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The Challenge, and the Promise, of Global Tobacco Control

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Presentation on theme: "The Challenge, and the Promise, of Global Tobacco Control"— Presentation transcript:

1 The Challenge, and the Promise, of Global Tobacco Control
Thomas J. Glynn, PhD American Cancer Society Washington, DC Presented at the International Quitline Institute, Seattle, Washington, USA - October, 2011

2 Preaching to the Converted

3 Singing to the Choir

4 Carrying Coals to Newcastle


6 How AIDS Changed America
Africa's Malaria Death Toll Still "Outrageously High" How AIDS Changed America

7 With so many competing interests, is tobacco actually important as a global issue?

8 So, are the tobacco control advocates crazy?
Are they just convinced that “my disease is more serious than your disease?” Are they blinded by zealotry? OR… Do they have facts that other people don’t?

9 Kill one billion (1,000,000,000) people
The answer may be that they DO have the facts. Consider that, if unchecked, the tobacco pandemic could in this century: Kill one billion (1,000,000,000) people Overwhelm cancer and cardiac hospital units Ravage the social well-being and finances of millions of families And kill 1 of every 10 people now alive






15 Why is Tobacco Control Important as a Global Issue?

16 The Disease Consequences of Tobacco Use Are Universal

17 Tobacco Related Cancers
Oral cavity and pharynx Esophagus Larynx Lung, trachea and bronchus Urinary bladder Renal pelvis Uterine cervix Pancreas Kidney

18 Tobacco Related Cardiovascular Diseases
Hypertension Ischemic heart disease Atherosclerosis Pulmonary heart disease Aortic aneurysm Stroke

19 Tobacco Related Respiratory Diseases
Chronic bronchitis Emphysema Asthma Pneumonia

20 Tobacco Related Pediatric Diseases
Low birth weight Respiratory distress syndrome Sudden infant death syndrome

21 Secondhand Tobacco Smoke Problems
Heart Disease Lung cancer Asthma attacks Bronchitis and pneumonia (especially children) Coughs and croup (especially children) Middle ear infections (children)

22 Conclusion of the U.S. Surgeon General—2004
“Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers in general.”

23 Smoking and Second-Hand Smoke Damage Every Part of the Body

24 Why Hasn’t Tobacco Control Received the Global Attention it Needs?
Tobacco use is viewed as a personal choice and a personal failing Most victims of tobacco-related disease die and disappear quickly Families and victims are often ashamed to discuss their tobacco use The tobacco pandemic has developed slowly and insidiously

25 Why Hasn’t Tobacco Control Received the Global Attention it Needs
Why Hasn’t Tobacco Control Received the Global Attention it Needs? (continued) 5) Tobacco is old news 6) Few strong tobacco control advocacy groups have arisen 7) The global effects of tobacco use – health and economic – are not well known 8) The multinational tobacco companies have controlled the playing field.

26 “Tobacco use is unlike other threats to global health
“Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists.” WHO Zeltner Report, 2000

27 Factoid Time

28 Global Smoking Prevalence
There are currently 1.3 billion smokers in the world – there will be 1.7 billion in 2025 Asia has the highest smoking rates in the world with overall country rates of up to 47%. China alone has over 300 million smokers that consume more than 1.7 trillion cigarettes a year – about 67% of the male population and 4% of the female population are smokers One-third of the global population age 15 and older smokes


30 Distribution of world’s smokers
2000 2025 WHO World Health Report 1999.

31 Tobacco deaths in the Industrialized and Developing World, 2000 and 2030
While tobacco-related deaths will only increase slightly in the industrialized world during the next 30 years, they will more than triple in the developing world. Industrialized countries Developing countries

32 Global Smoking Deaths Globally, more than 600,000 million people alive today – about 10% of the world’s population – will die from smoking-related causes; half of these victims are now children Every eight seconds a person dies of a smoking-related disease Cigarettes kill half of all lifetime users, with half of these dying in middle age – between 35 and 69 years old, their most productive years

