Evidence-based/Best PracticesTobacco Control

Hadii Mamudu, PhD, MPA

COPH-China Institute

November 17, 2011

Outline of PresentationTypes of tobacco products

Scientific bases for tobacco control

Health and Economic Consequences of Tobacco Use (Smoke and Smokeless)

Approaches to tobacco control◦ Demand-side◦ Supply-side◦ Production-side◦ Addressing tobacco industry interference in policy◦ Building capacity

Effects of tobacco control

Scientific Bases for Tobacco Control

Biomedical research

Epidemiology

Policy Analysis

Documents research

Scientific Bases for Tobacco Control

U.S. Surgeon General since 1964

UK Royal College of Physicians since 1962

World Health Organization since 1970

International Agency for Research on Cancer

World Bank

Tobacco Products

SmokeContains 400-500 known carcinogens

Cigarette Cigar

Kretek Hooka/Waterpipe

Smoke

The future of many kids is at stake

From Indonesia

Smokeless

Chewing

Snuff

Snus

Dip

Emerging Tobacco Products

E-cigarettes Herbal Cigarettes

Tobacco Use as a Global Problem

Smoking prevalence

The United States: 46+ million

China: 350+ million

Globally: 1.35+ billion

Consequences of Tobacco Use

Leading Cause of Preventable Diseases and Deaths

Health Consequences

Direct tobacco use

Death◦ United States: 443,000◦ Globally: 5.4 million

Increased health risks Cardiovascular Diseases Respiratory Diseases Cancer Adverse Reproductive Effects Adverse Early Childhood Effects

NB: Tobacco kills half of its users

Health Consequences

Secondhand smoke (SHS) /environmental tobacco (ETS)/Involuntary or Passive Smoking

Heart Disease◦ United States: 46, 000 deaths among nonsmokers◦ Globally: 600,000 deaths among nonsmokers

Lung Cancer

Sudden Infant Death Syndrome (SID)

Adverse effects for children◦ Bronchitis and pneumonia ◦ Cough◦ Asthma attacks◦ Ear infections

Health Consequences

Tobacco Addiction◦ Nicotine is a drug

U.S. Surgeon General Report, 1988

UK Royal College of PhysiciansTobacco is addictive more than banned

substances

Health Consequences

Source: U.S. Surgeon General Report, 2010

Economic Consequences

Direct Medical Costs + Lost Productivity◦ United States: $193 billion◦ Globally: $500+ billion

Household expenditure◦ Crowd out expenditure on essential needs◦ Increases poverty

Environmental damage◦ Deforestation◦ Toxic chemicals

Approaches to Tobacco Control

Prohibition vs. Control

ProhibitionLate 19th and early 20th Century: Cigarettes

Prohibition in the U.S.◦ Failed

Country with prohibition: Bhutan◦ Illicit trade: smuggling, counterfeiting, bootlegging

Control◦ Since the mid-20th Century◦ Has been successful

Cut smoking rates in the U.S. and Europe by more than a half.

CDC

Best Practices for Tobacco Control, 1999, 2007

World BankCurbing the Epidemic, 1999

World Health OrganizationThe WHO Framework Convention on

Tobacco Control (FCTC) International tobacco control treaty174 Members

◦ Not including United States

World Health OrganizationThe MPOWER Reports, 2008, 2009, 2011

Experts/Scientists

Individual vs. Population-Based

Individual-base: Cessation and treatment for tobacco dependence◦ Clinical interventions◦ Therapies◦ Counseling◦ Nicotine Replacement (e.g., patches, gum, inhalers,

drugs)

Note◦ Majority of smokers quit without cessation treatments◦ Most ex-smokers try several times before quitting

≈5-7 times

Individual vs. Population-Based

Population-based

Tax increasesBan on advertising and promotionsPreventionsAnti-tobacco campaignSmoke-free environmentsQuitlinesMonitoringAdvocacy

Individual vs. Population-Based

Demand-side policiesTax increases (70% of Retail Price)

◦ Reduce consumption◦ Encourage cessation

Health Warnings (45 countries with Pictograms)

Supply-side policies

Ban on sale to minors◦ Youth access laws◦ Restricting tobacco industry promotions

Control illicit trade in tobacco products◦ Smuggling◦ Counterfeiting◦ Bootlegging

Tracing and Tracing

Production-side policiesProduction-side policies

Tobacco and Poverty

Alternative sources of livelihoods◦ Switching from tobacco production

Capacity Building for Tobacco Control Institutions

Education

Advocacy◦ Encouraging civil society groups◦ Liaising with the international community

Scientific research◦ Country-specific data

Understand the Tobacco Industry’s Role(s) in Policy◦ The tobacco industry documents

The Tobacco Industry

The Global Industry: Market Share

The Tobacco IndustryPromote tobacco use

Undermine policy◦ Lobbying◦ Corrupting the policy process◦ Focus attention on economics; not health◦ Divert attention from the effects of tobacco use◦ Etc.

Effects of Tobacco Control

Smoking PrevalencePrevent smoking initiation

Reduce tobacco use

Health Improves healthReduces health risksHelps with cessation

Economic benefits

Does not harm economy ◦ See the World Bank’s Cubing the Epidemic

Saves medical costs◦ $80+ billion saved by the California Tobacco

Control Program

Generates revenue through higher taxes (“sin tax”)

Makes more money available to households

The Scientific Consensus

Mamudu et al., 2011

Thank you!!