best practices in tobacco control policy: an update

2011 Johns Hopkins Bloomberg School of Public Health

Best Practices in Tobacco Control Policy: An UpdateBest Practices in Tobacco Control Policy: An Update

Johanna Birckmayer, PhD, MPHCampaign for Tobacco Free Kids


The Global Tobacco Problem

Almost one billion men and 250 million women are daily smokers

Currently: 1 in 10 deaths

linked to tobacco 4.9 million people

die each year from tobacco use

By 2030: 8 million people a year will die from tobacco use 80% of those deaths will occur in developing countries

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Global Adult Tobacco Survey (GATS)

The GATS has been conducted in 14 countries between 2008 and 2010

Consistent, high quality methodology produced reliable rates within and across countries

Source: GATS. (2008-2010)

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* Bangladesh and India prevalence for tobacco users


Framework Convention on Tobacco Control (FCTC)

As the world’s first public health treaty, the FCTC is the key legal instrument guiding tobacco control worldwide

Negotiated by the 192 member states of the World Health Organization in 2003, almost all parties have now ratified

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Adding Momentum to the Tobacco Control Movement

The Global Non-Communicable Disease (NCD) Burden By 2030, NCDs are

projected to account for more than 75% of deaths worldwide

Tobacco use is a risk factor for all major NCDs, causing 1 in 6 of NCD deaths

UN High Level Meeting on NCDs calls for accelerated implementation of the FCTC as key component of NCD action plan (September 2011)

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Source: World Health Organization (WHO). (2008). The global burden of disease: 2004 update. Geneva: WHO. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf

Tobacco use

Unhealthy diets

Physical inactivit

y

Harmful use of alcohol

Cardio-vascular

Diabetes

Cancer

Chronic respiratory


Key Tobacco Control Policies

100% smoke-free policies

Graphic warning labels

Bans on tobacco advertising, promotion, and sponsorship (TAPS)

Increase in tobacco price through taxation

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Smoke-Free Policies

New evidence of impact of smoke-free laws Meta-analysis conducted by the United States Institute

of Medicine concluded that smoke-free laws decrease acute coronary events, such as myocardial infarction

Average hospital admissions for asthma dropped 15% among schoolchildren after Scotland’s 2006 smoke-free legislation

Exposure to secondhand smoke estimated to cause over 600,000 premature deaths worldwide each year 47% of premature deaths occur among nonsmoking

women and 28% occur among nonsmoking children

Source: Institute of Medicine.(2009); Mackay, D. et al. (2010); Öberg, M. et al. (2011).

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Countries with 100% Indoor Smoke-Free Policies

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Strong Public Support for Smoke-Free Laws: Turkey

In Turkey, 48% of men smoke

In 2008, the Turkish National Tobacco Control Law made all indoor public places, workplaces, educational institutions, and public transportation smoke-free

In 2010, 7 out of 10 places were complying with the law

In 2010, 92% of Turks and 77% of daily smokers supported the law

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Source: Quirk Global Strategies. Results from opinion research in Turkey: Support for smoke-free legislation. 2010.


Warning Labels

As of September 2011, more than 40 countries have mandated graphic warning labels on cigarette packs

And the list keeps growing …

Pakistan - 2010Malaysia - 2010 United States - 2012


Plain Packaging

A few years ago, tobacco control partners considered plain packaging unlikely to be seen in near future

Instead, legislation in Australia currently under consideration to require plain packaging, and the country appears poised to implement plain packaging

Plain packaging standardizes the appearance of cigarette packages, removes all brand imagery, allowing only the brand name in a mandated size, font, and position Government-mandated information,

such as health warnings, would remain

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Tobacco Advertising, Promotion, and Sponsorship Bans

