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The Tobacco Epidemic - Today. Source: WHO Report on the global tobacco epidemic, 2008. The Tobacco Epidemic is about to Get Much Worse. Second-hand smoke is estimated to cause ~600,000 premature deaths/year - PowerPoint PPT Presentation
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The Tobacco Epidemic - Today
Source: WHO Report on the global tobacco epidemic, 2008
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The Tobacco Epidemic is about to Get Much Worse
The Tobacco Epidemic is about to Get Much Worse
Second-hand smoke is estimated to cause ~600,000 premature deaths/year
Tobacco currently kills more than 5 million/yr but this will increase to over 8 million/yr in 2030
If current smoking patterns continue, the death toll from tobacco use will be: –2000 – 2025 ~ 150M–2025 – 2050 ~ 300M–2050 – 2100 > 500M (Peto, WHA 2008)
TOTAL for 20th Century 0.1 billion
TOTAL for 21st Century 1 billionTOTAL for 21st Century 1 billion
(half the deaths in middle age)
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Tobacco Consumption:Geographic Changes
Tobacco Consumption:Geographic Changes
Source: WHO calculations using ERC data.
Mechanisms of Tobacco Control
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WHO Framework Convention on Tobacco Control (WHO FCTC)
WHO Framework Convention on Tobacco Control (WHO FCTC)
First global health treaty negotiated under the auspices of WHO
The WHO FCTC– establishes tobacco control as a
priority on the public health agenda– provides an evidence-based tool for
adoption of sound tobacco control measures
– introduces a mechanism for firm country commitment and accountability
168 parties as of February 2010
Entry into force 27 Feb 2005
168
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Conference of the Parties (COP)Conference of the Parties (COP)
The Conference of the Parties (COP) is the governing body of the WHO Framework Convention on Tobacco Control (WHO FCTC) and is comprised of all Parties to the Convention, in accordance with Article 23 of the WHO FCTC.
The COP shall keep under regular review the implementation of the Convention and take the decisions necessary to promote its effective implementation and may also adopt protocols, annexes and amendments to the Convention.
The COP may establish such subsidiary bodies as are necessary to achieve the objective of the Convention The COP also established several working groups with the mandate to elaborate guidelines and recommendations for the implementation of the different treaty provisions.
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Working groups currently established by the COP
Working groups currently established by the COP
The COP requested four working groups to elaborate draft guidelines and recommendations for implementation of:
Articles 9 & 10: "Regulation of the contents of tobacco products" and "Regulation of tobacco product disclosures"
Article 12: "Education, communication, training and public awareness"
Article 14: "Demand reduction measures concerning tobacco dependence and cessation"
Articles 17 & 18: "Provision of support for economically viable alternative activities" and "Protection of the environment and the health of persons"
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WHO FCTC Guidelines adopted by COPWHO FCTC Guidelines adopted by COP
Article 5.3 Guidelines on the protection of public health policies with respect to tobacco control from commercial and other vested interests
Article 8 Guidelines on the protection from exposure to tobacco smoke
Article 11 Guidelines on packaging and labelling of tobacco products
Article 13 Guidelines on tobacco advertising, promotion and sponsorship
WHO TFI Supporting the implementation
of the FCTC
WHO TFI Supporting the implementation
of the FCTC
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Tobacco Free Initiative (TFI)Tobacco Free Initiative (TFI)
VISIONTo reduce the burden of disease and death caused by
tobacco use, thereby protecting present and future generations from the devastating health, social,
environmental and economic consequences of tobacco consumption and exposure to tobacco smoke
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TFI PrioritiesTFI Priorities Supporting health system development by building the capacity of decision
makers and partners at regional and country level;
Addressing economic policy issues with evidence-based knowledge and information;
Strengthening partnerships with strategic international organizations, decision makers and civil society;
Scaling up capacity for implementation of tobacco control interventions and the WHO-FCTC;
Strengthening surveillance, monitoring and evaluation systems;
Communication and advocacy.
