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The Challenge, and the Promise, of Global Tobacco Control

The Challenge, and the Promise, of Global Tobacco Control. Thomas J. Glynn, PhD American Cancer Society Washington, DC. Presented at the International Quitline Institute, Seattle, Washington, USA - October, 2011. Preaching to the Converted. Singing to the Choir.

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The Challenge, and the Promise, of Global Tobacco Control

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  1. The Challenge, and the Promise, of Global Tobacco Control Thomas J. Glynn, PhD American Cancer Society Washington, DC Presented at the International Quitline Institute, Seattle, Washington, USA - October, 2011

  2. Preaching to the Converted

  3. Singing to the Choir

  4. Carrying Coals to Newcastle

  5. Africa's Malaria Death Toll Still "Outrageously High" How AIDS Changed America

  6. With so many competing interests, is tobacco actually important as a global issue?

  7. So, are the tobacco control advocates crazy? • Are they just convinced that “my disease is more serious than your disease?” • Are they blinded by zealotry? • OR… • Do they have facts that other people don’t?

  8. The answer may be that they DO have the facts. Consider that, if unchecked, the tobacco pandemic could in this century: • Kill one billion (1,000,000,000) people • Overwhelm cancer and cardiac hospital units • Ravage the social well-being and finances of millions of families • And kill 1 of every 10 people now alive

  9. Why is Tobacco Control Important as a Global Issue?

  10. The Disease Consequences of Tobacco Use Are Universal

  11. Tobacco Related Cancers • Oral cavity and pharynx • Esophagus • Larynx • Lung, trachea and bronchus • Urinary bladder • Renal pelvis • Uterine cervix • Pancreas • Kidney

  12. Tobacco Related Cardiovascular Diseases • Hypertension • Ischemic heart disease • Atherosclerosis • Pulmonary heart disease • Aortic aneurysm • Stroke

  13. Tobacco Related Respiratory Diseases • Chronic bronchitis • Emphysema • Asthma • Pneumonia

  14. Tobacco Related Pediatric Diseases • Low birth weight • Respiratory distress syndrome • Sudden infant death syndrome

  15. Secondhand Tobacco Smoke Problems • Heart Disease • Lung cancer • Asthma attacks • Bronchitis and pneumonia (especially children) • Coughs and croup (especially children) • Middle ear infections (children)

  16. Conclusion of the U.S. Surgeon General—2004 “Smoking harms nearly every organ of the body, causing many diseases and reducing the health of smokers in general.”

  17. Smoking and Second-Hand Smoke Damage Every Part of the Body Second-Hand Smoke Smoking

  18. Why Hasn’t Tobacco Control Received the Global Attention it Needs? • Tobacco use is viewed as a personal choice and a personal failing • Most victims of tobacco-related disease die and disappear quickly • Families and victims are often ashamed to discuss their tobacco use • The tobacco pandemic has developed slowly and insidiously

  19. Why Hasn’t Tobacco Control Received the Global Attention it Needs? (continued) 5) Tobacco is old news 6) Few strong tobacco control advocacy groups have arisen 7) The global effects of tobacco use – health and economic – are not well known 8) The multinational tobacco companies have controlled the playing field.

  20. “Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists.” WHO Zeltner Report, 2000

  21. Factoid Time

  22. Global Smoking Prevalence • There are currently 1.3 billion smokers in the world – there will be 1.7 billion in 2025 • Asia has the highest smoking rates in the world with overall country rates of up to 47%. China alone has over 300 million smokers that consume more than 1.7 trillion cigarettes a year – about 67% of the male population and 4% of the female population are smokers • One-third of the global population age 15 and older smokes

  23. Distribution of world’s smokers 2000 2025 WHO World Health Report 1999.

  24. Tobacco deaths in the Industrialized and Developing World, 2000 and 2030 While tobacco-related deaths will only increase slightly in the industrialized world during the next 30 years, they will more than triple in the developing world. • Industrialized countries • Developing countries

  25. Global Smoking Deaths • Globally, more than 600,000 million people alive today – about 10% of the world’s population – will die from smoking-related causes; half of these victims are now children • Every eight seconds a person dies of a smoking-related disease • Cigarettes kill half of all lifetime users, with half of these dying in middle age – between 35 and 69 years old, their most productive years

  26. Global Smoking Deaths (continued) • 1 in 10 adult deaths worldwide are smoking related • Smoking diminishes health in more than 50 ways, at least 20 of which are fatal • In 2000, 4.83 million deaths worldwide were attributable to smoking: 1.69 million from cardiovascular disease, 970,000 from COPD, and 850,000 from lung cancer. This number will rise to 10 million by 2030

