Syndicate content

Good News from the Global War on Tobacco Use

Patricio V. Marquez's picture



Last week, I participated in the 16th World Conference on Tobacco or Health (WCTOH) in Abu Dhabi--a scientific event where the latest developments in tobacco control were presented.

While there was general agreement that the World Health Organization 2005 Framework Convention on Tobacco Control (WHO FCTC)--the first global treaty negotiated under the auspices of the World Health Organization--is an effective tool for tobacco control, there was concern that implementation at the national level has fallen short of objectives.  

I prefer, however, to see the glass half full rather than half empty.  Let me explain why.    

It should be clear to all of us that the WHO FCTC is a global framework that commits countries that have ratified it to move forward on tobacco control.  This is in itself a tremendous achievement. To help make this a reality, WHO introduced MPOWER, a package of effective policies and interventions to assist countries in reducing the demand for tobacco. The MPOWER package includes:  Monitor for tobacco use; Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion and sponsorship; and Raise taxes on tobacco products.

As shown at the conference, MPOWER is increasingly being implemented worldwide. WHO estimates that 2.3 billion people in 92 countries – one-third of the world's population – are now covered by at least one MPOWER measure, up from 1.3 billion people in 48 countries in 2007. 

More specifically, the 2012 WHO data show that:

  • 2.8 billion people in 54 countries (40% of the world's population) are covered by effective tobacco use surveillance;
  • 1.1 billion people in 43 countries (16% of the world's population) are covered by complete smoke-free legislation;
  • 1 billion people in 21 countries (15% of the world's population) are offered appropriate cessation support;
  • 1 billion people in 30 countries (14% of the world's population) are exposed to strong graphic health warnings;
  • 694 million people in 24 countries (10% of the world's population) live in countries with complete tobacco advertising, promotion and sponsorship bans; and
  • 530 million people in 32 countries (8% of the world's population) live in countries with sufficiently high taxes on tobacco products.
More importantly, according to WHO 2014 estimates, the implementation of the WHO FCTC over 2005-2015 has contributed to reduce smoking prevalence among males and females aged 15 years and older, from 40% to 35% , and from 9% to 6%, respectively. And, as documented in a recent study, evidence from 41 countries show that the effective implementation of MPOWER measures can help avert 7.4 million premature deaths by 2050. 

Substantial and regular increases in tobacco excise taxes that raise prices and make tobacco less affordable have been shown to be the most cost-effective measure, since prince increases are estimated to lead to a reduction of 7 million smokers and to 3.5 million smoking-attributable deaths averted.

To highlight the tangible progress being made in tobacco control in low- and middle-income countries, the winners of the 2015 Bloomberg Philanthropies Awards for Global Tobacco Control announced at the conference reflect good practices and results achieved in each of the MPOWER categories:

•           Monitoring: Brazil Ministry of Health and National Institute of Statistics   implemented the Global Adult Tobacco Survey in 2008, the first country to do so in the Americas, and the subsequent introduction of MPOWER measures into their existing national survey, creating strong technical capacity to monitor tobacco control.
•           Protecting: Regional Advocacy Life Center (“LIFE”) of Ukraine led and coordinated support for the 2012 countrywide smoke-free law and comprehensive anti-tobacco advertising, promotion, and sponsorship bill.
•           Offering help to quit: Uruguay’s Ministry of Health has been a leader in global tobacco control for nearly a decade. In 2008, the new Tobacco Control law mandated that all health care providers offer cessation support.
•           Warning: Nepal’s Ministry of Health and Population passed a comprehensive law comprised of large, graphic health warnings, bans on tobacco advertising and sponsorships, and a smoke-free law, all while facing immense pressure from the tobacco industry.
•           Enforcing: KONFOP, a Russian NGO, was a leader in the passage of 2013 tobacco control legislation in Russia, which is among the strongest comprehensive tobacco control legislation in the world.
•           Raising tobacco taxes: The Philippines Department of Finance and Department of Health played a critical role in passing the Sin Tax Law in 2012, which made it more efficient to raise the tobacco tax by simplifying the country’s tax structure and channeling the revenue to help expand universal healthcare across the country.

Also at last week’s conference, Michael Bloomberg and Bill Gates launched a US$4 Million Anti-Tobacco Trade Litigation Fund to help governments that pass tough anti-smoking laws defend against international trade suits and increase public awareness of legal threats from the tobacco industry.  And one of the most inspiring sessions addressed Australia’s move to mandate plain or standardized packaging for tobacco products in 2012, in spite of strong opposition from the tobacco industry. There were also a lot of discussion on how to best support agricultural diversification and end tobacco crop dependence.

