Alison Commar, Comprehensive Information Systems on Tobacco

Control, WHO

Is the world achieving the 2025 target on tobacco use?

A 30% relative reduction in prevalence of current tobacco use by 2025

Baseline: 2010

Each country has its own specific prevalence target

Working towards the target is voluntary

WHO monitors progress using data from countries

What is the tobacco target?

Tobacco's contribution to illness and death via noncommunicable diseases has been well-proven

Adopting the target will have a direct and measurable impact on reducing NCD deaths and disease

The target is achievable, but needs concerted effort

Why the target?

“We acknowledge that the global burden and threat of NCDs constitutes one of the major challenges for sustainable development in the twenty-first century”

(paragraph 141)

NCDs in the SDGs

NCDs included in the 2030 Agenda for Sustainable Development

By 2030:

Reduce by one third premature mortality from NCDs by prevention, treatment and promoting mental health and well-being

Strengthen the implementation of the WHO FCTC

2030 Agenda for Sustainable Development

The work of WHO in fighting NCDs

Goal:To reduce the preventable and avoidable burden of morbidity, mortality and disability due to NCDs by means of multisectoral collaboration and cooperation at national, regional and global levels

WHO Global NCD Action Plan 2013-2020

Halt the rise in diabetes

and obesity

A 10% relative reduction in prevalence of insufficient physical activity

At least a 10% relative reduction in the harmful use of alcohol

A 25% relative reduction in risk of premature mortality from cardiovascular disease, cancer, diabetes or chronic respiratory diseases

An 80% availability of the

affordable basic technologies and

essential medicines, incl.

generics, required to treat NCDs

A 30% relative reduction in

prevalence of current tobacco

use

A 30% relative

reduction in mean

population intake of

salt/sodium

A 25% relative reduction in prevalence of raised blood pressure or contain the prevalence of raised blood pressure

At least 50% of eligible people

receive drug therapy and

counselling to prevent heart

attacks and strokes

Where to focus: 9 global NCD targets

How are we monitoring the tobacco target?

Smoking data are available from 181 countries (women) and 178 countries (men).

To assess trends in smoking over time, we need at least two surveys since 1990. We have sufficient surveys for 149 countries.

Countries with little or no data are either in crisis or have low commitment to tobacco control.

Global surveillance

Countries have various surveillance systems in place

Surveillance in countries

Source: WHO TFI database

National surveillance

Source: WHO TFI database

Surveys in 34 low-income countries

Regular surveillance

Irregular surveillance

No surveillance

EU, excl Cyprus and MaltaArmeniaAzerbaijanIcelandKazakhstanNorwayRepublic of MoldovaRussian FederationSerbiaSwitzerlandTurkeyUkraine

AlbaniaAndorraBelarusBosnia & HerzegovinaCyprusGeorgiaIsraelKyrgyzstanMaltaMontenegroUzbekistan

MonacoSan MarinoTajikistanThe FYR of MacedoniaTurkmenistan

Surveillance in Europe

• European Health Interview Survey• Eurobarometer• Demographic and Health Survey• Global Adult Tobacco Survey

• Health Behaviour in School-aged Children (HBSC)• Global School-based Student Health Survey (GSHS)• Global Youth Tobacco Survey (GYTS)

Survey systems in Europe

WHO prevalence trend estimates

Global trends and projections for tobacco use, 1990–2025: an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control

A standard method for all countriesInternationally comparable resultsDefendable and peer-reviewed statistical methodEasy for Member States to comprehend and adopt

University of Newcastle

Trevor MoffietFrank TuylIrene Hudson

University of Tokyo

Ver BilanoStuart GilmourKenji Shibuya

WHO

Edouard Tursan d'EspaignetGretchen StevensAlison Commar

2000 2005 2010 2015 2020 20250

5

10

15

20

25

30

35

40

45

50

0

5

10

15

20

25

30

35

40

45

50

Current tobacco smoking globally among persons aged 15+, crude adjustedPrevalence (%) Prevalence (%)

men

women

overall

Source: WHO estimates

Global smoking trends

Source: WHO estimates

Smoking trends by income group

Source: WHO estimates

Smoking trends by WHO Region

Source: WHO estimates

Smoking trend – European Region

Achieve 30% Decrease No change Increase Unknown0

10

20

30

40

50

60

70

80

90

44

79

4

22

45

Number of countries globally, by trend in tobacco smoking to 2025

Source: WHO estimates

Meeting the tobacco target by 2025

Source: WHO estimates

AFR AMR EMR EUR SEAR WPR0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

3

14

11 2

1421

4

6

34

6

8

1 2

1

7 2

9

2

1

11513

6

52 4

Number and proportion of countries in WHO Regions who might meet 30% relative reduction in tobacco smoking between 2010 and 2025

UnknownIncreaseNo changeDecreaseAchieve 30%

Meeting the tobacco target by 2025

Will meeting the tobacco target reduce mortality?

• Policy effects have been measured for:– Higher taxes and prices– Smoke-free laws– Graphic health warnings– TAPS bans– Mass media campaigns– Cessation services

What brings down prevalence?

• Policy effects are largely unknown for:– Banning sales to minors– Regulation of tobacco product contents– Regulation of tobacco product disclosures– Stemming illicit trade– Supporting alternative livelihoods– Promoting sensitization and awareness among

healthcare workers, educators, media professionals, public and private agencies and NGOs

What brings down prevalence?

UNDER DEVELOPMENT

WHO's Interactive Smoking Projection Tool

Source: WHO estimates

Smoking trends in Fiji

P level 3 (scenario level 5)

O level 4 (scenario level 5)

W pack warnings level 5

mass media campaigns level 4 (scenario level 5)

E level 4 (scenario level 5)

R level 3 (scenario level 5)

Fiji MPOWER levels

Source: ISPT

2000 2010 2020 2030 20400%

10%

20%

30%

40%

50%

60%

Prevalence Trend: Male

Prev Trend

Business-As-Usual

With Policies

Target

Baseline Year

Policy Start Year

Target Year

Year

Smok

ing

Prev

alen

ce

Fiji

MPOWER scenario - Fiji

Source: ISPT

Mortality outcomes - Fiji

Contribution of six risk factors to achieving the 25×25 NCD mortality reduction target

Kontis, V et al., Lancet 2014; 384

• Authors from WHO, Imperial College London, Centre for Addiction and Mental Health, Toronto, University of Toronto, Technische Universität Dresden and University of Auckland. Funded by UK MRC.

• Findings: Even if the agreed risk factor targets are met, the 25% reduction in premature mortality target will not be met– If risk factor targets are achieved, the probability of dying prematurely from the

four main NCDs will decrease by 22% in men and by 19% in women – If trends continue as per business-as-usual, the probability of dying prematurely

will decrease by only 11% in men and 10% in women

• If the tobacco use target were to be increased from 30% to a 50% reduction, the mortality target for men would almost be achieved.

Global mortality outcomes

• Cut in youth initiation• Increase in cessation rates• Synergy effect - multiple policy actions

working together• Network effect – background effects of policy

actions and public awareness over time

What will reduce prevalence?

• Multisectoral implementation of WHO FCTC– Top levels of government– Ministries of Health– Ministries of Finance, Customs and Excise

Leadership

• WHO engages with non-State actors– Donors and philanthropic organisations– Academic institutions– NGOs

• Civil society• Mass media• Communities• Individuals• Social movements

Ground swell

We are all advocates

Thank youcommara@who.int