 2007 Johns Hopkins Bloomberg School of Public Health Section B Tobacco Control Experiences in Developing Countries

 2007 Johns Hopkins Bloomberg School of Public Health Tobacco Control Experiences in Developing Countries Several developing countries had started putting in place tobacco control policies before the FCTC negotiations began The FCTC negotiations process gave momentum to the tobacco control efforts in such countries and encouraged those without any measures to initiate policies and activities for tobacco control Whereas developing-country parties can learn from “best-practice models” in the developed world, there are some success stories from the developing-country parties Efforts should be made to encourage south-south cooperation in scientific, technical, and legal fields

 2007 Johns Hopkins Bloomberg School of Public Health Tobacco Control Experiences: Brazil A party to the FCTC, Brazil has had a national tobacco control program since 1989 This program has achieved important positive results  Smoking prevalence among adults (age 18+) decreased from 34.8% in 1989 to 22.4% in 2003: a 35% decrease In 2003, motivated by the FCTC negotiation process, the president of Brazil created the National Commission for the Implementation of the FCTC and its Protocols  A formal governmental forum that convenes the representation of 13 different ministries  Its main goal is to build a state agenda for the FCTC implementation

 2007 Johns Hopkins Bloomberg School of Public Health Tobacco Control Experiences: South Africa A party to the FCTC since 2005, South Africa has one of the most comprehensive tobacco control policies in the world The 1993 Tobacco Products Control Act included strong measures on smoke-free public places, taxation, health warnings, and advertising bans The Tobacco Products Amendment Act came into force in South Africa in October, 2000 Political commitment and strong tobacco control networks enabled adoption and implementation of strong tobacco control policies

 2007 Johns Hopkins Bloomberg School of Public Health Source: van Walbeek. (2003). Cigarette Price and Consumption: South Africa

 2007 Johns Hopkins Bloomberg School of Public Health Tobacco Control Experiences: Thailand Incorporated tobacco control as a key component of its overall health promotion strategy Serves as a best-practice example in tobacco control policies  Strong pictorial health warnings on tobacco products  Progressive taxation policy on tobacco products There are dedicated funds available for health promotion and tobacco control programs through earmarked tobacco and alcohol taxes (Health Promotion Foundation Act, 2001)

 2007 Johns Hopkins Bloomberg School of Public Health Image source: The University of Sydney Tobacco Control Supersite. (2006). Tobacco Control Experiences: Thailand Health warnings in Thailand

 2007 Johns Hopkins Bloomberg School of Public Health Tobacco Control Experiences: India In 2003, adopted a comprehensive legislation on tobacco control: The Cigarettes and Other Tobacco Products Act Elaboration of rules for implementation of various measures of the Act is ongoing; several challenges related to implementation remain A growing network of NGOs working on tobacco control and strong partnerships are being established between governmental and NGOs at various levels of governance for FCTC implementation

 2007 Johns Hopkins Bloomberg School of Public Health Recommendations for FCTC Implementation Establish a national coordination mechanism, involving multiple stakeholders, for implementation of policies towards full compliance with FCTC provisions—ensure its freedom from tobacco industry influence Develop a comprehensive national tobacco control legislation in line with the provisions and obligations under the FCTC Conduct a situation analysis of tobacco control in the country to analyze existing policies and develop new policies along with strengthening of existing measures, in accordance with the FCTC provisions

 2007 Johns Hopkins Bloomberg School of Public Health Recommendations for FCTC Implementation Integrate tobacco control into existing health systems, at all levels of governance (federal, state, provincial, local) to ensure sustainability of tobacco control interventions Strengthen human and institutional infrastructure for implementation of tobacco control measures (this may be done by establishing a national tobacco control program) Ensure coordination between different governmental agencies involved with tobacco control at national, provincial, and municipal levels Strengthen NGOs, especially those working on health and development issues, so that tobacco control can be integrated within a broad civil society agenda in the country

 2007 Johns Hopkins Bloomberg School of Public Health Recommendations for FCTC Implementation Train personnel engaged in tobacco control in monitoring and evaluation of tobacco control measures Conduct appropriate communication and public awareness campaigns to build a critical mass of public opinion in support of FCTC implementation and compliance with tobacco control legislation Develop locally appropriate cessation programs to support tobacco users in quitting tobacco use

 2007 Johns Hopkins Bloomberg School of Public Health Recommendations for FCTC Implementation Develop a national tobacco control research agenda that addresses not only health effects of tobacco use but also the socioeconomic aspects Establish and integrate a tobacco control surveillance program within the health systems

 2007 Johns Hopkins Bloomberg School of Public Health *Source: da Costa e Silva, V.L. (2004). Recommendations for FCTC Implementation Build national and regional capacity for tobacco product testing and disclosure of constituents and emissions  Essential for compliance with the provisions related to regulation of contents of tobacco products and disclosures Establish a national regulatory authority to regulate tobacco products  Revenue-generating models for such regulatory bodies exist  For example, Brazil: ANVISA (the National Agency for Sanitary Surveillance) is mandated to collect $35,000 USD* as annual registration fee for each brand from the tobacco companies

 2007 Johns Hopkins Bloomberg School of Public Health Recommendations for FCTC Implementation Mobilize resources for FCTC implementation  Conduct needs assessment, in light of total obligations to the FCTC, to identify program priorities as well as technical and financial needs for FCTC implementation  Seek support from bilateral and multilateral funding mechanisms and international agencies such as the WHO  Explore funding opportunities through mechanisms such as the Bloomberg Initiative to reduce tobacco use Actively participate in sessions of the Conference of the Parties to the FCTC for relevant matters, including the negotiation and adoption of protocols and guidelines for implementation of selected provisions

 2007 Johns Hopkins Bloomberg School of Public Health Recommendations for FCTC Implementation Be vigilant of tobacco industry strategies to counter efforts at FCTC implementation  As countries attempt to implement comprehensive advertising bans, the tobacco industry might use surrogate advertising and promotion strategies such as product placement in electronic media and movies  As taxation policies are put in place, governments need to monitor and curb possible increase in illicit trade (in which the tobacco industry might be complicit) Identify and promote economically viable alternatives for tobacco workers, growers, and sellers

 2007 Johns Hopkins Bloomberg School of Public Health Summary The success of the FCTC will be determined by the political commitment and resources applied for its implementation Several developing countries are parties to the FCTC and are now faced with the challenges of implementation There are existing best-practice models, from both developed and developing countries, on effective tobacco control implementation This lecture identifies challenges faced by developing countries in tobacco control and recommends strategies for effective implementation of the FCTC in a developing-country context