Best Practices in Tobacco Control Policy: An Update

1. Best Practices in Tobacco Control Policy: An Update Johanna Birckmayer, PhD, MPH Campaign for Tobacco Free Kids

2. The Global Tobacco Problem • Almost one billion men and 250 million women are daily smokers • Currently: • 1 in 10 deaths linked to tobacco • 4.9 million people die each year from tobacco use • By 2030: • 8 million people a year will die from tobacco use • 80% of those deaths will occur in developing countries

3. Global Adult Tobacco Survey (GATS) • The GATS has been conducted in 14 countries between 2008 and 2010 • Consistent, high quality methodology produced reliable rates within and across countries * Bangladesh and India prevalence for tobacco users Source: GATS. (2008-2010)

4. Framework Convention on Tobacco Control (FCTC) • As the world’s first public health treaty, the FCTC is the key legal instrument guiding tobacco control worldwide • Negotiated by the 192 member states of the World Health Organization in 2003, almost all parties have now ratified

5. Adding Momentum to the Tobacco Control Movement • The Global Non-Communicable Disease (NCD) Burden • By 2030, NCDs are projected to account for more than 75% of deaths worldwide • Tobacco use is a risk factor for all major NCDs, causing 1 in 6 of NCD deaths • UN High Level Meeting on NCDs calls for accelerated implementation of the FCTC as key component of NCD action plan (September 2011)              Source: World Health Organization (WHO). (2008). The global burden of disease: 2004 update. Geneva: WHO. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf

6. Key Tobacco Control Policies • 100% smoke-free policies • Graphic warning labels • Bans on tobacco advertising, promotion, and sponsorship (TAPS) • Increase in tobacco price through taxation

7. Smoke-Free Policies • New evidence of impact of smoke-free laws • Meta-analysis conducted by the United States Institute of Medicine concluded that smoke-free laws decrease acute coronary events, such as myocardial infarction • Average hospital admissions for asthma dropped 15% among schoolchildren after Scotland’s 2006 smoke-free legislation • Exposure to secondhand smoke estimated to cause over 600,000 premature deaths worldwide each year • 47% of premature deaths occur among nonsmoking women and 28% occur among nonsmoking children Source: Institute of Medicine.(2009); Mackay, D. et al. (2010); Öberg, M. et al. (2011).

8. Countries with 100% Indoor Smoke-Free Policies

9. Strong Public Support for Smoke-Free Laws: Turkey • In Turkey, 48% of men smoke • In 2008, the Turkish National Tobacco Control Law made all indoor public places, workplaces, educational institutions, and public transportation smoke-free • In 2010, 7 out of 10 places were complying with the law • In 2010, 92% of Turks and 77% of daily smokers supported the law Source: Quirk Global Strategies. Results from opinion research in Turkey: Support for smoke-free legislation. 2010.

10. Warning Labels • As of September 2011, more than 40 countries have mandated graphic warning labels on cigarette packs • And the list keeps growing … Malaysia - 2010 Pakistan - 2010 United States - 2012

11. Plain Packaging • A few years ago, tobacco control partners considered plain packaging unlikely to be seen in near future • Instead, legislation in Australia currently under consideration to require plain packaging, and the country appears poised to implement plain packaging • Plain packaging standardizes the appearance of cigarette packages, removes all brand imagery, allowing only the brand name in a mandated size, font, and position • Government-mandated information, such as health warnings, would remain

12. Tobacco Advertising, Promotion, and Sponsorship Bans • In 2008, the US National Cancer Institute released a comprehensive monograph on tobacco advertising • This was the first major scientific review to conclude that tobacco advertising has a causal impact on use • GATS data from countries with strong and enforced tobacco advertising, promotion, and sponsorship (TAPS) bans show low rates of exposure to marketing, compared to countries without strong bans • 12.4% of adults reporting exposure to tobacco marketing in Turkey vs. 58.7% of Russian adults • Turkey has a strong, well-enforced tobacco marketing ban while in Russia many forms of marketing are allowed Sources: National Cancer Institute. (June 2008). The role of the media in promoting and reducing tobacco use. Tobacco Control Monograph No.19.; Global Adult Tobacco Survey. Turkey (2008) and Russia (2009) Factsheets. Available from: http://www.who.int/tobacco/surveillance/gats/en/index.html

13. Focus on Point of Sale (POS) Advertising • Tobacco companies spend significant marketing dollars at POS • Relatively few countries ban POS advertising and many are trying to close the loophole or include it in comprehensive TAPS bans • Tobacco companies fight fiercely to exempt advertising and promotion at the POS

14. Tobacco Taxes and Price • Prices and taxes for tobacco products vary considerably around the world Source: Euromonitor International. (2011). Global briefing- Global tobacco findings 2011: Battle intensifies.

15. Tobacco Taxes and Price • The growing concern about the devastating impact of tobacco and the need for government revenue means more governments are turning to increased tobacco tax to raise revenue, decrease consumption, and save lives • Countries raising tobacco tax in 2010 include Turkey, Egypt, Mexico, and the United States Source: Euromonitor International. (2011). Global briefing- Global tobacco findings 2011: Battle intensifies.

16. Challenge—Affordability • Affordability of tobacco products varies across countries • Over time, cigarettes have become much less affordable in some countries, while in others they have become much more affordable Source: Blecher, E., Van Walbeek, C. (2008).

17. New Technical Guidance • A new technical manual from WHO provides a set of key recommendations for increasing taxes with the goal of increasing affordability • A new presentation by Frank Chaloupka provides an overview of this guide Source: World Health Organization. (2010).

18. Advances in Tobacco Product Regulation • In 2009, the United States Food and Drug Administration gained the authority to regulate tobacco under the Family Smoking Prevention and Tobacco Control Act • Over time, this will provide a model for other countries to consider • In 2010, Parties approved partial guidelines for FCTC Articles 9 and 10 • Articles 9 and 10 require Parties to regulate the contents of tobacco products and tobacco product disclosures • Countries taking steps to curb the use of additives in tobacco products include Australia, Canada, France, the EU, Singapore, Thailand, and the United States

19. New Frontiers: Trade Rules • Liberalized trade is designed to make products more available to more consumers at lower prices to expand their use • Trade rules are increasingly being used to challenge FCTC measures, examples include: • 2009: PMI v. Ireland in EU over retail display ban • 2010: PMI v. Uruguay under BIT over packaging • 2010: Indonesia v. US under WTO over cloves • 2010: PMI v. Norway in EU over retail display ban • 2011: PMI threatens Australia over plain packaging • Tobacco control partners cannot allow trade rules to become another tool for the industry to challenge legitimate public health measures

20. Unending Challenge: Tobacco Industry Opposition • In 2009, Parties to the FCTC unanimously approved Article 5.3 of the Convention • Principle 1: there is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests • The industry continues to seek to: • Legitimize itself where it operates • Interfere with the policy making process • Create new users and keep existing ones

21. Unending Challenge: Tobacco Industry Opposition • Tobacco companies increasingly engage in litigation challenging strong tobacco control policies; examples include: • Smoke-free laws in Argentina and Turkey • Advertising, promotion, and sponsorship laws in Brazil, Scotland, and South Africa • Warning labels in Indonesia and Philippines “In common with all other global consumer products companies, we will continue to focus on [emerging] markets going forward as they generally offer favorable demographic trends, economic growth, and increasing consumer purchasing power.” —PMI CEO Louis C Camilleri November 2010

22. Tobacco Control Policies Reduce Use Source: NYC.gov. (2011).