Evidence-based/Best Practices Tobacco Control

1. Evidence-based/Best PracticesTobacco Control HadiiMamudu, PhD, MPA COPH-China Institute November 17, 2011

2. Outline of Presentation • Types of tobacco products • Scientific bases for tobacco control • Health and Economic Consequences of Tobacco Use (Smoke and Smokeless) • Approaches to tobacco control • Demand-side • Supply-side • Production-side • Addressing tobacco industry interference in policy • Building capacity • Effects of tobacco control

3. Scientific Bases for Tobacco Control • Biomedical research • Epidemiology • Policy Analysis • Documents research

4. Scientific Bases for Tobacco Control • U.S. Surgeon General since 1964 • UK Royal College of Physicians since 1962 • World Health Organization since 1970 • International Agency for Research on Cancer • World Bank

5. Tobacco Products

6. Smoke • Contains 400-500 known carcinogens Cigarette Cigar Kretek Hooka/Waterpipe

7. Smoke • The future of many kids is at stake From Indonesia

8. Smokeless Chewing Snus Dip Snuff

9. Emerging Tobacco Products • E-cigarettes • Herbal Cigarettes

10. Tobacco Use as a Global Problem • Smoking prevalence • The United States: 46+ million • China: 350+ million • Globally: 1.35+ billion

11. Consequences of Tobacco UseLeading Cause of Preventable Diseases and Deaths

12. Health Consequences • Direct tobacco use • Death • United States: 443,000 • Globally: 5.4 million • Increased health risks • Cardiovascular Diseases • Respiratory Diseases • Cancer • Adverse Reproductive Effects • Adverse Early Childhood Effects • NB: Tobacco kills half of its users

13. Health Consequences • Secondhand smoke (SHS) /environmental tobacco (ETS)/Involuntary or Passive Smoking • Heart Disease • United States: 46, 000 deaths among nonsmokers • Globally: 600,000 deaths among nonsmokers • Lung Cancer • Sudden Infant Death Syndrome (SID) • Adverse effects for children • Bronchitis and pneumonia • Cough • Asthma attacks • Ear infections

14. Health Consequences • Tobacco Addiction • Nicotine is a drug • U.S. Surgeon General Report, 1988 • UK Royal College of Physicians Tobacco is addictive more than banned substances

15. Health Consequences Source: U.S. Surgeon General Report, 2010

16. Economic Consequences • Direct Medical Costs + Lost Productivity • United States: $193 billion • Globally: $500+ billion • Household expenditure • Crowd out expenditure on essential needs • Increases poverty • Environmental damage • Deforestation • Toxic chemicals

17. Approaches to Tobacco Control

18. Prohibition vs. Control • Prohibition • Late 19th and early 20th Century: Cigarettes Prohibition in the U.S. • Failed • Country with prohibition: Bhutan • Illicit trade: smuggling, counterfeiting, bootlegging • Control • Since the mid-20th Century • Has been successful • Cut smoking rates in the U.S. and Europe by more than a half.

19. CDC • Best Practices for Tobacco Control, 1999, 2007

20. World Bank • Curbing the Epidemic, 1999

21. World Health Organization • The WHO Framework Convention on Tobacco Control (FCTC) • International tobacco control treaty • 174 Members • Not including United States

22. World Health Organization • The MPOWER Reports, 2008, 2009, 2011

23. Experts/Scientists

24. Individual vs. Population-Based • Individual-base: Cessation and treatment for tobacco dependence • Clinical interventions • Therapies • Counseling • Nicotine Replacement (e.g., patches, gum, inhalers, drugs) • Note • Majority of smokers quit without cessation treatments • Most ex-smokers try several times before quitting • ≈5-7 times

25. Individual vs. Population-Based • Population-based • Tax increases • Ban on advertising and promotions • Preventions • Anti-tobacco campaign • Smoke-free environments • Quitlines • Monitoring • Advocacy

26. Individual vs. Population-Based

27. Demand-side policies • Tax increases (70% of Retail Price) • Reduce consumption • Encourage cessation • Health Warnings (45 countries with Pictograms)

28. Supply-side policies • Ban on sale to minors • Youth access laws • Restricting tobacco industry promotions • Control illicit trade in tobacco products • Smuggling • Counterfeiting • Bootlegging • Tracing and Tracing

29. Production-side policies • Tobacco and Poverty • Alternative sources of livelihoods • Switching from tobacco production

30. Capacity Building for Tobacco Control • Institutions • Education • Advocacy • Encouraging civil society groups • Liaising with the international community • Scientific research • Country-specific data • Understand the Tobacco Industry’s Role(s) in Policy • The tobacco industry documents

31. The Tobacco Industry • The Global Industry: Market Share

32. The Tobacco Industry • Promote tobacco use • Undermine policy • Lobbying • Corrupting the policy process • Focus attention on economics; not health • Divert attention from the effects of tobacco use • Etc.

33. Effects of Tobacco Control

34. Smoking Prevalence • Prevent smoking initiation • Reduce tobacco use

35. Health • Improves health • Reduces health risks • Helps with cessation

36. Economic benefits • Does not harm economy • See the World Bank’s Cubing the Epidemic • Saves medical costs • $80+ billion saved by the California Tobacco Control Program • Generates revenue through higher taxes (“sin tax”) • Makes more money available to households

37. The Scientific Consensus • Mamudu et al., 2011

38. Thank you!!