1 |1 | The Tobacco Epidemic - Today Source: WHO Report on the global tobacco epidemic, 2008

2 |2 | The Tobacco Epidemic is about to Get Much Worse Second-hand smoke is estimated to cause ~600,000 premature deaths/year Tobacco currently kills more than 5 million/yr but this will increase to over 8 million/yr in 2030 If current smoking patterns continue, the death toll from tobacco use will be: –2000 – 2025 ~ 150M –2025 – 2050 ~ 300M –2050 – 2100 > 500M (Peto, WHA 2008) TOTAL for 20th Century 0.1 billion TOTAL for 21st Century 1 billion (half the deaths in middle age)

3 |3 | Tobacco Consumption: Geographic Changes Source: WHO calculations using ERC data.

Mechanisms of Tobacco Control

5 |5 | WHO Framework Convention on Tobacco Control (WHO FCTC) First global health treaty negotiated under the auspices of WHO The WHO FCTC –establishes tobacco control as a priority on the public health agenda –provides an evidence-based tool for adoption of sound tobacco control measures –introduces a mechanism for firm country commitment and accountability 168 parties as of February 2010 Entry into force 27 Feb

6 |6 | Conference of the Parties (COP) The Conference of the Parties (COP) is the governing body of the WHO Framework Convention on Tobacco Control (WHO FCTC) and is comprised of all Parties to the Convention, in accordance with Article 23 of the WHO FCTC. The COP shall keep under regular review the implementation of the Convention and take the decisions necessary to promote its effective implementation and may also adopt protocols, annexes and amendments to the Convention. The COP may establish such subsidiary bodies as are necessary to achieve the objective of the Convention The COP also established several working groups with the mandate to elaborate guidelines and recommendations for the implementation of the different treaty provisions.

7 |7 | Working groups currently established by the COP The COP requested four working groups to elaborate draft guidelines and recommendations for implementation of: Articles 9 & 10: "Regulation of the contents of tobacco products" and "Regulation of tobacco product disclosures" Article 12: "Education, communication, training and public awareness" Article 14: "Demand reduction measures concerning tobacco dependence and cessation" Articles 17 & 18: "Provision of support for economically viable alternative activities" and "Protection of the environment and the health of persons"

8 |8 | WHO FCTC Guidelines adopted by COP Article 5.3 Guidelines on the protection of public health policies with respect to tobacco control from commercial and other vested interests Article 8 Guidelines on the protection from exposure to tobacco smoke Article 11 Guidelines on packaging and labelling of tobacco products Article 13 Guidelines on tobacco advertising, promotion and sponsorship

WHO TFI Supporting the implementation of the FCTC

10 | Tobacco Free Initiative (TFI) VISION To reduce the burden of disease and death caused by tobacco use, thereby protecting present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke

11 | TFI Priorities Supporting health system development by building the capacity of decision makers and partners at regional and country level; Addressing economic policy issues with evidence-based knowledge and information; Strengthening partnerships with strategic international organizations, decision makers and civil society; Scaling up capacity for implementation of tobacco control interventions and the WHO-FCTC; Strengthening surveillance, monitoring and evaluation systems; Communication and advocacy.

12 | TFI : Bringing in Change – MPOWER strategy monitor tobacco use and prevention policies protect people from tobacco smoke offer help to quit tobacco use warn about the dangers of tobacco enforce bans on tobacco advertising, promotion and sponsorship raise taxes on tobacco

13 | Only 5 per cent of the world's population were covered by comprehensive smoke-free laws in 2008 (up from 3% in 2007)

14 | Article 6 - Taxation 95% of world's population living in countries where taxes represent <75% of retail price Back Source: WHO Report on the global tobacco epidemic, 2009

15 | Article 8 – Smoke-Free 2% of world's population live in countries with comprehensive smoke-free laws that also have high level of compliance Source: WHO Report on the global tobacco epidemic, 2009

16 | Article 11 – Health Warnings 8% of the world's population live in a country with strong GRAPHICGRAPHIC WARNINGS WARNINGS WARNINGS on cigarette packs Source: WHO Report on the global tobacco epidemic, 2009

18 | Article 13 – Advertising More than 90% of the world's population is unprotected from tobacco industry marketing Source: WHO Report on the global tobacco epidemic, 2009

19 | DIRECT ADVERTISING Billboards, print media, radio, TV SPONSORSHIP Sports, music events BRAND STRETCHING Holidays, cafés, music MERCHANDISING Lighters, clothing LOYALTY SCHEMES AND COUPONS Collecting coupons to exchange for promotional items Coupons may offset the effect of price increases PACKAGING Reinforce brand imagery PRODUCT PLACEMENT Films and TV OTHER MARKETING COMMUNICATIONS Events/Participatory promotions POINT OF SALE Cigarette pack "power- walls" FREE SAMPLES A popular industry strategy Article 13 Guidelines: Ban or restrict marketing

20 | Article 14 – Cessation Only 17 countries provide access to comprehensive help to quit smoking Back Source: WHO Report on the global tobacco epidemic, 2009

21 | Cross Cutting Issues –Tobacco Industry MonitoringTobacco Industry Monitoring –GenderGender –Litigation support –Economics –International Development –Social Determinants –Intersectoral actionaction –UN Task Force –MDG Expert Groups: –WHO Study Group on Tobacco Product Regulation –WHO Tobacco Laboratory Network Global Level Implementation of WHO FCTC – Cross-cutting

