The Tobacco Epidemic - Today

1 |

The Tobacco Epidemic - Today

Source: WHO Report on the global tobacco epidemic, 2008

2 |

The Tobacco Epidemic is about to Get Much Worse

The Tobacco Epidemic is about to Get Much Worse

Second-hand smoke is estimated to cause ~600,000 premature deaths/year

Tobacco currently kills more than 5 million/yr but this will increase to over 8 million/yr in 2030

If current smoking patterns continue, the death toll from tobacco use will be: –2000 – 2025 ~ 150M–2025 – 2050 ~ 300M–2050 – 2100 > 500M (Peto, WHA 2008)

TOTAL for 20th Century 0.1 billion

TOTAL for 21st Century 1 billionTOTAL for 21st Century 1 billion

(half the deaths in middle age)

3 |

Tobacco Consumption:Geographic Changes

Tobacco Consumption:Geographic Changes

Source: WHO calculations using ERC data.

Mechanisms of Tobacco Control

5 |

WHO Framework Convention on Tobacco Control (WHO FCTC)

WHO Framework Convention on Tobacco Control (WHO FCTC)

First global health treaty negotiated under the auspices of WHO

The WHO FCTC– establishes tobacco control as a

priority on the public health agenda– provides an evidence-based tool for

adoption of sound tobacco control measures

– introduces a mechanism for firm country commitment and accountability

168 parties as of February 2010

Entry into force 27 Feb 2005

168

6 |

Conference of the Parties (COP)Conference of the Parties (COP)

The Conference of the Parties (COP) is the governing body of the WHO Framework Convention on Tobacco Control (WHO FCTC) and is comprised of all Parties to the Convention, in accordance with Article 23 of the WHO FCTC.

The COP shall keep under regular review the implementation of the Convention and take the decisions necessary to promote its effective implementation and may also adopt protocols, annexes and amendments to the Convention.

The COP may establish such subsidiary bodies as are necessary to achieve the objective of the Convention The COP also established several working groups with the mandate to elaborate guidelines and recommendations for the implementation of the different treaty provisions.

7 |

Working groups currently established by the COP

Working groups currently established by the COP

The COP requested four working groups to elaborate draft guidelines and recommendations for implementation of:

Articles 9 & 10: "Regulation of the contents of tobacco products" and "Regulation of tobacco product disclosures"

Article 12: "Education, communication, training and public awareness"

Article 14: "Demand reduction measures concerning tobacco dependence and cessation"

Articles 17 & 18: "Provision of support for economically viable alternative activities" and "Protection of the environment and the health of persons"

8 |

WHO FCTC Guidelines adopted by COPWHO FCTC Guidelines adopted by COP

Article 5.3 Guidelines on the protection of public health policies with respect to tobacco control from commercial and other vested interests

Article 8 Guidelines on the protection from exposure to tobacco smoke

Article 11 Guidelines on packaging and labelling of tobacco products

Article 13 Guidelines on tobacco advertising, promotion and sponsorship

WHO TFI Supporting the implementation

of the FCTC

WHO TFI Supporting the implementation

of the FCTC

10 |

Tobacco Free Initiative (TFI)Tobacco Free Initiative (TFI)

VISIONTo reduce the burden of disease and death caused by

tobacco use, thereby protecting present and future generations from the devastating health, social,

environmental and economic consequences of tobacco consumption and exposure to tobacco smoke

11 |

TFI PrioritiesTFI Priorities Supporting health system development by building the capacity of decision

makers and partners at regional and country level;

Addressing economic policy issues with evidence-based knowledge and information;

Strengthening partnerships with strategic international organizations, decision makers and civil society;

Scaling up capacity for implementation of tobacco control interventions and the WHO-FCTC;

Strengthening surveillance, monitoring and evaluation systems;

Communication and advocacy.

12 |

TFI : Bringing in Change – MPOWER strategy

TFI : Bringing in Change – MPOWER strategy

• monitor tobacco use and prevention policies

• protect people from tobacco smoke

• offer help to quit tobacco use• warn about the dangers of

tobacco• enforce bans on tobacco

advertising, promotion and sponsorship

• raise taxes on tobacco

13 |

Only 5 per cent of the world's population were covered by Only 5 per cent of the world's population were covered by comprehensive smoke-free laws in 2008 (up from 3% in 2007)comprehensive smoke-free laws in 2008 (up from 3% in 2007)

14 |

Article 6 - TaxationArticle 6 - Taxation

95% of world's population living incountries where taxes represent <75% of retail price Back


