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!!