While tobacco control remains a difficult challenge in a large number of countries (about 1 billion people are current smokers), I left the conference convinced that significant inroads have been made in the first 10 years of the WHO FCTC toward the 2013 World Health Assembly target of reducing tobacco use prevalence globally by 30% by 2025. But, as I noted in my presentations at the conference, reaching that target will require that we continue working on tobacco control across the world as a moral and development imperative. If we do that, we will also be able to honor the legacy of loved ones who have suffered and died prematurely due to lung cancer or other tobacco-related diseases.
 
Related:
Declarations of the 16th World Conference on Tobacco OR Health, Abu Dhabi, UAE, March 17-21, 2015
WHO Framework Convention on Tobacco Control
MPOWER:  WHO Policy Package to Reverse the Tobacco Epidemic
The Tobacco Atlas Fifth Edition (2015)
The Tobacco Dilemma: Corporate Profits or Customers’ Health?
 

Comments

Submitted by Anne Jones on

Its s true that there has been good progress but main problem is still the tobacco industry and its growing use of legal and economic threats to undermine the rights of governments to implement the FCTC. Its over a decade since lawyers first recommended an action in the International Court for Crimes Against Humanity and it was discussed again at the WCTOH - but still no resolution. There are already 6m deaths a year and children continue to be targeted and enslaved to nicotine. Countries may continue to not act for fear of industry opposition or they could work together to challenge the drug pushers in an international court. Even if it takes years, its a line in the sand that needs to be drawn.

Submitted by Justin on

Ciggarette are a horrible habbit and not to mention everyone in my family has died a horrible death. Doctors took advantage and got rich on their illness. I hold a huge resentment towards these companies... I might be poking at a hornets nets but I honestly don't care anymore. I will destroy this horrific business with the truth. Do you want facial reconstruction? Do you want to lose control of your facial features? Do you want to lose your ability to breathe? I'm fed up and will be spreading this horrific message. The devil has the worst plans for these companies. They lie to these poor people and advocate against the good things in life. Sounds like the devil to me? I Everyone in my family has died of cancer and it's not an easy thing to deal with. Who knows what Vaping might lead to. Doctors lie and so do the surgeons. If you don't believe me... Look up what people have recorded in the operating rooms. This is why doctors do not want cell phones in their office. Because they are deceitful rich ass holes. I hope everyone takes what I've said into consideration. -Justin Darnell

Submitted by Justin on

Cigarette are a horrible habit and not to mention everyone in my family has died a horrible death. Doctors took advantage and got rich on their illness. I hold a huge resentment towards these companies... I might be poking at a hornets nets but I honestly don't care anymore. I will destroy this horrific business with the truth. Do you want facial reconstruction? Do you want to lose control of your facial features? Do you want to lose your ability to breathe? I'm fed up and will be spreading this horrific message. The devil has the worst plans for these companies. They lie to these poor people and advocate against the good things in life. Sounds like the devil to me? I Everyone in my family has died of cancer and it's not an easy thing to deal with. Who knows what Vaping might lead to. Doctors lie and so do the surgeons. If you don't believe me... Look up what people have recorded in the operating rooms. This is why doctors do not want cell phones in their office. Because they are deceitful rich ass holes. I hope everyone takes what I've said into consideration. -Justin Darnell

Submitted by Dr Mugyenyi Possy on

I strongly agree with Patricio's opinion. Many more countries have passed legislations for Tobacco Control since FCTC came into force. In some countries, we are seeing a downward trend in smoking prevalence. Many countries have introduced stricter measures such as Tax Increase aiming at reducing consumption, declared smoke free cities and introduced pictorial health warnings on cigarette packs. These are big strides. Tobacco use and Economies relying on tobacco for revenue has been on for many years. The damage that has been done over the centuries cannot be reversed in just 10 years. Lets focus on the trend of things-We are moving forward.

Submitted by Patricio Marquez on

In full agreement Anne on the need to tackle tobacco addiction as a major global risk and development challenge, and not just as a health threat. Addiction and tobacco-related ill health, premature mortality, and disability undermine human capital accumulation, productivity gains, and economic and social development. So we need a whole society response!

Submitted by Patricio Marquez on

Many thanks Dr. Possy and as discussed in Abu Dhabi, while many countries in Africa have low smoking prevalence, these countries will likely evolve to later stages of the epidemic with increasing smoking prevalence. So working together, we need to push forward the smoking prevention agenda as a critical intervention in Africa to prevent new smokers initiating, given the already relatively high smoking prevalence among youth, rapid population growth and rising incomes, to avoid altogether the costs of smoking. Of all the demand-reduction strategies outlined in the FCTC, increasing the retail price of tobacco products through higher excise taxes to make tobacco products less affordable is the single most effective way to prevent new smokers initiation, decrease consumption, and encourage tobacco users to quit. Onwards my friend!