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TFI : Bringing in Change – MPOWER strategy
TFI : Bringing in Change – MPOWER strategy
• monitor tobacco use and prevention policies
• protect people from tobacco smoke
• offer help to quit tobacco use• warn about the dangers of
tobacco• enforce bans on tobacco
advertising, promotion and sponsorship
• raise taxes on tobacco
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Only 5 per cent of the world's population were covered by Only 5 per cent of the world's population were covered by comprehensive smoke-free laws in 2008 (up from 3% in 2007)comprehensive smoke-free laws in 2008 (up from 3% in 2007)
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Article 6 - TaxationArticle 6 - Taxation
95% of world's population living incountries where taxes represent <75% of retail price Back
Source: WHO Report on the global tobacco epidemic, 2009
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Article 8 – Smoke-FreeArticle 8 – Smoke-Free
2% of world's population live in countries with comprehensivesmoke-free laws that also have high level of compliance
Source: WHO Report on the global tobacco epidemic, 2009
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Article 11 – Health Warnings Article 11 – Health Warnings
8% of the world's population live in a country with strong GRAPHICWARNINGSWARNINGS on cigarette packs
Source: WHO Report on the global tobacco epidemic, 2009
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Article 13 – Advertising Article 13 – Advertising
More than 90% of the world's population is unprotected from tobacco industry marketing
Source: WHO Report on the global tobacco epidemic, 2009
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DIRECT ADVERTISINGBillboards, print media, radio, TV
SPONSORSHIPSports, music eventsBRAND STRETCHING
Holidays, cafés, musicMERCHANDISING
Lighters, clothing
LOYALTY SCHEMES AND COUPONS• Collecting coupons to exchange for promotional
items• Coupons may offset the effect of price increases
PACKAGINGReinforce brand imageryPRODUCT PLACEMENT
Films and TVOTHER MARKETING COMMUNICATIONS
Events/Participatory promotionsPOINT OF SALE
Cigarette pack "power-walls"
FREE SAMPLESA popular industry strategy
Article 13 Guidelines:Ban or restrict marketing
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Article 14 – Cessation Article 14 – Cessation
Only 17 countries provide access to comprehensive help to quit smokingBack
Source: WHO Report on the global tobacco epidemic, 2009
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Cross Cutting Issues– Tobacco Industry Monitoring– Gender– Litigation support– Economics – International Development– Social Determinants– Intersectoral action– UN Task Force– MDG
Expert Groups: – WHO Study Group on Tobacco Product Regulation– WHO Tobacco Laboratory Network
Global Level Implementation of WHO FCTC – Cross-cutting
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Gender-Specific Policy for Tobacco Control Gender-Specific Policy for Tobacco Control
There are different health risks associated with women’s smoking:
Faster development of certain diseases like lung cancer
Irreversible and serious health consequences for pregnant women and foetus
World No Tobacco Day 2010
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POLITICAL WILL
Ministry of Health
Ministry of FinanceMinistry of Justice
Ministry of Education
Ministry of Agriculture
PUBLIC AWARENESSNGOsMedia
Health Professionals
Trade unions
INTERNATIONAL SUPPORT
WLF
Bloomberg Philanthropies
CDC
Donor countries
Gates foundation
INTERGOVERNMENTAL WORK
WHO Headquarter (TFI)
WHO Country offices
WHO Regional Office
UN task force
SCIENTIFIC EVIDENCE
Researchers
IARC
WHO Collaborating Centres (UCSF)
WHO FCTC
Working togetherWorking together
to curb the to curb the
tobacco epidemictobacco epidemic
INTERSECTORAL ACTION
Tobacco Industry
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Largest Manufacturers/sellers of cigarettesLargest Manufacturers/sellers of cigarettes
• China National Tobacco CorporationChina National Tobacco Corporation• Philip Morris International and Philip Morris USA Philip Morris International and Philip Morris USA • British American Tobacco and associates British American Tobacco and associates
(including ITC and Reynolds American) (including ITC and Reynolds American) • Japan Tobacco International/Japan TobaccoJapan Tobacco International/Japan Tobacco• Imperial TobaccoImperial Tobacco
The “tobacco industry”The “tobacco industry”The “tobacco industry”The “tobacco industry”
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TOBACCO INDUSTRY INTERFERENCETOBACCO INDUSTRY INTERFERENCE
attempts to undermine science and legitimate messages from scientific quarters
the manipulation of the media
the industry’s public relations efforts
tactics designed to gain control of the public agenda
lobbying efforts
the use of front groups and artificially created grassroots movements
intimidation
harassment of tobacco control professionals Source: Fox B, Bialous S, Trochim W, Stillman F and Schmitt CL. Monograph 17: Evaluating ASSIST – A blueprint for understanding atate-
level tobacco control. Chapter 8. Evaluating tobacco industry tactics as a counterforce to ASSIST. 2006. http://cancercontrol.cancer.gov/tcrb/monographs/17/m17_complete.pdf
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Remains profitableRemains profitable
Expanding into low and middle income, but remaining Expanding into low and middle income, but remaining profitable in several high income countriesprofitable in several high income countries
Top of merger and acquisitions phaseTop of merger and acquisitions phase
New products, including smokelessNew products, including smokeless
In favor of “reasonable" regulationIn favor of “reasonable" regulation
Differences when competing, alliances when faced with Differences when competing, alliances when faced with stricter regulatory framework.stricter regulatory framework.