In 2008, the US National Cancer Institute released a comprehensive monograph on tobacco advertising This was the first major scientific review to conclude

that tobacco advertising has a causal impact on use

GATS data from countries with strong and enforced tobacco advertising, promotion, and sponsorship (TAPS) bans show low rates of exposure to marketing, compared to countries without strong bans 12.4% of adults reporting exposure to tobacco

marketing in Turkey vs. 58.7% of Russian adults Turkey has a strong, well-enforced tobacco

marketing ban while in Russia many forms of marketing are allowed

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Sources: National Cancer Institute. (June 2008). The role of the media in promoting and reducing tobacco use. Tobacco Control Monograph No.19.; Global Adult Tobacco Survey. Turkey (2008) and Russia (2009) Factsheets. Available from: http://www.who.int/tobacco/surveillance/gats/en/index.html


Focus on Point of Sale (POS) Advertising

Tobacco companies spend significant marketing dollars at POS

Relatively few countries ban POS advertising and many are trying to close the loophole or include it in comprehensive TAPS bans

Tobacco companies fight fiercely to exempt advertising and promotion at the POS

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Tobacco Taxes and Price

Prices and taxes for tobacco products vary considerably around the world

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Source: Euromonitor International. (2011). Global briefing- Global tobacco findings 2011: Battle intensifies.


Tobacco Taxes and Price

The growing concern about the devastating impact of tobacco and the need for government revenue means more governments are turning to increased tobacco tax to raise revenue, decrease consumption, and save lives

Countries raising tobacco tax in 2010 include Turkey, Egypt, Mexico, and the United States

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Source: Euromonitor International. (2011). Global briefing- Global tobacco findings 2011: Battle intensifies.


Challenge—Affordability

Affordability of tobacco products varies across countries

Over time, cigarettes have become much less affordable in some countries, while in others they have become much more affordable

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Source: Blecher, E., Van Walbeek, C. (2008).


New Technical Guidance

A new technical manual from WHO provides a set of key recommendations for increasing taxes with the goal of increasing affordability

A new presentation by Frank Chaloupka provides an overview of this guide

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Source: World Health Organization. (2010).


Advances in Tobacco Product Regulation

In 2009, the United States Food and Drug Administration gained the authority to regulate tobacco under the Family Smoking Prevention and Tobacco Control Act Over time, this will provide a model for other countries

to consider

In 2010, Parties approved partial guidelines for FCTC Articles 9 and 10 Articles 9 and 10 require Parties to regulate the

contents of tobacco products and tobacco product disclosures

Countries taking steps to curb the use of additives in tobacco products include Australia, Canada, France, the EU, Singapore, Thailand, and the United States

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New Frontiers: Trade Rules

Liberalized trade is designed to make products more available to more consumers at lower prices to expand their use

Trade rules are increasingly being used to challenge FCTC measures, examples include: 2009: PMI v. Ireland in EU over retail display ban 2010: PMI v. Uruguay under BIT over packaging 2010: Indonesia v. US under WTO over cloves 2010: PMI v. Norway in EU over retail display ban 2011: PMI threatens Australia over plain packaging

Tobacco control partners cannot allow trade rules to become another tool for the industry to challenge legitimate public health measures

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Unending Challenge: Tobacco Industry Opposition

In 2009, Parties to the FCTC unanimously approved Article 5.3 of the Convention Principle 1: there is a fundamental and irreconcilable

conflict between the tobacco industry’s interests and public health policy interests

The industry continues to seek to: Legitimize itself where it operates Interfere with the policy making process Create new users and keep existing ones

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Unending Challenge: Tobacco Industry Opposition

Tobacco companies increasingly engage in litigation challenging strong tobacco control policies; examples include: Smoke-free laws in Argentina and Turkey Advertising, promotion, and sponsorship laws in Brazil,

Scotland, and South Africa Warning labels in Indonesia and Philippines

“In common with all other global consumer products companies, we will continue to focus on [emerging] markets going forward as they generally offer favorable demographic trends, economic growth, and increasing consumer purchasing power.”

—PMI CEO Louis C Camilleri November 2010

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Tobacco Control Policies Reduce Use

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Source: NYC.gov. (2011).

best practices in tobacco control policy: an update

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