1. Professor Judith Mackay Plenary Session 4 - Chronic Disease World Congress of Epidemiology Edinburgh, Scotland; 9 August 2011

2. Smoking prevalence Male Female Same key

3. Female smoking numbers: Top 20

4. Youth smoking prevalence, 2000-2007, GYTS Boys Girls Same key

5. Health professionals

6. ↑ Tobacco epidemic (~ other NCD) Number smokers 1.4 b -> 1.6 b By 2030 Smoking prevalence Tobacco consumption Tobacco deaths 6m->8m p.a. by 2030

7. Global Cigarette Consumption, 1880-2020

8. Health risks known, but always more e.g. link with TB

9. Deaths caused by tobacco 2015

10. Deaths caused by Secondhand smoke

11. Cumulative deaths from tobacco, global, 2005-2030

12. Tobacco Costs HEALTH COSTS OTHER ECONOMIC COSTS Medical and healthcare costs Higher sickness and absence rates Loss of skilled workers by premature death Increased early retirement due to ill health Secondhand smoke risks Time off for “smoke breaks” Lost production and lower productivity Fires caused by careless smoking Damage to building fabric Litter of billions of cigarettes, matches, packets, lighters Risk of being sued

13. Costs to smoker: cig v. rice

14. Lack of awareness of risk factors Preoccupation with other diseases Tobacco may not yet cause many deaths Focus on curative medicine, not prevention Smoking, alcohol, diet seen as personal behaviour Tobacco industry: promotion, distortion of health and economic evidence, financial might, challenge/threats to governments  other industries not far behind Tobacco tax revenue (but not debit) seen Misperceived economic costs Lack of funds for research and intervention Obstacles to Tobacco Control

15. HK resident smoking through SARS mask

16. The tobacco industry: Not changed its spots… Acknowledgement to http://www.wildlife-pictures-online.com/leopard-pictures-1.html

17. Neo-libertarian groups – now gone global “Nanny state” “Less government” “Personal freedom”

18. Medical Model Not Enough

19. Tobacco Control: WHO FCTC WHO FCTC into effect 2005 Parties ratified: 174/ 192

20. Tobacco Control: FCTC Main Provisions

21. Tobacco Control: Ban Tobacco Promotion People’s Republic of China Las Palmas Philippines

22. Tobacco Control: Smoke-Free Laws Hong Kong Restaurant Tax Receipts Before ban and 2 years later:  31% Example: Hong Kong

23. Tobacco Control: Pack Warnings Example: Hong Kong 27 Oct 2006: Smoking (Public Health) Ordinance 2006 in effect 6 pictorial health warnings – all cigarettes to display 50% health warning messages in both Chinese & English

24. Tobacco Control: Media Campaigns worldlungfoundation.org/mmr

25. For Smoker: Quitting Works Tobacco Control: Quitting Reduces NCD Risk

26. Tobacco Control: Raising Taxes Key Economic Messages Tobacco is debit to the economy Tobacco control is cost-effective Price increases most effective  tobacco tax does not  govt revenue  tobacco tax does not  smuggling  tax on other NCD risk factors (e.g. alcohol, certain foods);  tax on vegetables??

27. Tobacco Control: Raising Taxes, consumption

28. Tobacco Control: Raising Taxes: revenues up

29. Tobacco Control: Earmarked Tax for Health Example: Thailand 2% of tobacco and alcohol tax used for health promotion

30. And now: Major private donors Michael Bloomberg Bill Gates But funding from governments completely inadequate…

31. NCDs: 60% Global Deaths NCDModifiable Causative Risk Factors Tobacco UseUnhealthy Diet Physical Inactivity Harmful Use of Alcohol Heart Disease & Stroke √√√√ Diabetes √√√√ Cancer √√√√ Chronic Lung Disease √ Source: WHO, 2010

32. Deaths from Cardiovascular Disease Coronary heart disease Stroke * Different keys

33. Cancer: Major Risk Factors

35. 7.9 13.0 19.0 82.0 7.1 85.0 67.0 17.0% total Cancer Registries % of the population covered by cancer registration IARC, 2011

36. Physicians Working in NCD

37. C21 Epidemics: New Paradigm Needed 1. International law/ treaties for public health WHO support Sound science/research Comprehensive policies, common risk factors Enforcement after legislation 2. Crucial role of government and political will 3. Extraordinary reach of NCD issues, from corporate criminality to poverty alleviation  new partners Key NGOs and individuals, coalitions 4. Political mapping of obstacles, esp. misperceived economic concerns, tactics of vested industries Effective advocacy targeting decision makers to the public The role of media

38. Source: WHO, 2010

39. UN Summit on NCDs 19-20 Sep 2011 28 such meetings at UN since end-WWII  only 1 on health (AIDS) This one: 135 co-sponsoring countries and unanimous approval Outcome Document is critical Call for addition of all NCDs into next round of UN MDGs in 2015

40. Public health come of age

44. Professor Judith Mackay Senior Advisor jmackay@worldlungfoundation.org