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PATHFINDER CASE STUDY

PATHFINDER CASE STUDY. TOBACCO CONTROL. Points to ponder. This is a model, not a definitive analysis Does this model reflect the way outcome is attributed to policy in your organisation?. NGOs. Ministry of Education. Customs and Excise. Tobacco Consumption. Health Status.

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PATHFINDER CASE STUDY

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  1. PATHFINDER CASE STUDY TOBACCO CONTROL

  2. Points to ponder • This is a model, not a definitive analysis • Does this model reflect the way outcome is attributed to policy in your organisation?

  3. NGOs Ministry of Education Customs and Excise • Tobacco Consumption • Health Status Ministry of Health Treasury International Agencies LEGISLATION TAX HEALTH PROMOTION

  4. MINISTRY OF HEALTH • HEALTH STATUS FOR NEW ZEALANDERS

  5. FUNDING POLICY MINISTRY OF HEALTH • HEALTH STATUS FOR NEW ZEALANDERS PROGRAMMES

  6. TOBACCO CONSUMPTION POLICY • HEALTH STATUS FOR NEW ZEALANDERS PROGRAMMES EVIDENCE FUNDING MINISTRY OF HEALTH

  7. THE LINK BETWEEN TOBACCO CONSUMPTION AND HEALTH STATUS • 4,700 New Zealand smokers die from smoking-related illnesses each year • In terms of Years of Life Lost (YLLs) the average smoker incurs 6.2 • In 1996, there were 49,960 YLLs attributable to smoking

  8. THE LINK BETWEEN TOBACCO CONSUMPTION AND HEALTH STATUS • Secondhand smoke increases the risk of SIDS and childhood respiratory disease, and causes 388 deaths per year in NZ • Tobacco is responsible for a large proportion (~25%) of the inequality in health status between Pakeha and Non-Pakeha

  9. TOBACCO CONSUMPTION POLICY • HEALTH STATUS FOR NEW ZEALANDERS PROGRAMMES EVIDENCE FUNDING “reducing smoking (and the harm from second hand smoke)” Goal 6, Objective 28, NZHS MINISTRY OF HEALTH

  10. TAXATION ON TOBACCO LEGISLATION CONCERNING TOBACCO • TOBACCO CONSUMPTION MINISTRY OF HEALTH HEALTH PROMOTION A1 A2 B1 B2 C2 C1

  11. HEALTH PROMOTION: MEDIA NRT COUNSELLING • TOBACCO CONSUMPTION MINISTRY OF HEALTH C1 C2

  12. MEDIA • Media-led tobacco cessation campaigns can: •  awareness of the harm of smoking • For example, awareness that every cigarette is doing damage from 75% to 82% (Australia) •  the utilisation of cessation services and products • For example, a 34% increase in calls to Quitline following media coverage of the link between smoking and blindness (New Zealand)

  13. MEDIA • Media-led tobacco cessation campaigns can: •  the frequency of quit attempts • For example, an increase in one year quit rate from 8% to 11% among smokers and recent quitters •  the prevalence of smoking • For example, by 1.5% in Australia

  14. COUNSELLING • Various reviews by Cochrane TAG: • Physician or nurse advice • Telephone counselling • Self-help material • Individual or group therapy • ALL helpful for smoking cessation • Of proven economic value is antenatal smoking cessation for pregnant women: savings of $3.31 for every $1 spent on counselling services.

  15. NICOTINE REPLACEMENT THERAPY • Significantly more efficacious than placebo • Odds ratio for abstinence with NRT compared to placebo of 1.73 (95% CI 1.62 – 1.85) • All forms of NRT effective • Different forms have different odds ratios, and there is some evidence that combinations are more effective • NRT products increase quit rates ~ 1.5 to 2 fold regardless of setting

  16. HEALTH PROMOTION: MEDIA  NRT COUNSELLING • TOBACCO CONSUMPTION MINISTRY OF HEALTH C1 C2

  17. QUITLINE and NRT in NZ • Quitline since mid-1998 • Subsidised NRT in November 2000 • Three-month evaluation

  18. 31,992 YLLs saved 726,300 smokers 360 quitters 2,232 YLLs saved x6.2 5,160 quitters NRT NRT net benefit: 29,760 YLLs saved No NRT x6.2

  19. QUITLINE and NRT in NZ • Coverage 20,600 smokers • Cost $2.5 million • Benefit 29,760 YLLs saved • Period: 3 months

  20. TAXATION ON TOBACCO LEGISLATION CONCERNING TOBACCO • TOBACCO CONSUMPTION MINISTRY OF HEALTH HEALTH PROMOTION A1 A2 B1 B2 C2 C1

  21. TOBACCO CONSUMPTION MINISTRY OF HEALTH TAXATION (EXCISE) ON TOBACCO PRODUCTS A1 A2

  22. TAXATION • WHO: most econometric studies show a convincing decrease in consumption as tax rates increase • Tobacco Industry: strongly resistant to taxation compared with other tobacco control interventions (internal industry documents) • World Bank: price increase of 10% would reduce smoking by about 4% in high income countries and by about 8% in low and middle income countries.

