Tobacco Control: The End-Game
Prof K Srinath Reddy, President, Public Health Foundation of India
President, World Heart Federation
Bernard Lown Professor of Cardiovascular Health,
Harvard School of Public Health
New Delhi, India
[email protected]
Tobacco Toll: Tale Of Two Centuries
20th Century
: 100 Million Deaths
(Estimated)
21st Century
: One Billion Deaths
(Projected)
Can We End This Threat By 2050?
UN/WHO Targets For 2025
Reduce NCD Mortality By 25%
Reduce Tobacco Consumption In Adults By 30%
Is This Unrealistic? Is This Too Modest?
What Are Countries Doing?
Finland
• Tobacco Act 2010
– Put an end to the use
of tobacco products in
Finland
– No target date
• Savuton Suomi 2040
– Civil society
movement for a
tobacco-free Finland
Government has
accepted the goal
What Are Countries Doing?
New Zealand
• Tupeka Kore Aotearoa 2020
– Future generations of New
Zealand will be free from
exposure to tobacco
• Maori Affairs Select
Committee, 2010
– Reducing tobacco consumption
and smoking prevalence to half by
2015
– Making New Zealand a smokefree nation by 2025
• The Government’s affirmative
response to the Committee
recommendations
What Are Countries Doing?
Bhutan
• Ban on sale of tobacco
products
– In 2004, the Bhutanese
Government banned sale of all
tobacco products
– It was the first country to
impose such a ban
– Violations were severely
penalized and owners of shops
and hotels can lose their
business licenses.
– Imposition of 100% tax on all
tobacco products brought into
the country for personal
consumption by Bhutanese.
– Foreigners selling tobacco to
locals severely penalized
What Are Countries Doing?
Australia/Tasmania
• Plain Packaging
– Through a landmark ruling
by its High Court, Australia
has become the first
country to introduce
mandatory plain packing
for all tobacco products
from December 1, 2012
• Tobacco-Free Generation
– In August 2012, the
Tasmanian Legislative
Council unanimously
passed a motion calling for
the sale of tobacco to
anyone born from the year
2000 to be banned.
What Are Countries Doing?
Singapore
• Tobacco-Free
Millennium
Generation
– This proposal from
Singapore considers a
new strategy for
phasing out tobacco
usage, by proposing
that individuals born in
or after the year 2000
have their supply of
tobacco restricted
(Khoo et al, 2010)
What Are Countries Doing?
Uruguay
• Since 2005, Uruguay implemented a
series of strong measures to reduce
tobacco use.
– Smoke-free workplaces and public
places, ban on TAPS (except PoS), Pack
warnings and tobacco tax increases
•
“Uruguay’s comprehensive tobaccocontrol campaign has been associated
with a substantial, unprecedented
decrease in tobacco use. Decreases
in tobacco use in other low-income and
middle-income countries of the
magnitude seen in Uruguay would
have a substantial effect on the future
global burden of tobacco-related
diseases.”
(Abascal, Lancet, Nov
2012)
What’s Happening In India?
Ban on SLT products
• Food Safety and
Standards Authority
notified prohibition on
sale of food items
containing tobacco or
nicotine as ingredients.
– 25 Indian states have
banned gutkha while
some have also banned
other smokeless tobacco
products like zarda and
paan masala
Other Measures In India
• Prohibition on any direct and
indirect TAPS
– Only restricted point of sale
advertisement allowed
• First of its kind measures
globally
– No advertisement or promotion
in films and television
• Minimum 30 seconds health spots
and static health warning
message
• Minimum 20 seconds audio visual
film on the ill effects of tobacco
use
• Non compliance may lead to
suspension of license
• No films to be certified without
compliance with the rules
Endgame Concepts On The Table
• ‘Endgame’ is a strategic plan to reduce prevalence within a
set period (E.g. < 5% globally by the year 2040)
• De-normalizing tobacco use
• Tobacco-free Generation (No sale to those born after the
year 2000)
• Focusing on supply-side measures; nicotine regulation;
taxation and price controls
• Addressing tobacco as a systemic issue
• Removing profitability from the business of tobacco
• Making the tobacco industry liable
AMBITIOUS CONCEPTS OR
ACTIONABLE STRATEGIES?
A Global Thrust To Counter
A Global Threat : FCTC + MPOWER
FCTC (2003)
:
Now 174 Countries
Subscribe To The Treaty
MPOWER
:
Monitoring; Protect Against
2o Smoke; Offer Help to
Quit; Warnings; Enforce
Ad Bans; Raise Tobacco
Taxes
Source: WHO Report on Global Tobacco Epidemic, 2011
Where Is An
‘Endgame Scenario’ Feasible?
• Countries/states with low prevalence of tobacco use
– California (U.S) – 11.9%
• Countries/states with a rapid reduction in prevalence of tobacco use
– Uruguay (32% in 2006 to 25% in 2009); Canada (30% in 1994 to 18% in 2008)
• High public understanding of the tobacco burden
• Support from all stakeholders/civil society movement
• Strong political leadership /Government intent
(Thomson et al, Tobacco Control, Aug 2011)- (Gutkha ban in India)
Building Blocks For An ‘Endgame’
POLICY ENVIRONMENT
• Strengthening the Framework
Convention on Tobacco
Control (WHO FCTC) for
internationally cohesive
national policies
• Adapt and strengthen WHO
MPOWER strategies
• Integrating tobacco control in
the health and development
agendas
• ‘Target-setting’ by
Governments
• Enhancing policymaker
interest in the issue
• Laws to facilitate litigation
against the industry
Community ACTION
• Building public support for
the Government targets
• Enhancing mass media
campaigns
• Better delivery of
cessation support
• Lawsuits/RTIs/PILs
against tobacco
companies
Building Blocks For An ‘Endgame’
POLICY ENVIRONMENT
• Strengthening the Framework
Convention on Tobacco
Control (WHO FCTC) for
internationally cohesive
national policies
• Adapt and strengthen WHO
MPOWER strategies
• Integrating tobacco control in
the health and development
agendas
• ‘Target-setting’ by
Governments
• Enhancing policymaker
interest in the issue
• Laws to facilitate litigation
against the industry
Community ACTION
• Building public support for
the Government targets
• Enhancing mass media
campaigns
• Better delivery of
cessation support
• Lawsuits/RTIs/PILs
against tobacco
companies
Citibank Scenarios
Scenario A
:
Existing trend of slow
decline continues till zero
Scenario B
:
Decline comes to a halt due
to hardcore addicts
Scenario C
:
Smoking gets to a tipping
point, where it becomes
easier to regulate or even
ban
(Gaurdian; Jan 7, 2011)
Second Hand/ Third Hand Smoke:
Trigger For Outrage – Catalyst For Change?
• Smoke Free Public Places
• Smoke Free Work Places
• Smoke Free Parks/Open Spaces
• Smoke Free Private Transport
• Smoke Free Homes?
Challenge of Cessation
• Need For Pharmacotherapy?
• Counseling Centres?
• Community Based Cessation?
• Status of Smokeless Tobacco?
Positioning Tobacco Endgame
In
The Post-2015
Development Agenda
UN Sustainable Development Goals
Or
Expanded Millennium Development Goals
Food
Insecurity
Pesticide
Use