1. Tobacco Control: developing and implementing a national program
E Tursan d’Espaignet
S Pujari, A Commar
Comprehensive Information Systems for Tobacco Control Tobacco Free Initiative WHO Geneva

2. A property of tobacco
"… tobacco is the only legal product that maims and kills a large proportion of its users when used exactly as intended by the manufacturer"

3. The Tobacco Epidemic
Currently estimated at just under six million deaths each year or one death every six seconds
Will cause the death of more than 8 million people in the year 2030 or one death every four seconds
Likely result in more than one billion deaths (1,000,000,000 deaths) during the 21st century
More than three out of every four of these deaths will be in low and middle income countries

4. How does an epidemic spread?
For Influenza: vector is a virus Antidote: vaccination, wash hands, etc
For malaria: vector is a mosquito Antidote: wide variety of anti-mosquito products
Anti-spread strategy: Limit or destroy vector
Common element of the vectors: - We know it exists but usually unseen - Requires strong population-based national, regional and global surveillance and interventions to reduce effect and impact

5. Spread of tobacco epidemic
The transmission vector is the industry
Secretive and history of hiding the truth
Enormous capacity for marketing and lobbying
Has a history of substantial political support
Claims it is blameless, responsibility rests with the users who have freedom of choice
The antitode is concerted strong national, regional and global surveillance and interventions antidote

6. The WHO Framework Convention on Tobacco Control6

7. The Antidote: The WHO FCTC
Carefully constructed comprehensive antidote aimed at controlling demand for and supply of tobacco products
Convention of Parties Secretariat responsible for providing the political and legislative tools for implementation of all articles
WHO Tobacco Free Initiative provides technical assistance to all Member States (mostly around selected demand reduction measures - MPOWER) 7 7

8. Protect people from tobacco smoke through smokefree environments 14
mpower: A package of measures each reflecting one or more provisions of the WHO FCTC
Articles
Description 20
Monitoring 8
Protect people from tobacco smoke through smokefree environments 14
Offering help to quit
11 & 12
Warning about dangers of tobacco 13
Enforcing bans on promotion, sponsorship and advertising 6
Raising taxes on tobacco

9. Monitoring Tobacco Control Policies
Reports on the Global Tobacco Epidemic
2008 Report
2009 Report

11. m: Evaluation of Monitoring Status11

12. m: How would you assess monitoring status in 2008 Global Report
Your country has done:
a national Youth Tobacco Survey in and 2004
A national Adult tobacco survey in and 2007 (Global Adult Tobacco Survey, STEPS, National Health Survey) 12

13. m: Example of Monitoring status in 2008 Global Report
Your country has done:
a national Youth Tobacco Survey in and 2004
A national Adult tobacco survey in and 2007 (Global Adult Tobacco Survey, STEPS, National Health Survey) 13

14. m: How would you assess the same information for the 2010 Global Report
Your country has done:
a national Youth Tobacco Survey in and 2004
A national Adult tobacco survey in and 2007 (Global Adult Tobacco Survey, STEPS, National Health Survey) 14

15. m: Example of Monitoring status in 2010
Your country has done:
a national Youth Tobacco Survey in and 2004
A national Adult tobacco survey in and 2007 (Global Adult Tobacco Survey, STEPS, National Health Survey) 15

16. m: HOW TO GET TO THE TOP AND STAY THERE
WHO and CDC provide assistance with surveys such as
- Global Youth Tobacco Survey
Global School Health Survey
Global Adult Tobacco Survey
STEPwise Survey
- Tobacco Questions for Surveys (to be included in other surveys) 16

17. Countries Completed GYTS 1999-2008
Countries Completed 3rd Round
Countries Completed 2nd Round
Countries Completed 17

19. p: Evaluation of Smoke free Status19

20. Examples of Protection against SHS interventions
Smokefree public places - restaurants, bars, public transport, health care facilities, indoor work places, etc
Examples: Australia: Illegal to smoke in a (private) vehicle with a minor present Mauritius; Illegal to smoke in a (private) vehicle if another person present 20

21. Evidence on support for protection against SHS
Legislation implemented
Legislation passed

22. o: Evaluation of Dependence Treatment Status22

23. Warning against dangers of tobacco exposure
Legislate for adequate warnings on packets of cigarettes - both sides covering average of 50% - selected effective fonts and colours and all local languages - rotating images

24. Attitude Towards Warnings
Pack warnings are effective, especially with pictures and covering half of pack
Most people are unaware of full range of health risks from tobacco use, second-hand smoke exposure
Anti-tobacco ads help change image of smoking
Latest approaches: Consideration of plain packaging Australia and moves in France for same
3/4 approve of warnings
More than half changed opinions
2/3 want to quit
Most tobacco users do not understand the full extent of their health risk – because they haven’t been told
People may know generally that tobacco use is harmful, but they thing they can reduce or stop tobacco use before health problems occur. The reality is that most tobacco users will be unable to quit, and up to half will die from tobacco-related illnesses
Comprehensive, graphic warnings about the dangers of tobacco can change tobacco’s image, especially among adolescents and young adults
Governments and NGOs should launch anti-tobacco counter-advertising campaigns in all forms of media to publicize the full extent of tobacco’s dangers
Pictorial health warnings on the packaging of all tobacco products are one of the most effective types of warning. Use of pictures with graphic depictions of disease and other negative images has greater impact than words alone, and is critical in reaching the large number of people worldwide who cannot read.
Strong health warnings on tobacco packages, particularly pictorial warnings, are an important information source for young people
Impact of pack warnings in Brazil

25. Database of Images
WHO Tobacco Free Initiative 18 25

26. w: Evaluation of Health Warnings Status26

27. Enforce legislation prohibiting advertising, promotion and sponsorship
Adopt and apply effective and efficient legislation that prohibits all forms of advertising, promotion, and sponsorship, both Direct, and Indirect forms

28. Evidence on Impact of banning advertising
Comprehensive advertising bans amplify effects of other interventions
9 times faster reduction in consumption with
ban after 10 yrs

29. Examples of bans on advertising
No billboards
No television, radio, internet (difficult)
No print media
In Turkey, not allowed to show cigarette smoking on television - smoking blotted out 20 29

30. e: Evaluation of Bans on Advertising, Promotion & Sponsorship30

31. Monitoring enforcement of banning ad bans
Only 9% of the worlds population live in countries with strong advertising bans and other forms of promotion and sponsorship

32. Raise taxes: Increase price of tobacco through tax increases
TFI led initiative: Assist Member States to increase the rate of taxation (two thirds to four fifths of the retail price)
Increase in price
Increase in revenues
Reduction in consumption
Examples Singapore (68%), Thailand (62%), Australia (62%)
Only 6% of the world population live in countries where taxes account for more than 75% of the retail price
WHO reviews the current tax structures and the potential to increase and improve (simpler, easy to administer) it with a view to decrease consumption and increase revenues. The World Bank recommends a tax of between two thirds to three quarters of the retail price.

33. Evidence of raising taxes on consumption and tax revenues
Consumption of cigarettes
Excise tax rate
Excise tax revenues

34. r: Evaluation of Tobacco Tax levels34

35. How can WHO-TFI help countries?
Assess and build capacity to take action across:
Monitoring of prevalence and outcomes
Protect against second hand smoke
Offer help to quit
Warn against dangers of tobacco
Enforce legislation against advertising and promoting tobacco
Raise taxes so that they make up at least 75% of retail price 25 35

36. Thank you tursandespaignet@who.int37 36