endgame of tobacco.experiences and perspectives from finland
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Endgame of Tobacco Conference
Delhi 11.9.2013
Endgame of tobacco: Experiencesand perspectives from Finland
Pekka Puska, MD, PhD, MPolScDirector General, National Institute for Health and Welfare (THL), FinlandPresident, Int. Association of National Public Health Institutes (IANPHI)Past President, World Health Federation (WHF)
13.04.2023
Greetings from Finland
Pekka Puska, Director General13.04.2023
69
10Pekka Puska, Director General13.04.2023
13.04.2023 Pekka Puska, Director General
Change in age-adjusted mortality rates Finland, males aged 35–64 (per 100 000 population)
extension of the Project nationally
start of the North Karelia Project
North Karelia -85%
All Finland -80%
Rate per 100 000
1969-1971
2006 Change from 1969-1971 to 2006
All causes 1328 583 -56%
All cardiovascular
680 172 -75%
Coronary heart disease
489 103 -79%
All cancers 262 124 -53%
Coronary heart diseaseCoronary heart disease
Gain of some 10 healthy years in Finnish popupaltion
Gain of some 10 healthy years in Finnish popupaltion
13.04.2023 Pekka Puska, Director General
13.04.2023 Esityksen nimi / Tekijä 7
Proportion of daily smokers among 15–64-year-olds and among 15–24-year-olds in 1978–2012 (%).
1978
-79
1980
-81
1982
-83
1984
-85
1986
-87
1988
-89
1990
-91
1992
-93
1994
-95
1996
-97
1998
-99
2000
-01
2002
-03
2004
-05
2006
2007
2008
2009
2010
2011
2012
0
10
20
30
40
50
Men
Women
15-24 y Men
15-24 y Women
%
13.04.2023
Adolescent daily cigarette smoking
Prevalence of daily cigarette smoking (%) among 1218-year-olds 19812013. Adolescent Health and Lifestyle Survey 2013.
0
5
10
15
20
25
30
35
40
45
50
0
5
14
18
Girls
12 14 16 18
%
0
5
10
15
20
25
30
35
40
45
50
1
3
13
19
Boys
12 14 16 18
%
13.04.2023 Esityksen nimi / Tekijä 9
Additional information on smoking trends in Finland
21.8.2013 Ministeri Susanna Huovisen vierailu / Erkki Vartiainen 10
Initiation of smokingDaily smoking
Naiset
Miehet
%
0
10
20
30
40
50
60
1960
1970
78-79
83-85
89-90
93-94 19
9719
9920
0120
0320
05
Women
Men
%
0
10
20
30
40
50
60
70
80
90
100
19-34 35-49 50-64 25-49 25-4919-34 35-49 50-64 25-49 25-49
1961
–65
1916
–20
1956
–60
1966
–70
1951
–55
1946
–50
1941
–45
1936
–40
1931
–35
1926
–30
1921
–25
1976
–80
1971
–75
13.04.2023 Esityksen nimi / Tekijä 11
Age-standardised proportion of 25–64-year-old daily smokers by gender and educational group in 1978–2011 (%).
78-81 82-85 86-89 90-94 95-99 2000-2003
2004-2007
2008-2011
0
10
20
30
40
50
Men
Low Middle High
%
78-81 82-85 86-89 90-94 95-99 2000-2003
2004-2007
2008-2011
0
10
20
30
40
50
Women
Low Middle High
%
13.04.2023 Esityksen nimi / Tekijä 12
Daily exposure to cigarette smoke for at least one hour at work among those who work outside the home by gender in 1985–2012.
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
0
20
40
60
80
Men, daily smokers
Women, daily smokers
Men, the others
Women, the others
year
%
13.04.2023 Esityksen nimi / Tekijä 13
Daily smoking in Finland in 2012 (15-84 years)
Men 19 %
Women 13 %
TOTAL 16 %
13.04.2023 Esityksen nimi / Tekijä 14
TOBACCO ACT, FINLAND(AMENDMENT 2010)Section 1
This Act prescribes measures to prevent people from taking up the use of tobacco products, to promote quitting their use and to pretect the population against exposure to tobacco smoke.
The aim of the Act is to end the use of tobacco products containing compounds that are toxic to humans and create addiction.
13.04.2023 Esityksen nimi / Tekijä 15
What has been done in Finland since the 1970´?
Comprehensive action:• Much health promotion
(experts,NGO’s, health services)• Strict legislation + taxation• Monitoring (+ feed back)
13.04.2023 Esityksen nimi / Tekijä 16
Important elements of Finnish tobacco policy• No advertizing or sales promotion (since 1978)• Public indoor places, restaurants and work sites
smokefree• Pictorial health warnings• Sale to minors (below 18) and vending machine
sale prohibited• Tobacco products not at display• Sale of smokeless tobacco prohibited• Taxation• Support to cessation and campaigns
13.04.2023 Esityksen nimi / Tekijä 17
13.04.2023 Esityksen nimi / Tekijä 18
Endgame of tobacco
More of the same?
OR
Completely new measures?
13.04.2023 Esityksen nimi / Tekijä 19
Finnish expert group proposals for the endgame
• Completely smoke free environments• Increased taxes• Further reductions in availability• Strengthened protection of children from tobacco• Plain packaging, big warnings with pictures etc.• Stronger support to cessation services• Strengthened regulation of products (additives etc.)• Liability issues• Communication campaigns
13.04.2023 Esityksen nimi / Tekijä 20
SUCCESSFUL TOBACCO CONTROL, including endgame
is not only rational decision making, based on academic science and solid scientific evidence, but
POLITICAL GAME, with the rules of politics (ie. lobbying, power structures, public perceptions and images etc.)
13.04.2023 Esityksen nimi / Tekijä 21
Successfull tobacco control and endgame is a social change process, where changes in tobacco use, intentions, knowledge and attitudes on one hand, and public policies and legislation on the other hand continuosly interact an influence each other
13.04.2023 Pekka Puska, Director General
13.04.2023 Esityksen nimi / Tekijä 23
Endgame of tobacco is a profound social change process where changes in people’s habits, intentions and attitudes go hand in hand with respective regulatory and legislative changes!
13.04.2023 Esityksen nimi / Tekijä 24
International/global collaboration is vital for successfull endgame
”No single country alone can get rid of tobacco” (Dr. G. H. Brundtland as DG of WHO)
Maximum use of the FCTC instrument!
UN high-level summit on NCDsNew York Sept 2011
• Preceeded by Ministerial Conference in Moscow (April 2011).
• Political declaration• Action on global NCD
prevention and control”• WHO’s leadership,
intersectoral support
FULL USE OF FCTC!
13.04.2023
RECENT POLITICAL SUPPORT
25Pekka Puska, Director General
13.04.2023
Thank you
13/04/2023 Pekka Puska, Director General 27
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