Tobacco Control in Europe: What Works Thomas E. Novotny, MD MPH Thomas E. Novotny, MD MPH
Tobacco Control in Europe: What Works Thomas E. Novotny, MD MPH.
Dec 26, 2015
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- Tobacco Control in Europe: What Works Thomas E. Novotny, MD MPH
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- Most smokers live in developing countries Source: Jha et al, 2002, AJPH Current smokers in 1995 (in millions) RegionNumber Low/Middle income 933 High Income 209 World 1,142
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- Smoking is more common among the less educated Smoking prevalence among men in Chennai, India, by education levels Source: Gajalakshmi and Peto 1997
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- Tobacco Control in Developing Countries and Curbing the Epidemic The World Bank WHO
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- Effective interventions: Demand reduction n Higher cigarette taxes; n Non-price measures : consumer information, research, cigarette advertising and promotion bans, warning labels, and restrictions on public smoking; n Increased access to nicotine replacement (NRT) and other cessation therapies.
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- Taxation is an effective measure to reduce demand n Higher taxes induce quitting and prevent starting n A 10% price increase reduces demand by: u 4% in high-income countries u 8% in low or middle-income countries n Young people and the poor are the most price responsive
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- Cigarette price-consumption relationship: So. Africa, 1970-1989
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- Non-price measures to reduce demand n Increase consumer information: dissemination of research findings, warning labels, counter-advertising n Comprehensive ban on advertising and promotion n Restrictions on smoking in public and work places n Increase access to nicotine-replacement therapies (NRT)
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- Health information reduces the demand for cigarettes Source: Kenkel and Chen, 2000
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- Comprehensive advertising bans reduce cigarette consumption Consumption trends in countries with such bans vs. those with no bans (n=102 countries) Source: Saffer, 2000
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- Effect of Smoke-free Workplaces on Smoking Behavior n International study, Ficthenberg and Glantz, BMJ July 2002; n Totally smoke-free workplaces associated with 3.8% reductions in prevalence and 3.1 fewer cigarettes smoked per day. n To achieve similar results in US and UK, taxes would have to increase to $1.11 and GBP4.26 n Italy, Ireland, Norway, Brunei, and others now smoke-free (to varying degrees).
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- Ineffective interventions: Most supply side measures n Prohibition n Youth access restrictions n Crop substitution n Trade restrictions n Control of smuggling is the only exception
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- Unless current smokers quit, smoking deaths will rise dramatically over the next 50 years Source: Peto and Lopez, 2001
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- Effectiveness of cessation Increase in 6 month Intervention quit rates (%) n n Brief advice to stop by clinician 2 to 3 n n Adding NRT to brief advice 6 n n Intensive support plus NRT 8 Source: Raw et al., 1999; AHCPR, 1999
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- Source: CMH, 2001 Cumulative deaths avoided (millions) before age 60 with interventions in low and middle-income countries, 1998-2020 Infectious and maternal conditions ($26-46 billion/year) Adult smoking cessation (self- financing) Year
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- Key Ethical Principles Related to Global Public Health n Autonomy- individual choice u requires resolution of information asymmetry and voluntary choice n Beneficence- do no harm and also prevent harm n Justice- esp. distributive justice u fair, equitable and appropriate distribution of social goods including political rights
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- Tobacco is Not an Equal Opportunity Killer n Smoking affects young, the poor, depressed, uninsured, less educated, blue-collar, and minorities most in the US; n Addiction affects those with the least information about health risks, with the fewest resources to resist advertising, and the least access to cessation services; n Those below poverty line are >40% more likely to smoke than those above poverty line.
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- Whats Wrong With This Picture? n Tobacco industry contributes five times as much to Republican candidates as to democratic candidates; n No global leadership from US DHHS; n Small funds channeled from CDC and NIH through World Bank, WHO, and other organizations, but not from USAID; n More is known about the health consequences of tobacco use and the effectiveness of tobacco control than any other risk factor. More is known about the vectors than ever before.
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- Global Tobacco Control Key questions for global tobacco control research and practice: u What is ethical basis for tobacco control? u What is the optimal policy mix for tobacco control? u What is the US role in u global tobacco control?
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- Summary n Tobacco mortality is growing, with higher burden among poor n Specific market failures support government intervention n Demand measures are the most cost effective n Helping adults quit is as important as preventing starting n Control of smuggling is major supply-side intervention n Poor implementation of effective interventions in lower income countriesneeds international cooperation n US has an ethical, scientific, and public health responsibility to lead and not to just passively follow global Tobacco Control through the FCTC.
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- Framework Convention on Tobacco Control n First treaty negotiated under WHO; n Agreement by consensus at 2003 World Heath Assembly (192 countries); n Takes effect February 27, 2005!! n So far, 168 have signed, >90 ratified; NOT U.S. n Depends on developing national policies in accordance with obligations; n Advertising ban, warning labels, misleading information on labels, taxation, clean-indoor air policy, liability, smuggling controls, etc.
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