Professor Judith Mackay Plenary Session 4 - Chronic Disease World Congress of Epidemiology...

Professor Judith MackayPlenary Session 4 - Chronic Disease

World Congress of Epidemiology Edinburgh, Scotland; 9 August 2011

Smoking prevalence

Male

Female

Same key

Female smoking numbers: Top 20

Youth smoking prevalence, 2000-2007, GYTS

Boys

Girls

Same key

Health professionals

↑ Tobacco epidemic (~ other NCD)

Number smokers1.4 b -> 1.6 b By 2030

Smoking prevalence

Tobacco consumption

Tobacco deaths 6m->8mp.a. by 2030

Global Cigarette Consumption, 1880-2020

Health risks known, but always moree.g. link with TB

Deaths caused by tobacco 2015

Deaths caused by Secondhand smoke

Cumulative deaths from tobacco, global, 2005-2030

Tobacco Costs

HEALTH COSTS OTHER ECONOMIC COSTS

Medical and healthcare costsHigher sickness and absence

ratesLoss of skilled workers by

premature deathIncreased early retirement due

to ill healthSecondhand smoke risks

Time off for “smoke breaks”Lost production and lower

productivityFires caused by careless

smokingDamage to building fabric

Litter of billions of cigarettes, matches, packets, lighters

Risk of being sued

Costs to smoker: cig v. rice

Lack of awareness of risk factorsPreoccupation with other diseasesTobacco may not yet cause many deathsFocus on curative medicine, not preventionSmoking, alcohol, diet seen as personal behaviourTobacco industry: promotion, distortion of health and

economic evidence, financial might, challenge/threats to governments other industries not far behind

Tobacco tax revenue (but not debit) seenMisperceived economic costsLack of funds for research and intervention

Obstacles to Tobacco Control

HK resident smoking through SARS mask

The tobacco industry: Not changed its spots…

Acknowledgement to http://www.wildlife-pictures-online.com/leopard-pictures-1.html

Neo-libertarian groups – now gone global“Nanny state” “Less government” “Personal freedom”

Medical Model Not Enough

Tobacco Control:

WHO FCTC

WHO FCTC into effect 2005 Parties ratified: 174/ 192

Tobacco Control:

FCTC Main Provisions

Tobacco Control:

Ban Tobacco Promotion

People’s Republic of China

Las Palmas

Philippines

Tobacco Control:

Smoke-Free Laws

Hong Kong RestaurantTax Receipts

Before ban and2 years later:

31%

Example: Hong Kong

Tobacco Control:

Pack WarningsExample: Hong Kong 27 Oct 2006: Smoking (Public Health) Ordinance 2006 in effect 6 pictorial health warnings – all cigarettes to display 50% health

warning messages in both Chinese & English

Tobacco Control:

Media Campaigns

worldlungfoundation.org/mmr

For Smoker:Quitting Works

Tobacco Control:

Quitting Reduces NCD Risk

Tobacco Control:

Raising TaxesKey Economic Messages

Tobacco is debit to the economy

Tobacco control is cost-effective

Price increases most effective

tobacco tax does not govt revenue

tobacco tax does not smuggling

tax on other NCD risk factors (e.g. alcohol, certain foods); tax on vegetables??

Tobacco Control:

Raising Taxes, consumption

Tobacco Control:

Raising Taxes: revenues up

Tobacco Control:

Earmarked Tax for Health

Example: Thailand 2% of tobacco and alcohol tax

used for health promotion

And now: Major private donorsMichael

Bloomberg

Bill Gates

But funding from governmentscompletely inadequate…

NCDs: 60% Global DeathsNCD Modifiable Causative Risk Factors

Tobacco Use Unhealthy Diet

Physical Inactivity

Harmful Use of Alcohol

Heart Disease& Stroke √ √ √ √

Diabetes √ √ √ √

Cancer √ √ √ √

Chronic Lung Disease

√

Source: WHO, 2010

Deaths fromCardiovascular Disease

Coronary heart disease

Stroke

* Different keys

Cancer: Major Risk Factors

7.9

13.0

19.0

82.0

7.1

85.067.0

17.0% total

Cancer Registries% of the population covered by cancer

registration

IARC, 2011

Physicians Working in NCD

C21 Epidemics:

New Paradigm Needed1. International law/ treaties for

public health• WHO support• Sound science/research• Comprehensive policies,

common risk factors• Enforcement after legislation

2. Crucial role of government and political will

3. Extraordinary reach of NCD issues, from corporate criminality to poverty alleviation new partners

• Key NGOs and individuals, coalitions

4. Political mapping of obstacles,esp. misperceived economic concerns, tactics of vested industries

• Effective advocacy targeting decision makers to the public

• The role of media

Source: WHO, 2010

UN Summit on NCDs 19-20 Sep 2011

28 such meetings at UN sinceend-WWII only 1 on health (AIDS)

This one: 135 co-sponsoring countries and unanimous approval

Outcome Document is critical

Call for addition of all NCDs into next round of UN MDGs in 2015

Public health come of age

Professor Judith MackaySenior Advisor

jmackay@worldlungfoundation.org