  23. TAXATION • Groups most responsive to price changes: • young people • people on low incomes • people with less education

  24. TOBACCO CONSUMPTION MINISTRY OF HEALTH HIGH TAXATION (EXCISE) ON TOBACCO PRODUCTS A1 A2

  25. TAXATION in NZ • In December 1995: • 38%  in the excise on loose tobacco  17%  in consumption of loose tobacco. • (This change equalised the excise on loose tobacco with that of manufactured cigarettes – there was no change in overall consumption). • In May 1998: • 13%  in tax  6%  in total tobacco consumption. • In May 2000: • 20%  in price (14%  in tax + 6%  in tobacco company price)  18%  in total tobacco consumption.

  26. 726,300 smokers 1,830,276 cigs/day 130,734 quitters 10,168,200 cigs/day 810,550 YLLs saved x6.2  tax NRT net benefit: 801,548 YLLs saved No  tax 20,328 cigs/day 9,002 YLLs saved 1,452 quitters x6.2

  27. 726,300 smokers 8,337,924 cigs/day $2,334,618 per day 10,168,200 cigs/day x $0.28 per cig  tax Net Revenue 2º to 20%  in tax ($100,871) per day ($9,204,478) per quarter No  tax 10,147,872 cigs/day $2,435,489 per day x $0.24 per cig

  28. TAXATION in NZ • Consumption decreases 18% • Equivalent to ~130,000 fewer smokers • Equivalent to 810,550 YLLs saved • Cost $9.2 million in lost excise revenue per quarter

  29. TAXATION ON TOBACCO LEGISLATION CONCERNING TOBACCO • TOBACCO CONSUMPTION MINISTRY OF HEALTH HEALTH PROMOTION A1 A2 B1 B2 C2 C1

  30. TOBACCO CONSUMPTION MINISTRY OF HEALTH B1 B2 LEGISLATION CONCERNING TOBACCO

  31. LEGISLATION • RESTRICTING TOBACCO SALES • Legislation can  smoking participation among young people • The effect is especially apparent when retailer education and enforcement is used in conjunction with legislation • In NZ, the number of sales to under-age volunteers fell from 10% to 5% over two years utilising a policy of retailer education, surveillance, and enforcement

  32. LEGISLATION • SMOKEFREE WORKPLACES •  smoking at work • rate of smoking by heavy smokers  by 25% (Australia) •  the cessation rate of workers by 25% (Australia) •  exposure of workers to ETS • In USA, exposure to ETS in a restaurant is ~1.8 x higher than in an office, in a bar exposure is ~5 x than in an office • In NZ, worker exposure to ETS decreased by ~50% following the SEA 1990

  33. 75,000 workers 77.5 YLLs saved 18,750 smokers 10 quitters 62 YLLs saved x6.2 12.5 quitters BAN net benefit of BAN: 15.5 YLLs saved No BAN x6.2

  34. LEGISLATION • SMOKEFREE WORKPLACES • Effect of workplace ban: • 25% increase in quit rate of workers • Equivalent to saving 15.5 YLLs • Period: 3 months • Cost: negligible (enforcement)

  35. LEGISLATION • PROPOSED EVALUATION OF AMENDMENTS TO SEA 1990 • the effect on total NZ tobacco consumption • the effect on barworkers’ respiratory health • analysis of nicotine exposure in hospitality workers • hospitality industry employment statistics • qualitative assessment of the attitudes and experiences of hospitality venue owners and managers • hospitality venue patrons attitudes to second hand smoke/smoking in licensed premises • community attitudes to bans on smoking in licensed premises

  36. TAXATION ON TOBACCO LEGISLATION CONCERNING TOBACCO • TOBACCO CONSUMPTION MINISTRY OF HEALTH HEALTH PROMOTION 810,550 YLLs A1 A2 B1 B2 15 YLLs C2 C1 29,760 YLLs

  37. NGOs Ministry of Education Customs and Excise • Tobacco Consumption • Health Status Ministry of Health Treasury International Agencies LEGISLATION TAX HEALTH PROMOTION

  38. NGOs Ministry of Education Customs and Excise • Tobacco Consumption • Health Status Ministry of Health Treasury International Agencies • Life expectancy 5 years •  GDP £3-5 billion (Wanless Report) LEGISLATION TAX HEALTH PROMOTION STATE OF THE ECONOMY

  39. NGOs Ministry of Education Customs and Excise • Tobacco Consumption • Health Status Ministry of Health Treasury International Agencies • Inequality in income  • (self-reported) health status (independent of the effect of income) (Kennedy et al, 1998) LEGISLATION TAX HEALTH PROMOTION STATE OF THE ECONOMY

  40. NGOs Ministry of Education Customs and Excise • Tobacco Consumption • Health Status Ministry of Health Treasury International Agencies Highest smoking prevalence  beneficiaries, low incomes (Tobacco Facts, 2001) LEGISLATION TAX HEALTH PROMOTION STATE OF THE ECONOMY

  41. NGOs Ministry of Education Customs and Excise • Tobacco Consumption • Health Status Ministry of Health Treasury HEALTH PROMOTION International Agencies “present levels of [tobacco] taxation appear indefensible on externality grounds” (Tax Review 2001) LEGISLATION TAX STATE OF THE ECONOMY

  42. CONCLUSIONS • This model provides a way of thinking about other influences on outcomes. • The policy framework involves many subtle interactions on the path to outcomes. • This model may be useful for directing research around the attribution of outcomes.

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