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Acting Team Leader Tobacco Free
Initiative WHO WPRO Manila
Oversee and manage Tobacco Free Initiative
(TFI) Regional Programme for accelerating
FCTC implementation in the countries of the
Region. Manage TFI-WPRO human and
financial resources Work in 37 countries and territories of the WHO-WPRO
Master in Public Health
Specialised in Developing Countries
Escuela Nacional de Sanidad. Madrid, Spain 1996-1997
Medical Doctor Degree
Facultad de Medicina de la Universidad Complutense
of Madrid. Madrid, Spain Sep 1973-July 1979
Dr. Carmen Audera-Lopez
Tobacco Control in the Western Pacific Region
Are we winning the battle?
Carmen Audera-Lopez-WPRO
Outline of the presentation
The tobacco epidemic
The effects of tobacco use
The global response
The big enemy in this battle
The way forward
4 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Western Pacific Region
Australia
Brunei Darussalam
Cambodia
China
Cook Islands
Fiji
Japan
Kiribati
Lao People's Democratic Republic
Malaysia
Marshall Islands
Micronesia (Federated States of),
Mongolia
Nauru
New Zealand
Niue
Palau
Papua New Guinea
Philippines
Republic of Korea
Samoa
Singapore
Solomon Islands
Tonga
Tuvalu
Vanuatu
Viet Nam
5 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
6 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
The tobacco epidemic in our part of the
world
In the West Pacific Region
There are an estimated 430 million smokers or about one third of the world's smokers (a fourth of the world’s population)
Highest rates of male smoking, and the fastest increase of tobacco use among women and young people.
It is estimated that two people die every minute from tobacco-related disease
50% of women and children are exposed to second hand smoke
7 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Age-standardized prevalence estimates for tobacco smoking among males
and females aged 15 years and over in the Western Pacific, 2011
8 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Youth smoking rates
9 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Current tobacco use in men and women in
ASEAN countries
WHO Report on the Global Tobacco Epidemic, 2013
10 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Current tobacco use in boys and girls
WHO Report on the Global Tobacco Epidemic, 2013
11 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Stages of the tobacco epidemic
12 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Trends in smoking and lung cancer in Japan
Bull WHO 2013, 91:332-340
13 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Slower rise of smoking among women
Has been attributed to social
disapproval of women who
smoke and to women’s lower
social and economic status.
RISKS: As women’s
empowerment continue, there
is potential link to increased
smoking among women and
to the ways in which the
tobacco industry is
capitalizing on societal
changes to target women.
14 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
15 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Outline of the presentation
The tobacco epidemic
The effects of tobacco use
The global response
The big enemy in this battle
The way forward
16 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
TOBACCO USE IS A RISK FACTOR FOR 6 OF 8 LEADING
CAUSES OF DEATH IN THE WORLD
5.3 M
17 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Chronic respiratory
diseases
Cardiovasculardisease
Diabetes
Cancer
Unhealthydiets
Tobacco
Harmful use of alcohol
Physical inactivity
Mental disorders
Injuries
Riskfactors
Noncommunicable Diseases and Conditions
Tobacco and the NCD action plan:4 risk factors, 4 noncommunicable diseases, 2 conditions
18 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Smokers body
19 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Diseases caused
by smoking
20 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
The tobacco industry has deliberately made smoking glamorous and the norm.
Few women are aware of
gender-specific health risks
◙ cervical cancer
◙ osteoporosis
◙ early menopause
◙ miscarriage
◙ ectopic pregnancy
◙ infertility
21 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Smoking during pregnancy
• Spontaneous abortion
• Ectopic pregnancy
• Low-birth weight babies
• Perinatal mortality
• Long-term effects on growth and development of the child
• AND carries a risk to the mother herself
Accounts for an increase in :
Pregnant women who smoke as few as 5 cigarettes per day are likely to have low birth weight babies
22 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Second Hand Smoke
We have a high tolerance for
second hand smoke exposure:
Of the 600 000 yearly deaths from
second hand smoke exposure---
167,000 or 28% are children
23 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Exposing an infant to
second-hand smoke
greatly increases the
child’s risk of:
• asthma
• pneumonia
• bronchitis
• fluid in the
middle ear
Second Hand Smoke
24 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Associations between tobacco and TB
A Qualitative Systematic Review Jointly
Conducted by WHO and The Union in 2007
concluded that:
– A link between active and passive tobacco
smoking and TB outcomes such as infection,
response to treatment, relapse rates, and
mortality is evident.