  27. Global Smoking Deaths (continued) • Smokers are twice as likely to die prematurely from any cause and 6.5 times more likely to die of lung cancer, compared to nonsmokers • No other consumer product is as dangerous or kills as many people when used as intended. Tobacco kills more than AIDS, legal drugs, illegal drugs, road accidents, murder, and suicide combined • Tobacco is expected to kill 8.4 million people annually by 2020, and 10 million people in 2030, if current consumption does not change

  28. Economic Effects of Tobacco Use • By 2010, the WHO estimates the annual global cost of tobacco to be US$500 billion – a figure higher than the GDP of 174 of 192 UN members • Smoking-related costs can contribute up to 15% of total health-care costs in developed countries • Japanese male smokers, for example, incur 11% more medical costs than never smokers and have increased inpatient medical-care costs 33% higher in smokers than never smokers

  29. Economic Effects of Tobacco Use (continued) • As much as ten percent of family income in some parts of the world is spent on tobacco, limiting needed expenditures on food, clothing, education, and shelter • A 1996 study – 15 years ago – estimated that total annual medical and social costs of tobacco use in Hong Kong were one-quarter of the total healthcare budget – and prevalence has risen since then • For nearly 50% of the world’s population, a pack of Marlboros costs approximately half of a family’s daily income

  30. Good News • The tobacco pandemic is preventable and its effects reversible: 1) The global tobacco control community has identified those areas which must be addressed in order to turn the tide of the tobacco pandemic 2) It is possible to document what the health and economic effects of turning the tide would be; and 3) We know what needs to be done

  31. Framework Convention on Tobacco Control: First Treaty Negotiated under WHO Objective: “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke”

  32. FCTC: History • May 1999: World Health Assembly Resolution • October 2000: First Intergovernmental Negotiating Body • February 2003: Final Intergovernmental Negotiating Body • May 2003: World Health Assembly Unanimous Approval

  33. FCTC Milestones • Entry into Force - February 27, 2005 • Signature by Member States (180) • Ratification by Member States (172) representing 87% of World Population • Conference of the Parties (COP): • 1st Session February 2006, Geneva • 2nd Session June 2007, Bangkok • 3rd Session November 2008, Durban • 4th Session November 2010, Punta del Este

  34. Why is the FCTC important? • The FCTC is the world’s first treaty to address a public health issue. • The FCTC offers the best change to address tobacco control globally. • The FCTC has, and will continue to, generate tobacco control advocacy in every country in the world.

  35. The FCTC Mantra Sign Ratify Implement Enforce Evaluate

  36. Measures Relating to the Reduction of the Supply of Tobacco • Illicit Trade in Tobacco Products (Art. 15) • Sales to and by Minors (Art. 16)

  37. Measures Relating to Reduction of Demand for Tobacco • Price and tax Measures (Art. 6) • Protection from Exposure to Tobacco Smoke (Art.8) • Regulation of Contents of Tobacco Products (Art. 9) • Regulation of Tobacco Product Disclosures (Art.10) • Packaging and Labeling of Tobacco Products (Art. 11) • Education, Communication, Training and Public Awareness (Art. 12) • Tobacco Advertising, Promotion and Sponsorship (Art. 13) • Tobacco Dependence and Cessation (Art. 14)

  38. — Línea de base — Si la proporción de adultos jóvenes que empiezan a fumar se reduce a la mitad para el año 2020 — Si la consumición por adultos se reduce a la mitad para 2020 Salvo que los fumadores actuales lo dejen, las muertes por tabaco aumentarán dramáticamente en los próximos 50 años Muertes por tabaco acumulativas estimadas entre 1950-2050 con diferentes estrategias de intervención Muertes por tabaco (en millones) Año World Bank. Curbing the epidemic: Governments and the economics of tobacco control. World Bank Publications, 1999. p80.

  39. How Many Smokers Are Affected by Article 14? • There are 1.3 billion smokers worldwide • More than 50% of these smokers – or more than 650 million – want to stop • This is equivalent to more than 200x the entire population of Uruguay

  40. Trends in cigarette consumption and lung cancer mortality, US, 1900-2005 Cigarette Consumption Lung CancerMen Lung CancerWomen

  41. FCTC – Article 14 Demand Reduction Measures Concerning Tobacco Dependence and Cessation Each Party shall develop and disseminate appropriate, comprehensive and integrated guidelines based on scientific evidence and best practices, taking into account national circumstances and priorities, and shall take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence. 50

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