Tobacco Control Policy Linda Waverley, MSc, PhD Research for International Tobacco Control (RITC) Insert your image here

2 Global Burden of Non Communicable Diseases (NCDs)  Tobacco use linked causally to cancers, cardiovascular disease, respiratory diseases, tuberculosis, and diabetes  Population aging and changes in risk factors have accelerated the epidemic of NCDs in many developing countries  Burden of NCDs is increasing, accounting for nearly half of the global burden of disease (all ages)  Many developing countries now face a “double burden”

3 Why is Tobacco Unique as a Policy Issue?  Tobacco use sustained through addictive properties, low prices, social norms, vigorous marketing by powerful multinational corporations  Perceived by many to contribute to social and psychological well-being  Tobacco epidemic exacerbated by complex factors with cross border effects, including trade liberalization, foreign direct investment, global marketing; transnational advertising, promotion and sponsorship; international movement of contraband and counterfeit cigarettes.

4 Global Tobacco Consumption  Approximately 1.3 billion people smoke cigarettes (1 in 5 of the world’s population; 1 in 3 of those over 15)  Global prevalence (2000) = 29% (47% men: 10% women)  One in two long-term smokers will die from a tobacco related disease - many before 65  Tobacco expected to be the leading global cause of death before age 65 by 2020

5 Past and Future Annual Deaths due to Tobacco Use Source: Who (2002) The Tobacco Atlas, p.36.

Stages of the Tobacco Epidemic Source: WHO, 1995, after Peto & Lopez

7 Policy Challenges in Developing Countries  Appropriate balance between:  Population Strategies  High Risk Strategies  Need to switch from an infectious disease paradigm to primary and secondary prevention  Need to incorporate economic policies as well as health policies (e.g. tobacco taxes)

8 The Framework Convention on Tobacco Control (FCTC)  First global treaty to focus on a health issue  Negotiated under the auspices of the WHO  Came into force in Feb following ratification by 40 countries  168 signatories; 116 parties  Includes demand and supply reduction strategies

9 The FCTC: includes a variety of policy measures:  Price and tax measures to reduce demand  Non-price measures:  Protection from exposure to tobacco smoke  Regulation of the contents of tobacco products  Regulation of tobacco product disclosures  Packaging and labelling of tobacco products  Education, communication, training and public awareness  Tobacco advertising promotion and sponsorship  Demand reductions measures concerning tobacco dependence and cessation

10 The FCTC: includes a variety of policy measures:  Supply reduction provisions include:  Illicit trade in tobacco products  Sales to and by minors; and  Provision of support for economically viable alternative activities.

11 Recurring Concerns regarding Tobacco Control Research  Lack of standardized and comparable data  Need to focus on high-risk populations  Absence of a network for communication of information, data, and best practices  Need for better understanding of knowledge brokering  Lack of adequate capacity for tobacco control research (especially in non-health related areas such as economics and policy analysis)  Need for concerted mobilization of human and financial resources

12 South Africa as a model for policy-making  A “policy window”  A “champion” in the Minister of Health”  Strong advocacy  A sound research base  “Framing” as both a health and an economic issue

13 Cigarette prices and consumption

14 Cigarette excise taxes and government revenue

15 Tobacco Control as a Model for Other Risk Factors  Comprehensive approach – no “silver bullet”  Prevention, promotion, protection and treatment  Successful strategy includes programming, policy, research, communication and community development  Multi-site interventions  Evidence-based policy  Country-specific evidence

16 Thank You Research for International Tobacco Control (RITC)

17 Prevalence (%) of Never, Former and Current Smokers in Controls by Region (INTERHEART Study) NeverFormerCurrent Western Europe North America Australia/NZ Eastern/Central Europe South America/Mexico South East Asia/Japan China/Hong Kong South Asia Middle East Africa