– Active smoking is significantly associated with
recurrent TB and TB mortality.
25 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
26 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Tobacco-attributable mortality rates in the
Philippines, the Western Pacific and worldwide
Source: WHO Global Report: mortality attributable to tobacco, 2012.
27 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
28 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Tobacco impact on poverty
Tobacco
attributable
deaths and
diseases
impose a
high
economic
cost
The
poor are
the ones
who
smoke
the most
Tobacco
worsens poverty
among its
users: money
spent on
tobacco
opportunity cost
Increased health
expenditure due
do disease
reduced access
to essential
goods such as
education and
health care
29 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Opportunity Cost
2.3%
0.9%
1.4%
2.7%
6.3%
7.1%
2.5% 12.5%
64.3%
Food
Clothing
Housing
Health
Education
Utilities
Transport &
CommunicationTobacco
Other expenses
Poor
households
spend more
on Tobacco
than on
Education,
Health and
Clothing
Source: Upcoming WHO publication
Monthly expenditure by poorest households, Philippines, 2003
30 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Opportunity cost
Minutes of labour to purchase
0
10
20
30
40
50
60
70
80
Chile China Colombia India Russia Thailand
Min
ute
s
1 kg Rice Pack 20 local cigarettes
Source: Economist Intelligence Unit, 2006
31 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Prevalence by income groups
China
0
10
20
30
40
50
Q1 Q2 Q3 Q4 Q5
%
Daily smokers All smokers
Source: World Health Survey 2006
Note: Q1-Q5: Lowest-Highest income groups
32 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
33 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Outline of the presentation
The tobacco epidemic
The effects of tobacco use
The global response
The big enemy in this battle
The way forward
34 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Global response to the tobacco epidemic
35 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Mechanisms for Tobacco Control
WHO Framework Convention on
Tobacco Control (WHO FCTC)
36 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Objective:“To protect present and future
generations from the devastating health, social,
environmental and economic consequences
of tobacco consumption and exposure to tobacco smoke …
to reduce continually and substantially the prevalence of tobacco use and
exposure to tobacco smoke.”
WHO Framework Convention on Tobacco Control:An evidence-based tool to save lives
World No Tobacco Day Poster 2011
37 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
What is the WHO FCTC?
First global health treaty negotiated under the
auspices of WHO
Establishes tobacco control as a priority on the
public health agenda
Provides a political and legal platform for
adoption of sound, evidence based tobacco
control measures
Introduces a mechanism for firm country
commitment and accountability.
It is a dynamic model of global standard setting.
179 Parties
Entry into force 27 Feb 2005
179 parties covering about over 90% of the world’s population
176
38 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Demand reduction
provisions
Price and tax measures (Art.6)
Protection from secondhand smoke
(Art.8)
Contents regulation (Art.9)
Disclosure of contents (Art.10)
Packaging and labelling (Art.11)
Education and awareness-raising
(Art.12)
Advertising, promotion and
sponsorship (Art.13)
Cessation programmes (Art.14)
Supply reduction
provisions
Elimination of illicit trade (Art.15)
Prohibition of sales to and by minors
(Art.16)
Support for viable crops for growers
(Art.17)
39 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
MPOWER - a tool to assist countries with WHO FCTC
demand reduction measures
-
40 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Supply reduction measures
Control of illicit trade
Sales to and by minors
Crop substitution
41 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
The state of selected tobacco control policies
in the world-GT
Creation of smoke-free public places and workplaces continues to be the most commonly established measure at the highest level of achievement
42 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
43 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Raise Taxes on Tobacco (Art 6)
Raising the price
of tobacco
regularly is one
of the most
effective
tobacco control
measures
• On average, a 10% price increase on a pack of cigarettes would be expected to reduce demand for cigarettes by about 4% in high-income countries and by 4% to 5% in low- and middle-income countries
• Children and adolescents are also more sensitive to price increases than adults, allowing price interventions to have a significant impact on this age group.