15 |

Article 8 – Smoke-FreeArticle 8 – Smoke-Free

2% of world's population live in countries with comprehensivesmoke-free laws that also have high level of compliance


16 |

Article 11 – Health Warnings Article 11 – Health Warnings

8% of the world's population live in a country with strong GRAPHICWARNINGSWARNINGS on cigarette packs


18 |

Article 13 – Advertising Article 13 – Advertising

More than 90% of the world's population is unprotected from tobacco industry marketing


19 |

DIRECT ADVERTISINGBillboards, print media, radio, TV

SPONSORSHIPSports, music eventsBRAND STRETCHING

Holidays, cafés, musicMERCHANDISING

Lighters, clothing

LOYALTY SCHEMES AND COUPONS• Collecting coupons to exchange for promotional

items• Coupons may offset the effect of price increases

PACKAGINGReinforce brand imageryPRODUCT PLACEMENT

Films and TVOTHER MARKETING COMMUNICATIONS

Events/Participatory promotionsPOINT OF SALE

Cigarette pack "power-walls"

FREE SAMPLESA popular industry strategy

Article 13 Guidelines:Ban or restrict marketing

20 |

Article 14 – Cessation Article 14 – Cessation

Only 17 countries provide access to comprehensive help to quit smokingBack


21 |

Cross Cutting Issues– Tobacco Industry Monitoring– Gender– Litigation support– Economics – International Development– Social Determinants– Intersectoral action– UN Task Force– MDG

Expert Groups: – WHO Study Group on Tobacco Product Regulation– WHO Tobacco Laboratory Network

Global Level Implementation of WHO FCTC – Cross-cutting

22 |

Gender-Specific Policy for Tobacco Control Gender-Specific Policy for Tobacco Control

There are different health risks associated with women’s smoking:

Faster development of certain diseases like lung cancer

Irreversible and serious health consequences for pregnant women and foetus

World No Tobacco Day 2010

23 |

POLITICAL WILL

Ministry of Health

Ministry of FinanceMinistry of Justice

Ministry of Education

Ministry of Agriculture

PUBLIC AWARENESSNGOsMedia

Health Professionals

Trade unions

INTERNATIONAL SUPPORT

WLF

Bloomberg Philanthropies

CDC

Donor countries

Gates foundation

INTERGOVERNMENTAL WORK

WHO Headquarter (TFI)

WHO Country offices

WHO Regional Office

UN task force

SCIENTIFIC EVIDENCE

Researchers

IARC

WHO Collaborating Centres (UCSF)

WHO FCTC

Working togetherWorking together

to curb the to curb the

tobacco epidemictobacco epidemic

INTERSECTORAL ACTION

Tobacco Industry

25 |

Largest Manufacturers/sellers of cigarettesLargest Manufacturers/sellers of cigarettes

• China National Tobacco CorporationChina National Tobacco Corporation• Philip Morris International and Philip Morris USA Philip Morris International and Philip Morris USA • British American Tobacco and associates British American Tobacco and associates

(including ITC and Reynolds American) (including ITC and Reynolds American) • Japan Tobacco International/Japan TobaccoJapan Tobacco International/Japan Tobacco• Imperial TobaccoImperial Tobacco

The “tobacco industry”The “tobacco industry”The “tobacco industry”The “tobacco industry”

26 |

TOBACCO INDUSTRY INTERFERENCETOBACCO INDUSTRY INTERFERENCE

attempts to undermine science and legitimate messages from scientific quarters

the manipulation of the media

the industry’s public relations efforts

tactics designed to gain control of the public agenda

lobbying efforts

the use of front groups and artificially created grassroots movements

intimidation

harassment of tobacco control professionals Source: Fox B, Bialous S, Trochim W, Stillman F and Schmitt CL. Monograph 17: Evaluating ASSIST – A blueprint for understanding atate-

level tobacco control. Chapter 8. Evaluating tobacco industry tactics as a counterforce to ASSIST. 2006. http://cancercontrol.cancer.gov/tcrb/monographs/17/m17_complete.pdf

27 |

Remains profitableRemains profitable

Expanding into low and middle income, but remaining Expanding into low and middle income, but remaining profitable in several high income countriesprofitable in several high income countries

Top of merger and acquisitions phaseTop of merger and acquisitions phase

New products, including smokelessNew products, including smokeless

In favor of “reasonable" regulationIn favor of “reasonable" regulation

Differences when competing, alliances when faced with Differences when competing, alliances when faced with stricter regulatory framework.stricter regulatory framework.