22 | Gender-Specific Policy for Tobacco Control There are different health risks associated with women’s smoking: Faster development of certain diseases like lung cancer Irreversible and serious health consequences for pregnant women and foetus World No Tobacco Day 2010

23 | POLITICAL WILL Ministry of Health Ministry of Finance Ministry of Justice Ministry of Education Ministry of Agriculture PUBLIC AWARENESS NGOsMedia Health Professionals Trade unions INTERNATIONAL SUPPORT WLF Bloomberg Philanthropies CDC Donor countries Gates foundation INTERGOVERNMENTAL WORK WHO Headquarter (TFI) WHO Country offices WHO Regional Office UN task force SCIENTIFIC EVIDENCE Researchers IARC WHO Collaborating Centres (UCSF) WHO FCTC Working together to curb the to curb the tobacco epidemic INTERSECTORAL ACTION

Tobacco Industry

25 | Largest Manufacturers/sellers of cigarettes Largest Manufacturers/sellers of cigarettes China National Tobacco CorporationChina National Tobacco Corporation Philip Morris International and Philip Morris USAPhilip Morris International and Philip Morris USA British American Tobacco and associates (including ITC and Reynolds American)British American Tobacco and associates (including ITC and Reynolds American) Japan Tobacco International/Japan TobaccoJapan Tobacco International/Japan Tobacco Imperial TobaccoImperial Tobacco The “tobacco industry”

26 | TOBACCO INDUSTRY INTERFERENCE attempts to undermine science and legitimate messages from scientific quarters the manipulation of the media the industry’s public relations efforts tactics designed to gain control of the public agenda lobbying efforts the use of front groups and artificially created grassroots movements intimidation harassment of tobacco control professionals Source: Fox B, Bialous S, Trochim W, Stillman F and Schmitt CL. Monograph 17: Evaluating ASSIST – A blueprint for understanding atate- level tobacco control. Chapter 8. Evaluating tobacco industry tactics as a counterforce to ASSIST

27 | Remains profitable Remains profitable Expanding into low and middle income, but remaining profitable in several high income countries Expanding into low and middle income, but remaining profitable in several high income countries Top of merger and acquisitions phase Top of merger and acquisitions phase New products, including smokeless New products, including smokeless In favor of “reasonable" regulation In favor of “reasonable" regulation Differences when competing, alliances when faced with stricter regulatory framework. Differences when competing, alliances when faced with stricter regulatory framework. The “tobacco industry”

28 | Tobacco industry strategies to undermine tobacco control activities at the World Health Organization “the evidence shows that tobacco companies have operated for many years with the deliberate purpose of subverting the efforts of WHO to address tobacco issues. The attempted subversion has been elaborate, well financed, sophisticated and usually invisible… This inquiry adds to the mounting evidence that it is also a struggle against an active, organized and calculating industry.” Source: World Health Organization committee of experts on tobacco industry documents. Tobacco industry strategies to undermine tobacco control activities at the World Health Organization Available from

29 | US vs PM et al.: Judge Kessler Final Opinion "the intricate, interlocking, and overlapping web of national and international organizations, committees, affiliations, conferences, research laboratories, funding mechanisms, and repositories for smoking and health information which Defendants established, staffed, and funded in order to accomplish the following goals: counter the growing scientific evidence that smoking causes cancer and other illnesses, avoid liability verdicts in the growing number of plaintiffs’ personal injury lawsuits…and ensure the future economic viability of the industry.“ Source: Kessler G. Final Opinion: United States of America v. Philip Morris. Civil Action No (GK)

30 | Main Challenge? Dissemination of information to a level where awareness of tobacco industry’s CSR strategies and its impact on health, community welfare and sustainable development become integrated in the decision making process of policy makers and opinion leaders, as well as the population Dissemination of information to a level where awareness of tobacco industry’s CSR strategies and its impact on health, community welfare and sustainable development become integrated in the decision making process of policy makers and opinion leaders, as well as the population

31 | TFI ongoing monitoring of industry activities Monitoring the industry and sharing information about industry’s strategies to derail tobacco control is a WHO mandate Monitoring the industry and sharing information about industry’s strategies to derail tobacco control is a WHO mandate Resolution of the 54th World Health Assembly (May 2001) Resolution of the 54th World Health Assembly (May 2001) TFI main activities on industry monitoring: tracking information for database, awareness raising, background information, technical assistance to member states and sister UN agencies TFI main activities on industry monitoring: tracking information for database, awareness raising, background information, technical assistance to member states and sister UN agencies Art.5.3

32 | Tobacco industry interference with tobacco control Documents history of attempts to interfere with tobacco control Recent strategies Recent strategies Old strategies with new “clothes” Old strategies with new “clothes” Source: _eng.pdf

33 | Princi Principle 1: There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests. Principle 2: Principle 2: Parties, when dealing with the tobacco industry or those working to further its interests, should be accountable and transparent. Principle 3: Principle 3: Parties should require the tobacco industry and those working to further its interests to operate and act in a manner that is accountable and transparent. Principle 4: Principle 4: Because their products are lethal, the tobacco industry should not be granted incentives to establish or run their businesses. Article 5.3 GUIDING PRINCIPLES

34 | "We must make the prevention and control of non- communicable diseases and improvement of maternal health top priorities of the development agenda. Both are part of the agenda for strengthening health systems and revitalizing health care. Both are fully ready and mature areas for efficient interventions with a huge return. Both are begging for more attention." Dr Margaret Chan WHO Director-General ECOSOC High-level Segment 6 July 2009 WHO has accorded a high priority to scaling up technical support for the prevention and control of non-communicable diseases in developing countries