33 Global Smoking Deaths (continued)
1 in 10 adult deaths worldwide are smoking related Smoking diminishes health in more than 50 ways, at least 20 of which are fatal In 2000, 4.83 million deaths worldwide were attributable to smoking: 1.69 million from cardiovascular disease, 970,000 from COPD, and 850,000 from lung cancer. This number will rise to 10 million by 2030

34 Global Smoking Deaths (continued)
Smokers are twice as likely to die prematurely from any cause and 6.5 times more likely to die of lung cancer, compared to nonsmokers No other consumer product is as dangerous or kills as many people when used as intended. Tobacco kills more than AIDS, legal drugs, illegal drugs, road accidents, murder, and suicide combined Tobacco is expected to kill 8.4 million people annually by 2020, and 10 million people in 2030, if current consumption does not change

35 Economic Effects of Tobacco Use
By 2010, the WHO estimates the annual global cost of tobacco to be US$500 billion – a figure higher than the GDP of 174 of 192 UN members Smoking-related costs can contribute up to 15% of total health-care costs in developed countries Japanese male smokers, for example, incur 11% more medical costs than never smokers and have increased inpatient medical-care costs 33% higher in smokers than never smokers

36 Economic Effects of Tobacco Use (continued)
As much as ten percent of family income in some parts of the world is spent on tobacco, limiting needed expenditures on food, clothing, education, and shelter A 1996 study – 15 years ago – estimated that total annual medical and social costs of tobacco use in Hong Kong were one-quarter of the total healthcare budget – and prevalence has risen since then For nearly 50% of the world’s population, a pack of Marlboros costs approximately half of a family’s daily income

37 Good News The tobacco pandemic is preventable and its effects reversible: 1) The global tobacco control community has identified those areas which must be addressed in order to turn the tide of the tobacco pandemic 2) It is possible to document what the health and economic effects of turning the tide would be; and 3) We know what needs to be done

38 Framework Convention on Tobacco Control: First Treaty Negotiated under WHO
Objective: “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke”

39 FCTC: History May 1999: World Health Assembly Resolution
October 2000: First Intergovernmental Negotiating Body February 2003: Final Intergovernmental Negotiating Body May 2003: World Health Assembly Unanimous Approval

40 FCTC Milestones Entry into Force - February 27, 2005
Signature by Member States (180) Ratification by Member States (172) representing 87% of World Population Conference of the Parties (COP): 1st Session February 2006, Geneva 2nd Session June 2007, Bangkok 3rd Session November 2008, Durban 4th Session November 2010, Punta del Este



43 Why is the FCTC important?
The FCTC is the world’s first treaty to address a public health issue. The FCTC offers the best change to address tobacco control globally. The FCTC has, and will continue to, generate tobacco control advocacy in every country in the world.

44 The FCTC Mantra Sign Ratify Implement Enforce Evaluate

45 Measures Relating to the Reduction of the Supply of Tobacco
Illicit Trade in Tobacco Products (Art. 15) Sales to and by Minors (Art. 16)

46 Measures Relating to Reduction of Demand for Tobacco
Price and tax Measures (Art. 6) Protection from Exposure to Tobacco Smoke (Art.8) Regulation of Contents of Tobacco Products (Art. 9) Regulation of Tobacco Product Disclosures (Art.10) Packaging and Labeling of Tobacco Products (Art. 11) Education, Communication, Training and Public Awareness (Art. 12) Tobacco Advertising, Promotion and Sponsorship (Art. 13) Tobacco Dependence and Cessation (Art. 14)

47 Salvo que los fumadores actuales lo dejen, las muertes por tabaco aumentarán dramáticamente en los próximos 50 años Muertes por tabaco acumulativas estimadas entre con diferentes estrategias de intervención Línea de base Si la proporción de adultos jóvenes que empiezan a fumar se reduce a la mitad para el año 2020 Si la consumición por adultos se reduce a la mitad para 2020 Muertes por tabaco (en millones) Año World Bank. Curbing the epidemic: Governments and the economics of tobacco control. World Bank Publications, p80.