Submitted by Konstantin Krasovsky on

I agree that MPOWER works. In my country, Ukraine, in 2008-2014 annual cigarette sales decreased from 125 billion to 73 billion (42% decline in 6 years). Prevalence of daily smoking, according to the annual household surveys, conducted by the National Statistics Service, decreased from 25.6% in 2008 to 20.9% in 2014 (18% decline in six years). The key factor was tobacco taxation: average tax rate increased 10-fold in six years. While cigarette sales declined by 42%, tobacco revenues in 2008-2014 increased from 3.5 bln UAH to 18 bln UAH or 5-fold. Other tobacco control policies, such as ad ban, health warnings, smoke-free policies, which were gradually introduced and strengthened those years, also contributed to the tobacco epidemic decline. Rates of smoking prevalence decrease were much higher among young and less affluent persons, so tobacco control policies were not regressive. Some decline of smoking-related morbidity and mortality in Ukraine is already observed. However there are some parts of the glass to be filled: for example, smoking cessation services are almost absent. There are no governmental funding of tobacco control activities despite of huge increase of tobacco revenues. Ukraine (as many other developing and transition countries) has to find national resources in addition to the international ones, to overcome the tobacco epidemic.

Submitted by Bidyut K Sarkar on

While the global FCTC strategy is effective and significant progress has been made in MPOWER implementation, there is an urgent need to adapt global guidelines to formulate country specific strategies and priorities for low and middle income countries (LMICs)like India.What works in US, UK, Europe or Australia does not necessarily work to the same extent in India. Let me explain why:
1. Most of the FCTC and MPOWER strategies are based on an effective legislations and enforcement mechanism which are extremely weak or almost non-existent in countries in India.
2. India passed a comprehensive tobacco control legislation COTPA more than 11 years ago but there has been very weak implementation and enforcement.

Submitted by Dr Bidyut K Sarkar MD,PhD on

Further in countries like India and Bangladesh smokeless tobacco and not smoking is the predominant form of tobacco which renders smoke free laws partly irrelevant and ineffective. Why is the 'O' of MPOWER offering support to quit given step motherly treatment in comparison to the rest is hard to understand.We are remarkably blind and silent on

Submitted by Nigar Nargis on

I took the same message from the World Conference on Tobacco or Health held in Abu Dhabi on 17-21 March 2015.
It is notable that the progress in MPOWER indicators has been the least with respect to taxation measures indicating that more concerted effort is needed in this area.
Also, tobacco control has to be included in the sustainable development agenda as well.

Submitted by Florence on

Discussions on how to best support agricultural diversification to end tobacco crop dependence have to keep up the momentum. Diversification and eventual substitution of tobacco should be the target. It is needless to mention therefore that with access to the much required supportive services and infrastructure, which national governments should effectively deliver; ‘diversification’ is within reach.

Submitted by Judith Mackay on

There is a crucial need to address the economic arguments on tobacco, and the involvement of the World Bank is vital.
The tobacco industry and its allies use identical economic arguments globally to subvert tobacco control measures, in particular tobacco taxation and tobacco control legislation. The industry argues that tobacco control will lead to job and business losses for farmers, factory workers, retailers, the hospitality industry and other businesses, and governments, e.g :

1. The creation of smoke-free areas will cause loss of income for restaurant owners;
2. Bans on advertising will severely affect the advertising industry and cause job losses;
3. Increasing tobacco taxes will not only harm the poor but will also lead to significant increases in illicit trade with loss of income to government; and
4. Even that if tobacco control is successful, it will lead to an increasing elderly population that will become an economic burden to the state.

Many governments echo these concerns, to the extent that these mistaken economic arguments are the major obstacle to tobacco control.

The reality could not be more different, as we have shown in the 5th edition of the Tobacco Atlas. Many countries have now undertaken economic surveys, showing that tobacco control is good for the wealth and well as the health of nations.

Submitted by Kellen Nyamurungi on

10 years is good time to do evaluation but with tobacco control its a very short time especially in Africa! In addition to taxation, we need to support gov'ts to implement the time bound measure.These need a lot in terms of capacity building and advocacy.

Submitted by Justin on

Ciggarette are a horrible habbit and not to mention everyone in my family has died a horrible death. Doctors took advantage and got rich on their illness. I hold a huge resentment towards these companies... I might be poking at a hornets nets but I honestly don't care anymore. I will destroy this horrific business with the truth. Do you want facial reconstruction? Do you want to lose control of your facial features? Do you want to lose your ability to breathe? I'm fed up and will be spreading this horrific message. The devil has the worst plans for these companies. They lie to these poor people and advocate against the good things in life. Sounds like the devil to me? I Everyone in my family has died of cancer and it's not an easy thing to deal with. Who knows what Vaping might lead to. Doctors lie and so do the surgeons. If you don't believe me... Look up what people have recorded in the operating rooms. This is why doctors do not want cell phones in their office. Because they are deceitful rich ass holes. I hope everyone takes what I've said into consideration. -Justin Darnell

Add new comment