Presentation on theme: "The Challenge, and the Promise, of Global Tobacco Control"— Presentation transcript:
1The Challenge, and the Promise, of Global Tobacco Control Thomas J. Glynn, PhDAmerican Cancer SocietyWashington, DCPresented at the International Quitline Institute, Seattle, Washington, USA - October, 2011
6How AIDS Changed America Africa's Malaria Death Toll Still "Outrageously High"How AIDSChanged America
7With so many competing interests, is tobacco actually important as a global issue?
8So, 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?
9Kill 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) peopleOverwhelm cancer and cardiac hospital unitsRavage the social well-being and finances of millions of familiesAnd kill 1 of every 10 people now alive
15Why is Tobacco Control Important as a Global Issue?
16The Disease Consequences of Tobacco Use Are Universal
17Tobacco Related Cancers Oral cavity and pharynxEsophagusLarynxLung, trachea and bronchusUrinary bladderRenal pelvisUterine cervixPancreasKidney
18Tobacco Related Cardiovascular Diseases HypertensionIschemic heart diseaseAtherosclerosisPulmonary heart diseaseAortic aneurysmStroke
19Tobacco Related Respiratory Diseases Chronic bronchitisEmphysemaAsthmaPneumonia
20Tobacco Related Pediatric Diseases Low birth weightRespiratory distress syndromeSudden infant death syndrome
21Secondhand Tobacco Smoke Problems Heart DiseaseLung cancerAsthma attacksBronchitis and pneumonia (especially children)Coughs and croup (especially children)Middle ear infections (children)
22Conclusion 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.”
23Smoking and Second-Hand Smoke Damage Every Part of the Body
24Why Hasn’t Tobacco Control Received the Global Attention it Needs? Tobacco use is viewed as a personal choice and a personal failingMost victims of tobacco-related disease die and disappear quicklyFamilies and victims are often ashamed to discuss their tobacco useThe tobacco pandemic has developed slowly and insidiously
25Why 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 news6) Few strong tobacco control advocacy groups have arisen7) The global effects of tobacco use – health and economic – are not well known8) 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
28Global Smoking Prevalence There are currently 1.3 billion smokers in the world – there will be 1.7 billion in 2025Asia 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 smokersOne-third of the global population age 15 and older smokes
30Distribution of world’s smokers 20002025WHO World Health Report 1999.
31Tobacco 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 countriesDeveloping countries
32Global Smoking DeathsGlobally, 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 childrenEvery eight seconds a person dies of a smoking-related diseaseCigarettes kill half of all lifetime users, with half of these dying in middle age – between 35 and 69 years old, their most productive years
33Global Smoking Deaths (continued) 1 in 10 adult deaths worldwide are smoking relatedSmoking diminishes health in more than 50 ways, at least 20 of which are fatalIn 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
34Global 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 nonsmokersNo 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 combinedTobacco is expected to kill 8.4 million people annually by 2020, and 10 million people in 2030, if current consumption does not change
35Economic 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 membersSmoking-related costs can contribute up to 15% of total health-care costs in developed countriesJapanese 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
36Economic 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 shelterA 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 thenFor nearly 50% of the world’s population, a pack of Marlboros costs approximately half of a family’s daily income
37Good NewsThe 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 pandemic2) It is possible to document what the health and economic effects of turning the tide would be; and3) We know what needs to be done
38Framework 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”
39FCTC: History May 1999: World Health Assembly Resolution October 2000: First Intergovernmental Negotiating BodyFebruary 2003: Final Intergovernmental Negotiating BodyMay 2003: World Health Assembly Unanimous Approval
40FCTC Milestones Entry into Force - February 27, 2005 Signature by Member States (180)Ratification by Member States (172) representing 87% of World PopulationConference of the Parties (COP):1st Session February 2006, Geneva2nd Session June 2007, Bangkok3rd Session November 2008, Durban4th Session November 2010, Punta del Este
43Why 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.