48 How Many Smokers Are Affected by Article 14?
There are 1.3 billion smokers worldwide More than 50% of these smokers – or more than 650 million – want to stop This is equivalent to more than 200x the entire population of Uruguay

49 Trends in cigarette consumption and lung cancer mortality, US, 1900-2005
Lung Cancer Men Lung Cancer Women

50 Demand Reduction Measures Concerning Tobacco Dependence and Cessation
FCTC – Article 14 Demand Reduction Measures Concerning Tobacco Dependence and Cessation Each Party shall develop and disseminate appropriate, comprehensive and integrated guidelines based on scientific evidence and best practices, taking into account national circumstances and priorities, and shall take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence. 50

51 FCTC – Article 14 Towards this end, each Party shall endeavor to:
Design and implement effective programs aimed at promoting the cessation of tobacco use, in such locations as educational institutions, health care facilities, workplaces, and sporting environments; Include diagnosis and treatment of tobacco dependence and counseling services on cessation of tobacco use in national health and education programs, plans and strategies, with the participation of health workers, community workers and social workers as appropriate; Establish in health care facilities and rehabilitation centers programs for diagnosing, counseling, preventing and treating tobacco dependence; and Collaborate with other Parties to facilitate accessibility and affordability for treatment of tobacco dependence including pharmaceutical products pursuant to Article 22. Such products and their constituents may include medicines, products used to administer medicines and diagnostics when appropriate. 51

Quitlines. All Parties should offer quitlines in which callers can receive advice from trained cessation specialists. Ideally they should be free and offer proactive support. Quitlines should be widely publicized and advertised, and adequately staffed, to ensure that tobacco users can always receive individual support. Parties are encouraged to include the quitline number on tobacco product packaging.

53 Article 14 History/Timetable
February 2010: 2nd meeting of A14 Working Group, in Auckland, NZ, finalizes A14 text November 2008: COP III accepts background document and calls for draft A14 guidelines November 2010: COP IV meets in Punta del Este, Uruguay, discusses and adopts A14 July 2007: COP II calls for background document on tobacco dependence treatment September 2009: 1st meeting of the A14 Working Group, in Seoul, Korea, considers A14 draft July 2007 – November 2008: FCTC Secretariat develops background document November 2008 – September 2009: FCTC Secretariat develops draft A14 guidelines September 2009 – December 2009: UK prepares updated, final A14 draft and submits it to FCTC Secretariat March 2010 – November 2010: FCTC Secretariat finalizes A14 text and submits it to all FCTC Parties for consideration November 2010 and beyond: All FCTC Parties now obligated to implement A14 53

54 Article 14 Highlights A14 is a guideline for the development of guidelines, not a guideline in itself A14 text recognizes the interaction of A14 with Articles 6,8,11-13, 15 and 22 A primary principle of A14 is that tobacco dependence treatment is a key component of any national tobacco control program All Parties to A14 must agree to develop national tobacco dependence treatment guidelines Guidelines developed under A14 must meet the needs and circumstances of Parties at all income levels All Parties to A14 must address tobacco use among their health care providers, especially physicians 54

55 Article 14 Highlights (cont.)
All Parties to A14 are encouraged to address tobacco dependence treatment at both the population and the individual level All Parties to A14 are encouraged to use a stepwise, rather than simultaneous, approach to implementing all aspects of a national tobacco dependence treatment scheme All parties to A14 must develop an evaluation plan, and adjust their approaches according to the results of this evaluation of their A14 implementation 55

56 Article 14 Challenges Strong draft guidelines from the A14 Working Group Parties interested and willing to support A14 at COP IV Approval of guidelines at COP IV Assuring effective implementation of the guidelines at the country and regional levels Guidelines Monitoring and Evaluating Partnerships with groups at national, regional, and international levels: Medical associations Scientific societies Businesses Others Prevention of tobacco industry interference 56


58 Four Stages of the Tobacco Pandemic
STAGE STAGE STAGE STAGE 4 Countries in each stage Sub- Saharan Africa China Japan Southeast Asia Latin America North Africa Eastern Europe Southern Europe Western Europe, UK USA Canada Australia Adapted from: Lopez AD, Collishaw NE, Piha T. A descriptive model of the cigarette epidemic in developed countries. Tobacco Control, 1994, 3:

