Saïd Business School 1-3 September 2004

Tobacco Working Group Learning from tobacco to address diet and nutrition more effectively Professor Martin McKee 2 September 2004

Remit Prepare a report of the experience of those involved in tobacco control to inform those working to tackle other risk factors for chronic disease

Areas for examination The epidemiology of tobacco –And the need for evidence! The strong pressures exerted on policies –Globalization Policies that can make a difference –Who are the major players? CAVEAT: FOOD = TOBACCO

The difficulty with epidemiological evidence for diet

The difficulty with epidemiollogical evidence for diet Varying intakes over lifetimes Recall of consumption Varying nutritional content of natural foodstuffs Processing of food

WHO Technical Report 916 ObesityType 2 diabetes CVDCancerDental disease Osteoporosis Energy and fats Hi intake energy- dense foods C+ Saturated fats P+C+ Transfatty acids C+ Dietary cholesterol P+ Fish and fish oils P- Carbohydrate High intake dietary fibre C-P- Free sugars C+ Vitamins Vitamin D C- Minerals High sodium C+ Local fluoride C-

Pressures for change Litigation has been successful against tobacco in the US Investment banks are looking at the risks associated with food & drink companies

Tobacco control €£$¥ What works Taxes Ad bans Smoke- free Litigation What doesn’t Education in schools Voluntary agreements on ad bans Voluntary agreements on smoke-free areas

How might FCTC policies be relevant to diet and physical activity? €£$¥ Make fruit & vegetables more affordable; research effect of taxation Restrict advertising to children; discourage unhealthy lifestyles Health warnings and disclosure of nutritional information; labelling guidelines, health claims

How might FCTC policies be relevant to diet and physical activity? Product content: Regulation of harmful of ingredients; food safety regulations Education campaigns: in schools, workplaces and sites reaching the general public Clinical interventions: based on collaborative goal- setting, skill-building, self-monitoring, personalized feedback, planned follow-up & links to community resources

Many key players in tobacco control Agenda setters: Researchers NGOs Globalink, Framework Convention Alliance Governments: Health Ministries Treasuries International: UN WHO World Bank IMF Private sector: Pharmaceutical companies Tobacco companies

Twelve lessons from tobacco 1.Address the issue of individual responsibility versus collective/environmental action early and often 2.Evidence of harm is necessary but not sufficient to motivate policy change 3.Decisions to act need not wait for evidence of the effectiveness of interventions

4.The real and perceived needs and concerns of developing countries need to be addressed even if they involve going beyond the initial scope of the risk being addressed Twelve lessons from tobacco 5.The more comprehensive the package of measures considered, the greater the impact 6.Broad-based, vertical and horizontal coalitions, well networked, are key

7.Media-savvy individual and institutional leadership matters Twelve lessons from tobacco 8.Change in support for tobacco control took decades of dedicated effort by all 9.Modest, well-spent funds can have a massive impact. But without clear goals they may not be sustainable

10.Complacency that past actions will serve well in future may retard future progress Twelve lessons from tobacco 11.Rules of engagement with the tobacco and food industries need to be different and continually under review 12.Risk factor envy is harmful!

Tobacco Working Group Learning from tobacco to address diet and nutrition more effectively

Saïd Business School 1-3 September 2004