1.2 billion smokers globally 83% of global smokers (956 million) live in developing countries

1. 1.2 billion smokers globally83% of global smokers (956 million) live in developing countries Prevalence rates in selected developing countries 1990s

2. Smoking- the epidemic of the 20th C • 100 million people died of tobacco-related causes during the 20th century • The WHO predicts that, without intervention, tobacco will kill more than 8 million people every year by 2030, and 1 billion this 21st century; 80% of those deaths will occur in developing countries • The WHO proposes six policies to reduce global tobacco deaths: the FCTC • 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

3. Unless current smokers quit, smoking deaths will rise dramatically over the next 50 years Source: Peto and Lopez, 2001

4. Famous Issues in Epidemiology • A second year medical student Ernst Wynder 1948, attended the autopsy of a two-pack-a-day smoker who had died from lung cancer • collected case histories of lung cancer victims • Captured the interest of thoracic surgeon Evarts Graham. He was a sceptical smoker. • 1950 Wynder and Graham published a large case-control study that had used standardised interviews linking smoking and lung cancer • In the following decade, hundreds of reports were published linking lung cancer and smoking • Doctors were convinced of the health risks of smoking. Many doctors quit, including Graham, who quit in 1952, but died of lung cancer in 1957

5. TOBACCO and LUNG CANCERThe 1950 Large Case Control Studies* Author Cases Controls OR % of Non-Smokers Doll & Hill 0.3 4.2 14 Wynder & Graham 1.3 14.6 13 *More than 600 Men per group. Smokers were all life-long smokers, and ex-smokers were carefully excluded Conclusion: Life-long Smokers are 13-14 times as likely to get lung cancer as life-long never smokers

6. Major cause Lip Mouth Pharynx Oesophagus Larynx Lung Pancreas Kidney, pelvis Bladder Associated Nose Stomach Kidney, body Liver Colorectal Cervix uteri Childhood cancer TobNutr Cancers associated with smoking AD164 From: Doll, 1988

7. Chronic Non-communicable Diseases-NCD • Cardiovascular disease, mainly heart disease and stroke • Cancer • Chronic respiratory diseases • Diabetes

8. Adult per capita consumption of tobacco products in the 20th Century in Australia 4.0000 Early research on health effects of smoking Report of the US Surgeon General 3.5000 Broadcast of tobacco Uptake by women advertising phased out 3.0000 Commencement of Quit Campaigns Tobacco Taxation World War II 2.5000 Introductionof Annual amount of tobacco dutied per adult over 15 years ( kg) manufactured Workplace smoking bans introduced Depression cigarettes 2.0000 New health warnings 1.5000 1.0000 0.5000 0.0000 1903 1906 1909 1912 1915 1918 1921 1924 1927 1930 1933 1936 1939 1942 1945 1948 1951 1954 1957 1960 1963 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 Year

9. Trends in lung cancer mortality and smoking prevalence in Australia 1940-2004

10. TobNutr Impact of lung cancer on male cancermortality trends in Australia: 1910–94 180 170 160 150 1401301201101009080 All cancer All cancer without lung Age standardised mortality per 100,000 males 1910 1920 1930 1940 1950 1960 1970 1980 1990 Year of Death AD145 Anti-Cancer Council of Victoria Epidemiology Centre, 1996

11. Taxation is the most effective measure around the globe • As taxes/prices increase, consumption falls • A 10% increase in price reduces cigarette consumption by: • 4% in developed countries, • 8% in developing countries • People with low incomes (including youth) are more price-sensitive • A 10% price increase reduces smoking as much as 10% among youth and poor groups • Deters youth from taking up smoking

12. How Price/Tax Measure WorkPrice Elasticity EvidenceAs price/ tax increases, consumption decreases

13. Prevalence of Tobacco Use in China: Taxation Works

14. Tobacco advertising:Most effective way of gaining market share and attracting new smokers Evidence show that: Smokers often associate smoking imported-cigarettes with: • Glamour • Economic independence • High social status • Smoking healthier cigarettes • with low tar and nicotine level and “light” brands • Better taste and easy inhale “quality” • Competitive prices with domestic brands

15. Countries that support advertising ban with comprehensive TC measures are more successful on reducing consumptionBanning Tobacco Advertising Works

16. 3 Historical trend 2.5 Packs smoked (billions) Proposition 99 2 Media campaign suspended and reinstated 1.5 1980 1982 1984 1986 1988 1990 1992 1994 Smoking Rates: CaliforniaAnti Tobacco Mass Media Works Stan Glanz Tobacco Wars-Media impact

17. Government ResponsibilitiesWHO Framework Convention on Tobacco Control (FCTC) 2005, Signed by Most Countries and Ratified by Many: includes 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