EFFECT
• Price increase will have a negative effect on revenue
• Tax increase will have a negative effect in smugglingMYTH
• When tobacco taxes rise, tax revenues increase.
• High tobacco taxes are not the cause for increased smuggling.
FACTS
Taxation
45 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Taxes- SinTax
46 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Affordability = GDP per capita / CPI of tobacco.
A rising affordability index reflects average income rises faster
than tobacco prices.
Vietnam
Source: Guindon et al, 2010
47 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Price of the most popular brand in international dollars In
tern
atio
nal
do
llars
48 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Taxes in WPR
Half of the WPR countries have taxes over 50% of retail price
49 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Single stick sale
A challenge!
50 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Article 8 Protection from second
hand smoke
100% Smoke free policies
• The World Bank estimates that smoking restrictions reduce overall tobacco consumption by an estimated 4-10%.
• Smoke free workplaces may reduce overall tobacco consumption by as much as 29%.
• The number of cigarettes smoked by people who continue to smoke is also likely to fall.
EFFECT
• 100% tobacco-free public places damage profits of cafés and restaurantsMYTH
• Smoke-free laws do not damage the profits of catering and drinking establishments.
• Evidence has shown that smoke-free laws have no impact or a positive impact on sales and employment. Studies reporting a negative impact were commissioned by the tobacco industry.
• Smoke-free laws can help businesses improve their profits by increasing worker productivity – less breaks and absenteeism due to illness – and decreasing costs associated with permitting smoking, including medical and insurance costs.
• Smoke-free environments are good for health, business and the economy
FACTS
SMOKE FREE POLICIES
52 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Legislation Fully Enforced Moderately
enforced
Not yet enforced No data
Complete Brunei
New Zealand
Singapore
Mongolia Nauru Australia (national
level)
Marshall Islands
PNG
6-7 Public places Palau Viet Nam
Malaysia
Cambodia
Solomon Islands
Samoa
3-5 Public Places Cook Islands
Fiji
Philippines
Tuvalu
Lao
Up to 2 public
Places
China
Rep of Korea
Japan
Kiribati
Micronesia
Niue
Tonga
Vanuatu
Smoke free Legislation and Enforcement in WPR
53 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Smoke free cities
Of the 100 largest cities in the world 43 are in WPR (29 in China)
Of the 43 only 4 have comprehensive smoke free Policies (Hong
Kong, Melbourne, Singapore and Sydney)
We have other examples of smaller cities that are smoke free in
Malaysia, Philippines, China, Fiji,…
54 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Smoke-free
Cities ASEAN Network (SCAN)
Launched in Davao during a Regional Workshop organised by
SEATCA in collabotaion with WPR0 in 2013
SCAN is a coalition of countries in the ASEAN, that will support each
other and strengthen policies and efforts on 100% smoke-free places
(FCTC Article 8).
55 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Health Warnings
56 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Philippines GHW
57 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Tobacco Advertising Promotion
and SponsorshipComprehensive ban on all kinds of direct and indirect TAPS has
proven to reduce tobacco consumption
WNTD 2013:TAPS
58 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Enforce Bans on Tobacco Advertising,
Promotion and Sponsorship
Comprehensive ban on all
kinds of direct and indirect
TAPS has proven to reduce
tobacco consumption
59 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Corporate social responsibility activities
Such as making donations to charities to appear as good
corporate citizens
60 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Packaging is advertising
61 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Packaging
62 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
In the Western Pacific
Region, 19 out of 27
countries have
implemented tobacco
advertising ban on
national television, radio
and print media.
However, advertising
with significant influence
over youth e.g. point of
sales advertising, brand
stretching and product
placement remains
unregulated.