The “tobacco industry”The “tobacco industry”The “tobacco industry”The “tobacco industry”

28 |

Tobacco industry strategies to undermine tobacco control activities at the Tobacco industry strategies to undermine tobacco control activities at the World Health OrganizationWorld Health Organization

Tobacco industry strategies to undermine tobacco control activities at the Tobacco industry strategies to undermine tobacco control activities at the World Health OrganizationWorld Health Organization

“the evidence shows that tobacco companies have operated for many years with the deliberate purpose of subverting the efforts of WHO to address tobacco issues. The attempted subversion has been elaborate, well financed, sophisticated and usually invisible… This inquiry adds to the mounting evidence that it is also a struggle against an active, organized and calculating industry.”

Source: World Health Organization committee of experts on tobacco industry documents. Tobacco industry strategies to undermine tobacco control activities at the World Health Organization. 2000. Available from http://www.who.int/tobacco/en/who_inquiry.pdf

29 |

US vs PM et al.: Judge Kessler Final OpinionUS vs PM et al.: Judge Kessler Final OpinionUS vs PM et al.: Judge Kessler Final OpinionUS vs PM et al.: Judge Kessler Final Opinion

"the intricate, interlocking, and overlapping web of national and international organizations, committees, affiliations, conferences, research laboratories, funding mechanisms, and repositories for smoking and health information which Defendants established, staffed, and funded in order to accomplish the following goals: counter the growing scientific evidence that smoking causes cancer and other illnesses, avoid liability verdicts in the growing number of plaintiffs’ personal injury lawsuits…and ensure the future economic viability of the industry.“

Source: Kessler G. Final Opinion: United States of America v. Philip Morris.

Civil Action No. 99-2496 (GK). 2006. http://tobacco.neu.edu/litigation/cases/DOJ/20060817KESSLEROPINIONAMENDED.pdf

30 |

Main Challenge?Main Challenge?Main Challenge?Main Challenge?

Dissemination of information to a level where Dissemination of information to a level where

awareness of tobacco industry’s CSR awareness of tobacco industry’s CSR

strategies and its impact on health, strategies and its impact on health,

community welfare and sustainable community welfare and sustainable

development become integrated in the development become integrated in the

decision making process of policy makers decision making process of policy makers

and opinion leaders, as well as the populationand opinion leaders, as well as the population

31 |

TFI ongoing monitoring of industry activitiesTFI ongoing monitoring of industry activitiesTFI ongoing monitoring of industry activitiesTFI ongoing monitoring of industry activities

Monitoring the industry and sharing information Monitoring the industry and sharing information about industry’s strategies to derail tobacco about industry’s strategies to derail tobacco control is a WHO mandatecontrol is a WHO mandate

Resolution 54.18 of the 54th World Health Resolution 54.18 of the 54th World Health Assembly (May 2001)Assembly (May 2001)

TFI main activities on industry monitoring: TFI main activities on industry monitoring: tracking information for database, awareness tracking information for database, awareness raising, background information, technical raising, background information, technical assistance to member states and sister UN assistance to member states and sister UN agenciesagencies

Art.5.3

32 |

Tobacco industry interference with tobacco control

Tobacco industry interference with tobacco control

Documents history of Documents history of attempts to interfere with attempts to interfere with tobacco controltobacco control

Recent strategiesRecent strategies

Old strategies with new Old strategies with new “clothes”“clothes”

Source: http://whqlibdoc.who.int/publications/2008/9789241597340_eng.pdf

33 |

PrinciPrinciple 1: There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests.

Principle 2:Principle 2: Parties, when dealing with the tobacco industry or those working to further its interests, should be accountable and transparent.

Principle 3: Principle 3: Parties should require the tobacco industry and those working to further its interests to operate and act in a manner that is accountable and transparent.

Principle 4: Principle 4: Because their products are lethal, the tobacco industry should not be granted incentives to establish or run their businesses.

Article 5.3 GUIDING PRINCIPLES

34 |

"We must make the prevention and control of non-communicable diseases and improvement of maternal health top priorities of the development agenda.

Both are part of the agenda for strengthening health systems and revitalizing health care.

Both are fully ready and mature areas for efficient interventions with a huge return.

Both are begging for more attention."

Dr Margaret ChanWHO Director-GeneralECOSOC High-level Segment 6 July 2009

WHO has accorded a high priority to scaling up technical support for WHO has accorded a high priority to scaling up technical support for the prevention and control of non-communicable diseases in the prevention and control of non-communicable diseases in developing countriesdeveloping countries

The Tobacco Epidemic - Today

Documents

Transcript of The Tobacco Epidemic - Today