59 Number of Cases per 100,000 Population
Lung Cancer Incidence: Men Micro/Poly=Micronesia/Polynesia; NZ=New Zealand; Temp=Temperate; Trop=Tropical. Adapted from Parkin et al. CA Cancer J Clin. 1999;49(1):33-64. Number of Cases per 100,000 Population Western Africa Eastern Africa Middle Africa Melanesia South Central Asia Northern Africa Central America Trop. South America Southern Africa Southeast Asia Caribbean Western Asia China Japan Other East Asia Australia/NZ Micro/Poly Western Europe Temp. South America Southern Europe Northern Europe North America Eastern Europe Region 75.9 Incidence of Lung Cancer in Men by World Region

60 Number of Cases per 100,000 Population
Lung Cancer Incidence: Women Micro/Poly=Micronesia/Polynesia; NZ=New Zealand; Temp=Temperate; Trop=Tropical. Parkin et al. CA Cancer J Clin. 1999;49(1):33-64. Incidence of Lung Cancer in Women by World Region Number of Cases per 100,000 Population Middle Africa Western Africa Eastern Africa South Central Asia Northern Africa Melanesia Western Asia Trop. South America Southern Europe Temp. South America Southern Africa Central America Western Europe Southeast Asia Caribbean Eastern Europe Japan Other East Asia China Australia/NZ Micro/Poly Northern Europe North America Region 32.9

61 21st Century Tobacco Control Challenges
CHALLENGES TO INCREASE Support for/adherence to the World Health Organization Framework Convention on Tobacco Control Tobacco excise taxes/unit price of tobacco Access to comprehensive treatment for tobacco dependence Media-based tobacco countermarketing campaigns Regulation of all tobacco products Health warnings on tobacco packaging Availability of tobacco health/economic information to the general public Primacy of health over commerce in trade agreements Basic and applied tobacco control research Extent and accuracy of tobacco epidemiologic data Litigation aimed at the tobacco industry CHALLENGES TO DECREASE Physician and other health care provider tobacco use Targeting of women for increased tobacco use Exposure to secondhand smoke Illicit trade and smuggling of tobacco Duty-free and reduced-cost sales of tobacco Tobacco advertising, promotion, and sponsorship Misleading tobacco product claims/descriptors Targeting of youth for increased tobacco use Subsidies for tobacco production and sales Youth access to tobacco

62 Good News (continued) What areas need to be addressed?
We need to INCREASE: Support for the Framework Convention on Tobacco Control Taxes/price of tobacco Access to affordable tobacco dependence treatment Regulation of tobacco products

63 Good News (continued) Size and strength of health warnings
Primacy of health over trade Basic and applied research Litigation aimed at the tobacco industry Comprehensive tobacco control campaigns Collection of epidemiological data Availability of tobacco health and economic information to the public

64 Good News (continued) We need to DECREASE:
1) What areas need to be addressed? We need to DECREASE: Physician and other health care provider tobacco use Targeting of women Exposure to secondhand smoke Cigarette smuggling

65 Good News (continued) Duty free and other low cost sales of tobacco
Advertising and promotion of tobacco Misleading claims and descriptions Targeting of children and youth Youth access to tobacco Agricultural subsidies

66 Good News (continued) Other Leading Challenges Included:
Developing a new generation of tobacco control leaders Raising the profile of tobacco control on global health and development agendas Considering strategic alliances with NCD efforts Harnessing and integrating modern communications technology into global tobacco control efforts Developing new and more sophisticated methods of tracking and countering the plans of the multinational tobacco companies Focusing more effort on linguistic needs and culturally appropriate interventions Promoting the development of strong advocacy skills Obtaining additional resources, both financial and in-kind.

67 Good News (continued) What will the effects of turning the tide be?
As many as 200 million premature deaths will be avoided in the next 50 years Lung cancer could virtually disappear as a public health menace Global heart disease risks would be reduced by as much as 25% Over time, global life expectancy would rise by 3-5 years Trillions of dollars will be saved from healthcare expenditures and redirected to research and public health


69 Thank you

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