45Measures Relating to the Reduction of the Supply of Tobacco Illicit Trade in Tobacco Products (Art. 15)Sales to and by Minors (Art. 16)
46Measures 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)
47Salvo que los fumadores actuales lo dejen, las muertes por tabaco aumentarán dramáticamente en los próximos 50 añosMuertes por tabaco acumulativas estimadas entre con diferentes estrategias de intervención—Línea de baseSi la proporción de adultos jóvenes que empiezan a fumar se reduce a la mitad para el año 2020Si la consumición por adultos se reduce a la mitad para 2020Muertes por tabaco (en millones)AñoWorld Bank. Curbing the epidemic: Governments and the economics of tobacco control. World Bank Publications, p80.
48How Many Smokers Are Affected by Article 14? There are 1.3 billion smokers worldwideMore than 50% of these smokers – or more than 650 million – want to stopThis is equivalent to more than 200x the entire population of Uruguay
49Trends in cigarette consumption and lung cancer mortality, US, 1900-2005 Lung Cancer MenLung Cancer Women
50Demand Reduction Measures Concerning Tobacco Dependence and Cessation FCTC – Article 14Demand Reduction Measures Concerning Tobacco Dependence and CessationEach 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
51FCTC – 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; andCollaborate 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
52KEY COMPONENTS OF A SYSTEM TO HELP TOBACCO USERS QUIT 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.
53Article 14 History/Timetable February 2010:2nd meeting of A14 Working Group, in Auckland, NZ, finalizes A14 textNovember 2008: COP III accepts background document and calls for draft A14 guidelinesNovember 2010: COP IV meets in Punta del Este, Uruguay, discusses and adopts A14July 2007:COP II calls for background document on tobacco dependence treatmentSeptember 2009:1st meeting of the A14 Working Group, in Seoul, Korea, considers A14 draftJuly 2007 – November 2008: FCTC Secretariat develops background documentNovember 2008 – September 2009: FCTC Secretariat develops draft A14 guidelinesSeptember 2009 – December 2009:UK prepares updated, final A14 draft and submits it to FCTC SecretariatMarch 2010 – November 2010: FCTC Secretariat finalizes A14 text and submits it to all FCTC Parties for considerationNovember 2010 and beyond:All FCTC Parties now obligated to implement A1453
54Article 14 HighlightsA14 is a guideline for the development of guidelines, not a guideline in itselfA14 text recognizes the interaction of A14 with Articles 6,8,11-13, 15 and 22A primary principle of A14 is that tobacco dependence treatment is a key component of any national tobacco control programAll Parties to A14 must agree to develop national tobacco dependence treatment guidelinesGuidelines developed under A14 must meet the needs and circumstances of Parties at all income levelsAll Parties to A14 must address tobacco use among their health care providers, especially physicians54
55Article 14 Highlights (cont.) All Parties to A14 are encouraged to address tobacco dependence treatment at both the population and the individual levelAll Parties to A14 are encouraged to use a stepwise, rather than simultaneous, approach to implementing all aspects of a national tobacco dependence treatment schemeAll parties to A14 must develop an evaluation plan, and adjust their approaches according to the results of this evaluation of their A14 implementation55
56Article 14 ChallengesStrong draft guidelines from the A14 Working GroupParties interested and willing to support A14 at COP IVApproval of guidelines at COP IVAssuring effective implementation of the guidelines at the country and regional levelsGuidelines Monitoring and EvaluatingPartnerships with groups at national, regional, and international levels:Medical associationsScientific societiesBusinessesOthersPrevention of tobacco industry interference56
58Four Stages of the Tobacco Pandemic STAGE STAGE STAGE STAGE 4Countries in each stageSub-SaharanAfricaChinaJapanSoutheast AsiaLatin AmericaNorth AfricaEastern EuropeSouthern EuropeWesternEurope, UKUSACanadaAustraliaAdapted from: Lopez AD, Collishaw NE, Piha T. A descriptive model of the cigarette epidemic in developed countries. Tobacco Control, 1994, 3:
59Number of Cases per 100,000 Population Lung Cancer Incidence: MenMicro/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 PopulationWestern AfricaEastern AfricaMiddle AfricaMelanesiaSouth Central AsiaNorthern AfricaCentral AmericaTrop. South AmericaSouthern AfricaSoutheast AsiaCaribbeanWestern AsiaChinaJapanOther East AsiaAustralia/NZMicro/PolyWestern EuropeTemp. South AmericaSouthern EuropeNorthern EuropeNorth AmericaEastern EuropeRegion75.9Incidence of Lung Cancer in Men by World Region
60Number of Cases per 100,000 Population Lung Cancer Incidence: WomenMicro/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 RegionNumber of Cases per 100,000 PopulationMiddle AfricaWestern AfricaEastern AfricaSouth Central AsiaNorthern AfricaMelanesiaWestern AsiaTrop. South AmericaSouthern EuropeTemp. South AmericaSouthern AfricaCentral AmericaWestern EuropeSoutheast AsiaCaribbeanEastern EuropeJapanOther East AsiaChinaAustralia/NZMicro/PolyNorthern EuropeNorth AmericaRegion32.9
6121st Century Tobacco Control Challenges CHALLENGES TO INCREASESupport for/adherence to the World Health Organization Framework Convention on Tobacco ControlTobacco excise taxes/unit price of tobaccoAccess to comprehensive treatment for tobacco dependenceMedia-based tobacco countermarketing campaignsRegulation of all tobacco productsHealth warnings on tobacco packagingAvailability of tobacco health/economic information to the general publicPrimacy of health over commerce in trade agreementsBasic and applied tobacco control researchExtent and accuracy of tobacco epidemiologic dataLitigation aimed at the tobacco industryCHALLENGES TO DECREASEPhysician and other health care provider tobacco useTargeting of women for increased tobacco useExposure to secondhand smokeIllicit trade and smuggling of tobaccoDuty-free and reduced-cost sales of tobaccoTobacco advertising, promotion, and sponsorshipMisleading tobacco product claims/descriptorsTargeting of youth for increased tobacco useSubsidies for tobacco production and salesYouth access to tobacco
62Good News (continued) What areas need to be addressed? We need to INCREASE:Support for the Framework Convention on Tobacco ControlTaxes/price of tobaccoAccess to affordable tobacco dependence treatmentRegulation of tobacco products
63Good News (continued) Size and strength of health warnings Primacy of health over tradeBasic and applied researchLitigation aimed at the tobacco industryComprehensive tobacco control campaignsCollection of epidemiological dataAvailability of tobacco health and economic information to the public
64Good News (continued) We need to DECREASE: 1) What areas need to be addressed?We need to DECREASE:Physician and other health care provider tobacco useTargeting of womenExposure to secondhand smokeCigarette smuggling
65Good News (continued) Duty free and other low cost sales of tobacco Advertising and promotion of tobaccoMisleading claims and descriptionsTargeting of children and youthYouth access to tobaccoAgricultural subsidies
66Good News (continued) Other Leading Challenges Included: Developing a new generation of tobacco control leadersRaising the profile of tobacco control on global health and development agendasConsidering strategic alliances with NCD effortsHarnessing and integrating modern communications technology into global tobacco control effortsDeveloping new and more sophisticated methods of tracking and countering the plans of the multinational tobacco companiesFocusing more effort on linguistic needs and culturally appropriate interventionsPromoting the development of strong advocacy skillsObtaining additional resources, both financial and in-kind.
67Good 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 yearsLung cancer could virtually disappear as a public health menaceGlobal heart disease risks would be reduced by as much as 25%Over time, global life expectancy would rise by 3-5 yearsTrillions of dollars will be saved from healthcare expenditures and redirected to research and public health