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Tobacco Control Research: Local Priority Setting and a Global Vision

Confronting the Epidemic: A Global Agenda for Tobacco Control Research

RITC Focused Research Priority Topics

Integrating Research into a Global Vision: What Have We Learned in Tobacco Control?

Example from South Africa

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Confronting the Epidemic: A Global Agenda for Tobacco Control Research

(

http://www.who.int/tobacco/resources/publications/general/en/)

Published by RITC-WHO in 1999

Based on RITC-sponsored agenda-setting meetings in Africa, Latin America and the Caribbean, and South and Southeast Asia; review of previous agendas

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Research ThemesCountry-Specific Research

Lack of standardized and comparable data; need for county and regional data on:Prevalence and consumptionKnowledge of health risksAttitudes and behaviours with respect to

tobacco use especially in specific population sub-groups

Pricing and tax policies

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Research ThemesPolicy Interventions

Economic policy research:Elasticity of demand studies to determine

optimal levels of taxation according to social class, age and geographic conditions

The determinants, process and impact of illegal trafficking and the influence of smuggling on tobacco use

Opportunities and barriers for harmonization of prices at the regional level

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Research ThemesPolicy Interventions

Legislative research:Effect of international trade agreements

on the production, trade and marketing of tobacco products

Empirical and theoretical research to assist in drafting, implementing and evaluating policies (including those outlined in the FCTC)

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Research ThemesProgramme Interventions

Opportunities/barriers to tobacco control

Optimal components (programs and policies) for a comprehensive tobacco control strategy

Development of effective messages to counter tobacco industry promotions

Behavioural research to test prevention and treatment programmes for specific age/ethnic/cultural groups

Strategies for high risk groups

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Research ThemesTreatment of Tobacco Dependence

Development of a range of approaches to increase cessation in specific populations

Evaluation of pharmaceutical interventions and delivery mechanisms, their cost-effectiveness, and their impact in diverse socio-cultural subgroups.

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Research ThemesTobacco Product Design and

Regulation The biology of tobacco addiction

Characterization of additives of tobacco products

Examination of alternative labelling for tobacco products

Examination of public expectations and behaviour with respect to existing and new tobacco products

A research base for regulation of tobacco products

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Research ThemesTobacco Industry Analysis

Overview of ownership, corporate structure, and regulation of the tobacco industry at local and international level

Tobacco production as an international and regional trade issue in terms of foreign exchange, employment, imports and exports, trafficking

Tobacco industry relationships with government (including lobbying)

Tobacco industry involvement in illegal trade

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Research ThemesTobacco Industry Analysis

Tobacco industry advertising, marketing and promotion activities (particularly with respect to women, children and other high risk groups)

The impact of changes in advertising on consumption and public perceptions

Industry representation of the health consequences of tobacco use and addiction (including their influence on the content and direction of research.)

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Research ThemesTobacco Farming

Relationship of tobacco production to destruction of the ecosystem

Attitudes and beliefs of tobacco farmers and the underlying historical/cultural context

Economic impact of tobacco control in countries that grow and manufacture tobacco or tobacco products for domestic or foreign markets

Opportunities for alternative crops and livelihoods; information on crop options employment for all family members

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Research ThemesTobacco Farming

Cultivation and curing practices at the country and local level

Occupational hazards related to cultivating, curing and handling tobacco

Impact of tobacco cultivation on women and children

The feasibility of diversification in countries heavily dependent on tobacco farming and manufacturing and the mechanisms for supporting these countries in their diversification efforts

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Research ThemesThe FCTC

Research to support specific provisions of the FCTC

Monitoring mechanisms to evaluate the implementation and effectiveness of the FCTC and related protocols

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Cross-cutting Themes

High risk populations

Country readiness

Dissemination

Capacity Development

Mobilization of Human and Financial Resources

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RITC Focused ResearchPriority Topics

Poverty and Tobacco

Tobacco Farming: Health, Livelihoods, Economics and the Environment

Health Systems Interventions

Globalization, Trade and Tobacco

Alternate Forms of Tobacco Use

What have we learned from tobacco?

Lesson # 1

There is no “magic bullet”

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Lesson #1

A comprehensive strategy is needed to change social norms and support individual behaviour change

This consists of: Programming Policy Mass media Research Community development Industry “denormalization”

What have we learned from tobacco?

Lesson # 2

All sectors must work together

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Coordination of All Sectors

Researchers

Policy-makers

Advocates

Practitioners

The media

Private sector

Public

The Media

Public Opinion

Main Policy

SectorsVOLUNTARYPRIVATE

Policy Sectors in Tobacco Control

PUBLIC

Source: Waverley Brigden, L. (1997) after Spicker, P. (1995) & Kingdon, J.W. (1995)

What have we learned from tobacco?

Lesson # 3

Understand the politics

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Politics

Multinational industries have enormous resources and the ability to influence policy-makers

They can argue on economic grounds as well as from a health standpoint (e.g., loss of jobs)

Ability to provide jobs and manufacturing

A problem “solved” in the developed world may emerge in developing countries

They are always several steps ahead of us (e.g., waterpipe, harm-reduction tobacco products)

Industries will often challenge “health” research

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South Africa

A “policy window”

A “champion” in the Minister of Health

Strong advocacy

A sound research base

“Framing” as both a health and economic issue

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Cigarette prices and consumptionSouth Africa

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100

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1961

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Real

pri

ce p

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pack o

f 20 (

1995

cen

ts)

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Cig

are

tte c

on

su

mp

tio

n (

mil

lio

ns

of

packs)

Real price of cigarettes Consumption of cigarettes

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Cigarette excise taxes and government revenue – South Africa

0

50

100

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250

19

61

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63

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65

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67

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69

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71

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ate

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Re

al

ex

cis

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nu

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Real excise rate (1995 prices, cents/pack of 20)

Real excise revenue (1995 prices, R million)

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Trends in Cigarette Consumption and Smoking Prevalence

Year

1993 2000

Cigarette consumption (millions of packs)

1,802 1,333

Per capita consumption (packs p.a. aged 15+)

72.6 45.7

Smoking prevalence percentage (15+)

32.6 27.1

Avg. consumption per smoker (packs p.a.)

223 169

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Changes in Smoking Prevalence by Gender and Age Group

1993 2000 Change

Male 51.4 43.8 -7.6

Female 12.9 11.7 -1.2

Aged 16–24 24.0 18.7 -5.3

Aged 25–34 38.7 31.9 -6.8

Aged 35–49 38.5 35.2 -3.3

Aged 50+ 23.4 22.5 -0.9

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Lessons Learned: 6 Case Studies

Legislative successes won in the face of vigorous opposition from an industry striving to protect its profits and market

Key role played by NGOs and charismatic individuals with commitment and dedication

Coalitions brought new skills and perspectives

Effective advocacy has to be learned

Lack of an organizational home and minimal level of funding make it hard to operate effectively

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Lessons Learned: 6 Case Studies (cont’d)

Strong political support and political champions are crucial to success

Significant transformations in social norms can occur

The media can have a powerful role in influencing popular opinion

Understand the political framework and legislative timetable of the country

Legislation must be coupled with attention to implementation and enforcement

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Lessons Learned: 6 Case Studies (cont’d)

Sound research is needed for good policy decisions

Policies and strategies must be comprehensive

It may be necessary to bring together diverse interest groups (e.g., Ministries of Health and Finance)

Even when the situation has seemed hopeless, progress has been made

Persistence is essential

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Thank You

Linda Waverley

http://www.idrc.ca/ritc