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Tobacco Control: The End-Game
Prof K Srinath Reddy, President, Public Health Foundation of IndiaPresident, World Heart Federation
Bernard Lown Professor of Cardiovascular Health, Harvard School of Public Health
New Delhi, [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 smoke-free 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 tobacco-control 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?
• 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
Ban on SLT products
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-2015Development Agenda
UN Sustainable Development Goals
OrExpanded Millennium Development Goals
Food Insecurity
Pesticide Use
