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Health Systems and Tobacco Control. Dr Yussuf Saloojee National Council Against Smoking South Africa. Objectives :. To review: · tobacco control as a global public health priority; · effective interventions to reduce tobacco use; and
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Health Systems and Tobacco Control Dr Yussuf Saloojee National Council Against Smoking South Africa
Objectives: To review: · tobacco control as a global public health priority; · effective interventions to reduce tobacco use; and · the role of health systems in promoting cessation.
“Tobacco use is a cause –and an important cause – of lung cancer” Doll & Hill, 1950
Unhappy Fact • Globally, the industry has been better at recruiting new customers, than we have been at discouraging tobacco use
Smoking related deaths worldwide Now: • 5.4 million deaths per year By 2025: • 10 million deaths per year
World Deaths in 2000 attributable to selected leading risk factors Number of deaths (000s) Source: WHR 2002
Cigarette consumption in Turkey, 1987-2000 Source: Tekel, and USDA database
Prevalence Sources: WHO, National Centre for Health Statistics, Japan Tobacco Inc., Comité Français d’Éducation pour la Santé, Serbian Ministry of Health, The World Bank, SADHS,
Turkey: health and economic impact • Tobacco use has an enormous negative impact. • Annually: - 100.000 premature deaths; - economic loss of US$ 17.72 billion Prime Ministers Circular 2006/29
Happy Fact We have the tools to quickly and substantially reduce consumption.
What is to be done? “The educational campaign should be the main weapon in the fight against cigarette smoking, but some restrictive legislation will also be necessary. There should be no hesitation about banning smoking in public places and on public transport. Here the discomfort and disease of the non-smoker must be considered before the convenience of the smoker.
“The law about providing cigarettes to children must be more strictly enforced and automatic vending machines must be banned. Cigarette advertising should at first be restricted in quantity and content with a view to its eventual complete limitation. It might also be advisable to insist that each cigarette packet should carry a notice to the effect that the contents are potentially dangerous to health.
“The Minister of Health may also attempt further restrictions of smoking by increasing the taxation on cigarettes...The matter is important and urgent." South African Medical Journal, September 1963.
Elements of a Comprehensive Tobacco Control Policy · Health education · Increase tobacco excise taxes · Ban tobacco advertising, promotions & sponsorships · Restrict smoking in public places, transport, workplaces · Rotating health warnings · Ban sales to children · Product regulation · Anti-smuggling measures · Generic packaging · Litigation · Assisting smokers in quitting · Using 1% of tobacco tax revenues for TC programmes
WHO Policy Priorities • Monitor tobacco use & prevention policies • Protect people from tobacco smoke • Offer help to quit tobacco use • Warn about the dangers of tobacco use • Ban tobacco advertising, promotion and sponsorship • Raise taxes on tobacco
1st Law of Economics • When price goes UP consumption goes DOWN. • When price goes DOWN consumption goes UP.
Are prices increasing in Turkey? Source: TEKEL, USDA, Onder 2002, and World Bank Calculation
Cigarette consumption in Turkey, 1987-2000 Source: Tekel, and USDA database
An increase in “the real price of cigarettes by 10% worldwide would cause 40 million smokers alive in 1995 to quit, and prevent a minimum of 10 million tobacco-related deaths.” World Bank, 1999
Smuggling • Drives down prices – increases consumption. • 30% of exported cigarettes globally lost to smuggling
What drives smuggling? High taxes or the tobacco industry? • The difference in duty levels between neighbouring states is only a MINOR cause of smuggling. • Smuggling, is driven by the commercial activities of the tobacco companies
Industry participation in smuggling British American Tobacco had “for decades secretly encouraged tax evasion and cigarette smuggling in a global effort to secure market share and lure generations of new smokers”. The International Consortium of Investigative Journalists
BAT admits it benefits • British American Tobacco admitted that it would lose profits if it took active steps to reduce smuggling by its wholesalers . • British American Tobacco, Confirmation of earnings estimates, 5 December 2001
Advertising tobacco “The problem is how do you sell death? How do you sell a poison that kills 350,000 people per year [in the US]? You do it with the great open spaces … the mountains… the lakes coming up to the shore. How could a whiff of a cigarette be of any harm in a situation like that?” Fritz Gahagan, former tobacco industry marketing consultant.
‘Selling tobacco products to women currently represents the single largest product marketing opportunity in the world.’ Kaufman and Nichter 2001
Purpose of Advertising The aim of advertising is to increase sales by: • attracting new customers • getting existing customers to use more, • getting lapsed users to resume consumption.
Purpose of public health: * prevent kids from starting • help smokers quit • help ex-smokers to remain quit Advertising undermines public health goals
Smoke free is good for business. • A review of 97 published studies on the economic effect of smoke free policies on the hospitality industry, concluded that ‘all of the best designed studies report no impact or a positive impact of smoke free restaurant and bar laws on sales or employment’ (Scollo et al 2002).
Acute effects of SHS on the heart 30 minutes of SHS exposure activates platelets and depress vascular endothelium function. • This could trigger a heart attack in people at risk. • Six independent studies (US, Italy, Ireland, and Scotland) have shown about a 25% drop in hospital admissions for heart attacks after smokefree laws went into effect.
Eliminate ETS from the workplace and public places “The most direct and effective method of eliminating ETS from the workplace is to prohibit smoking in the workplace” US National Institute for Occupational Safety and Health, 1991 “Smoking in public places should be restricted on the grounds of public health” UK Scientific Committee on Tobacco and Health, 1998
“When yousmoke, you inhale arsenic and naphthalene also used against rats and cockroaches”
Do health warnings work? In Canada: 90% of smokers noticed the new warnings. 44% of smokers said the new warnings increased their motivation to quit smoking, 38% of those who attempted to quit, said the warnings were a factor in motivating them in their attempt to quit.
