attention, the company uses the backs of your children and mine has walking billboards of their tobacco products. I can tell you that we are continuously threatened by an industry that is targeting our adolescents and effectively addicting them to smoking. Their realities that they use is not today in a position to make a difference or a concentrated effort to stop. When they become totally addicted with three cigarettes and absolutely addicted with hundred or five packs of cigarettes, I'm afraid sometimes that complacency in the policy makers and indifference in the average citizen has made the fight against tobacco a little bit more cumbersome.
I'm not being cynical when I say the time has come to stop talking about cigarette advertising and say that we have enough data to just move forward. I suggest that if we are going to succeed we have to do things in four areas. One is going to be tobacco taxation. Two is going to be tobacco product advertising. Three is going to be the regulation of nicotine content in tobacco like it was a drug. And number four is to support the countries and the regional coalitions that are pursuing any policy that is going to help youths stop tobacco. I have come to believe that there is no specific solution to the issues that we are about to tackle for the year 2000. But I can tell you that if we're going to be successful we must do more than anything an integrated approach. And more importantly, synergy will have to be utilized if we are going to tackle tobacco. Because synergy is extremely good for the avocation of health promotion. International organizations which have commitment to health will have to stop talking about what they need to do and start coordinating their efforts for our ideas to be cohesive and triumphant at the end of the year 2000. Even though we all talk about it, there is little being done among coordination between agencies. Not only at the local level but at the international level as well. I can tell you that the success in the future is going to depend on the coordination skill of each one of us. Because if we do not coordinate for the future, if we do not compete with the industry, I can tell you that we will have missed a chance of a lifetime. I have heard many comments about meetings like this are extremely important in the international arena. Not only do we learn but we share our successes and our failures and then take them back home.
It seems to me that the dialogue of today and the dialogue of tomorrow has absolutely in need of being used to make a common international tobacco control agenda. A tobacco control agenda that one, utilizes countries straight policies to enhance health and not to enhance company profits. Two, and international agenda that denies tobacco companies the access, the honors, the privileges and the recognition of normal businesses and instead brand them as international merchants of disease and misery. Number three, an international agenda that assists bordering states with enforcing their internal laws concerning tobacco use and one that does not provide sanctuary for smuggling, for illicit advertisement or for increased sales. But more importantly, and international agenda that requires the adoption of health promotion strategies that will embark the young people to understand the dangers of becoming addicted. I assure you that this common international tobacco control agenda will proclaim our united commitment to protect the children in the next millennium. I think the time for studies is over. It is clear that the industry willingly will not responsibly act in this manner. This international reunion and tomorrow tobacco day. It must be combined to say that there is enough talking and the time has come for action. If we stop the first cigarette, I assure you that we stop a life of addiction in your son and mine. In the future, children will judge us for our vision or will punish us for our indifference. I can tell you that the time to act is now, a generation at risk and there is very little time to rehearse. As Jim Grant would have said, the words of Dante Allegary, hottest place in hell will be saved for those that during the time of conflict decided to stay neutral. It is my hope that none of you go to hell, but if you do I hope to see you in hell's research. Thank you very much.