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Effective Interventions to Reduce Tobacco Use. Joy de Beyer Tobacco Control Coordinator World Bank Meeting of Mediterranean Countries, Malta, September 2001. Outline. Why intervene to reduce tobacco use ? Which interventions are effective, and how do we know?
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Effective Interventions to Reduce Tobacco Use Joy de Beyer Tobacco Control Coordinator World Bank Meeting of Mediterranean Countries, Malta, September 2001
Outline • Why intervene to reduce tobacco use ? • Which interventions are effective, and how do we know? • Which interventions are not effective? • Who are the key stakeholders ?
Why intervene to reduce tobacco use ?Large and growing number of deaths from tobacco World: Annual Tobacco Deaths (millions) 2000 2030 Developed 2 ~3 Developing ~2 ~7 World Total 4 ~10 • 1 in 2 of long-term smokers killed by their addiction • 1/2 of deaths in middle age (35-69) Source: Peto, Lopez, and others 1997; WDR 1993
Tobacco Attributable Deaths in EU Countries in the Mediterranean Region Source: Peto, Lopez, 2001
Tobacco Related Deaths in Mediterranean Countries in 1990Tracheal, Lung & Bronchial Cancer per 100,000 deaths
1.1 Billion Smokers Worldwide(1990-1995 estimate, million) Males Females Total Developed 200 100 300 Developing 700 100 800 World 900 200 1.1 Bil.
Why should governments intervene?Economic rationale – “market failures” • People do not know the risks of tobacco use • Most smokers start young – protect youth • Nicotine is VERY addictive • Tobacco users impose costs on others • second hand smoke harms non-smokers • children and infants need protection • health care costs (families and government) • opportunity cost for families
3 strong reasons for governments to intervene • Deter children from smoking • Protect non-smokers from others’ smoke • Provide adults with good information so they can make well-informed choices
Smoking Prevalence (1990s) and Consumption (1999) in Selected Mediterranean Countries
Allocating Tobacco Expenditure to Other Goods and ServicesBetter Nutrition, Better Health: Evidence from Hungary
Effective interventions to reduce tobacco use • Higher cigarette taxes • Non-price measures: • Consumer information, large clear warning labels • Comprehensive bans on cigarette advertising and promotion, or counter-advertising • Restrictions and bans on smoking in workplaces and other public places • Help for people who want to quit • Better access to cessation therapies such as nicotine replacement (NRT), etc
Interventions that are not effective in reducing tobacco use Most “supply side” measures: • Prohibition • Youth access restrictions • Crop substitution • Trade restrictions Control of smuggling is the exception. It is the key supply-side measure.
An effective measure:Complete Ban on Tobacco Advertising and PromotionConsumption trends in countries with such bans v. those with no bans n=102 countries) 1
Current smokers need help!Cessation Treatments • Cessation support from health professionals is key • NRTs double the effectiveness of cessation efforts • Quit lines, community support, etc., also work • Governments may increase accessibility and affordability of NRTs by: • OTC sales, allowing advertising, licensing • Conducting more studies on cost-effectiveness (especially in low/middle income countries) • Considering NRT subsidies for poorest smokers
Cessation Efforts:Health Care Professionals First Physician rate: Greece, Italy, Malta, Spain, Turkey, Egypt, Syria Medical Student rate: Algeria (male+female), Morocco, Tunisia, Cardiologist: France
Key stakeholders • Ministry of Finance: Tobacco Tax Revenues • Customs Administration: Smuggling, Border Control • Ministry of Labor: Farmers and Manufacturing Labor • Ministry of Agriculture: Tobacco Production • Ministry of Education: Youth education on tobacco • Smokers: Low prices, variety and appealing products • Producers: Profit, market share, sales • Ministry of Trade: Export earnings from tobacco
Ministry of Finance: Tobacco is a good source of government tax revenue EU Med: France, Greece, Italy, Portugal, Spain Other Med: Algeria, Cyprus, Egypt, Morocco, Jordan,Lebanon, Syria, Turkey, Tunisia,
Summary: Modest action could achieve great gains for public health without hurting the economy