TAPS-Progress in our Region
63 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Point of sale advertising
64 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Tobacco Dependence Treatment
Tobacco cessation advice incorporated into
primary and routine health-care service
Strengthening Health Systems
65 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
During prenatal care
WHO recommendations for the prevention and
management of tobacco use and second-hand
smoke exposure during pregnancy
66 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
By the end of 2007, DOTS was
being applied in more than 180
countries, covering 94% of the
world’s population
By the end of 2007, Almost the
entire population of the Asia
Pacific Region had access to
DOTS
About 5.8 million new and
relapse TB cases notified
under DOTS in 2011. Even if
only 20% of them use tobacco,
the DOTS programmes could
reach >1 million tobacco users
a year
DOTS programmes have the potential to reach
more than 1 million tobacco users a year
Source: Global Tuberculosis Report 2012
67 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Tobacco
dependence
treatment
68 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Sales by minors
Sale to minors
70 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
New products
71 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
The global e-cigarettes market is
rapidly expanding
• $US 3 billion spent on e-cigarettes globally in 2013*
– US sales doubling every year**
– E-cigs sales forecast to increase 17-fold by 2030*
*Euromonitor International
**‘Vape ’em if you got ’em: A challenge to Big Tobacco’, The Economist, March 23 2013
72 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Outline of the presentation
The tobacco epidemic
The effects of tobacco use
The global response
The big enemy in this battle
The way forward
73 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Tobacco Industry Interference
Very strong tobacco industry interference in many countries.Great lack of awareness!!!
74 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
If it wasn’t for the tobacco industry wanting to make a big profit we would have finished with the tobacco epidemic
75 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Targeting Developing World Markets
Tobacco companies have adopted aggressive strategies to expand global trade
and achieve market penetration in developing countries and emerging market
economies
They entered Latin American markets in 1960s
Those of the newly industrialized economies of Asia in the 1980s
Markets of Africa, China, and Eastern Europe in the 1990s
Youth and women are the prime targets for these campaigns.
–
76 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Epidemiological models
Tobacco use & Malaria infection
Cultural, historical,
economic &
political factors
Tobacco products
&Tobacco smoke
Smokers &
Involuntary smokers
VECTOR
AGENT ENVIRONMENT
Tobacco manufacturers and Anopheles mosquito
are both vectors to disease.
Infected host
Infected
blood
Parasite
Plasmodium
HOST
77 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Tobacco Industry - A Mutating Vector
"The tobacco industry's mutative processes reflect the
tobacco industry's primary role as the sole vector of the
leading preventable cause of death in world today."
Tobacco industry remains unchallenged in many countries
Some strategies have been employed for decades; some for few years – depending on the level of acceptance of industry interference in each country
Source: Successes and new emerging challenges in tobacco control: addressing the vector, Tobacco Control, March 2012
78 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
79 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
WHO FCTC
Article 5.3
In setting and implementing their public health
policies with respect to tobacco control, Parties shall act to
protect these policies from commercial and other vested
interests of the tobacco industry in accordance with
national law.
80 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
World No
Tobacco Day
31st May
2012
Stop Tobacco
Industry
Interference in
Tobacco
Control
81 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
COUNTERACTING TOBACCO INDUSTRY
INTERFERENCE
-
82 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Outline of the presentation
The tobacco epidemic
The effects of tobacco use
The global response
The big enemy in this battle
The way forward
83 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Males prevalence rates-current smokersP
reva
len
ce c
urr
ent
smo
kin
g
84 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Females prevalence rates-current
smokers
Pre
vale
nce
cu
rren
t sm
oki
ng
85 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
Tobacco end game: Single digit
In Australia smoking prevalence 14 years and older,
declined from 15.1% to 12.8% between 2010 and 2013
Hong Kong adult smoking rates 11.8%
Brunei adult smoking rates 13%
Singapore adult smoking rates 14%
86 |FCTC Workshop WPR- Fiji 2014
WHO Regional Office for the Western Pacific
2015-2019 RAP
- Sustainable capacity
- Policy development and efficient enforcement
- Multisectorial engagement
FIVE YEAR REGIONAL ACTION PLAN