The “tobacco industry”The “tobacco industry”The “tobacco industry”The “tobacco industry”
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Tobacco industry strategies to undermine tobacco control activities at the Tobacco industry strategies to undermine tobacco control activities at the World Health OrganizationWorld Health Organization
Tobacco industry strategies to undermine tobacco control activities at the Tobacco industry strategies to undermine tobacco control activities at the World Health OrganizationWorld Health Organization
“the evidence shows that tobacco companies have operated for many years with the deliberate purpose of subverting the efforts of WHO to address tobacco issues. The attempted subversion has been elaborate, well financed, sophisticated and usually invisible… This inquiry adds to the mounting evidence that it is also a struggle against an active, organized and calculating industry.”
Source: World Health Organization committee of experts on tobacco industry documents. Tobacco industry strategies to undermine tobacco control activities at the World Health Organization. 2000. Available from http://www.who.int/tobacco/en/who_inquiry.pdf
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US vs PM et al.: Judge Kessler Final OpinionUS vs PM et al.: Judge Kessler Final OpinionUS vs PM et al.: Judge Kessler Final OpinionUS vs PM et al.: Judge Kessler Final Opinion
"the intricate, interlocking, and overlapping web of national and international organizations, committees, affiliations, conferences, research laboratories, funding mechanisms, and repositories for smoking and health information which Defendants established, staffed, and funded in order to accomplish the following goals: counter the growing scientific evidence that smoking causes cancer and other illnesses, avoid liability verdicts in the growing number of plaintiffs’ personal injury lawsuits…and ensure the future economic viability of the industry.“
Source: Kessler G. Final Opinion: United States of America v. Philip Morris.
Civil Action No. 99-2496 (GK). 2006. http://tobacco.neu.edu/litigation/cases/DOJ/20060817KESSLEROPINIONAMENDED.pdf
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Main Challenge?Main Challenge?Main Challenge?Main Challenge?
Dissemination of information to a level where Dissemination of information to a level where
awareness of tobacco industry’s CSR awareness of tobacco industry’s CSR
strategies and its impact on health, strategies and its impact on health,
community welfare and sustainable community welfare and sustainable
development become integrated in the development become integrated in the
decision making process of policy makers decision making process of policy makers
and opinion leaders, as well as the populationand opinion leaders, as well as the population
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TFI ongoing monitoring of industry activitiesTFI ongoing monitoring of industry activitiesTFI ongoing monitoring of industry activitiesTFI ongoing monitoring of industry activities
Monitoring the industry and sharing information Monitoring the industry and sharing information about industry’s strategies to derail tobacco about industry’s strategies to derail tobacco control is a WHO mandatecontrol is a WHO mandate
Resolution 54.18 of the 54th World Health Resolution 54.18 of the 54th World Health Assembly (May 2001)Assembly (May 2001)
TFI main activities on industry monitoring: TFI main activities on industry monitoring: tracking information for database, awareness tracking information for database, awareness raising, background information, technical raising, background information, technical assistance to member states and sister UN assistance to member states and sister UN agenciesagencies
Art.5.3
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Tobacco industry interference with tobacco control
Tobacco industry interference with tobacco control
Documents history of Documents history of attempts to interfere with attempts to interfere with tobacco controltobacco control
Recent strategiesRecent strategies
Old strategies with new Old strategies with new “clothes”“clothes”
Source: http://whqlibdoc.who.int/publications/2008/9789241597340_eng.pdf
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PrinciPrinciple 1: There is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests.
Principle 2:Principle 2: Parties, when dealing with the tobacco industry or those working to further its interests, should be accountable and transparent.
Principle 3: Principle 3: Parties should require the tobacco industry and those working to further its interests to operate and act in a manner that is accountable and transparent.
Principle 4: Principle 4: Because their products are lethal, the tobacco industry should not be granted incentives to establish or run their businesses.
Article 5.3 GUIDING PRINCIPLES
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"We must make the prevention and control of non-communicable diseases and improvement of maternal health top priorities of the development agenda.
Both are part of the agenda for strengthening health systems and revitalizing health care.
Both are fully ready and mature areas for efficient interventions with a huge return.
Both are begging for more attention."
Dr Margaret ChanWHO Director-GeneralECOSOC High-level Segment 6 July 2009
WHO has accorded a high priority to scaling up technical support for WHO has accorded a high priority to scaling up technical support for the prevention and control of non-communicable diseases in the prevention and control of non-communicable diseases in developing countriesdeveloping countries