Global Health Policies for Tobacco Control: Implications for Health Promotion Helda Pinzon-Perez, Ph.D., RN, CHES Suzanne Kotkin-Jaszi, DrPH California State University, Fresno Presentation for APHA November, 2007

Statement of Need Tobacco is the leading cause of preventable death in the world (WHO, 2003). There are 1.3 billion smokers (Who, 2006) By the year 2030, there will be 10 million annual deaths because of tobacco use (Haviland, 2005) The urgency of international cooperation in the fight against tobacco use should be shared by all nations and civil societies of the World (Martabit, president of the First Tobacco Treaty International Conference)

Statement of Need Most health promotion and health education specialists lack appropriate training on health policy. There has been a gap between health promotion and health policy. This presentation addresses the applications of global health policy for tobacco control on global/international health promotion agendas

Research Questions What policy initiatives and global treaties have been created to control tobacco use? How globalization has influenced the creation of health policies related to tobacco control? What are the implications of global health policies for tobacco control for health promotion?

Literature Review Globalization-Social interactions that cross and transcend national boundaries World Health Report 2000-Health Systems (WHO)– France, Italy, Spain, Oman, Austria, and Japan have best health care systems- U.S ranks 37th. Global Efforts: Global Partnership for Tobacco Control (2000) WHO Framework Convention on Tobacco Control (2003). Global Tobacco Control Treaty (2005)

Literature Review Tobacco Free Initiative of the WHO– Canada became example. First Conference of the Parties of WHO (2006)—Develop protocols and legally binding instruments for global tobacco control The Warsaw Declaration for a Tobacco-Free Europe (2002) The Copenhagen Declaration on Health Policy (1994) The Charter Against Tobacco (1994) WHO No Tobacco Day (2006)- Smokeless Tobacco International Day for Smoke Free Movies (2005)– Movie industries to eliminate tobacco ads in movies

Literature Review International Health Promotion conferences: Alma Ata (1978) Ottawa Charter for Health Promotion (1986) Jakarta Declaration on Health Promotion in the 21st Century (1997) Adelaide conference on Health Promotion & Health Policy (1998) Mexico Conference on Health Promotion (2000) Bangkok Conference on Health Promotion (2005) Policy Initiatives World Bank Policy for Tobacco Control (1991) United Nations Tobacco Free Policy (2006)

Literature Review International Health Policies: Reduce loans to tobacco-related industries Control illicit trade and smuggling Develop agricultural substitution programs for tobacco growers Control marketing and trade Include graphic health warnings on tobacco products- literacy level Eliminate use of tobacco products in public places Create international legislation for multinational tobacco corporations

Policy Recommendations Principles: Cost-benefits; Social equity and justice. Policy Recommendations: Global Approach (WHO) Regional Approach (PAHO, European Union, etc) Local Approach (National Governments) Recommended Policy: Global Approach Criteria: Cost-effectiveness

Policy Recommendations Global Approach (Agriculture substitution, marketing, trade, production, and use) Medium effectiveness and High feasibility Benefits: empowering networks for control of multinational corporations and coordinated efforts Costs: International coordination meetings, conferences, regulatory bodies Administrative requirements: Expansion of international policies in Global Tobacco Control Treaty– policies, regulations, and political bodies Judicial Requirements: Creation of international body, coordinated by WHO, to ensure compliance of participating countries- Guarantee accountability and adherence to agreed international policies

Policy Implications for Health Promotion Integration of health promotion practitioners and health policy-makers How should people with interest in health promotion approach the policy change process?– Through social justice policy What skills are needed to engage in the policy change process?– Development of political and advocacy skills How do we build collaborations across policy arenas?—Management of the political process

Policy Implications for Health Promotion Health policies are value driven and health promotion policies have a value basis– values such as social equity and social justice Health promotion and health policy need to emphasize the concept is a right– not a market commodity Health promotion practitioners need to become familiar with the process or method of policy making Challenge_ To ensure sustainability and democratic accountability of health policies.

Selected References American Public Health Association (2006). Global Tobacco use becoming more common among girls. The Nation’s Health. April 2006. Catford, J. (2000). Mexico Ministerial Statement for the Promotion of Health: from ideas to action. Health Promotion International, 15(4); 275-276. Davies, M. & Bozoky, Z. (2002). 5th IUHPE European Conference on the Effectiveness and Quality of Heatlh Promotion. IUHPE-Promotion and Education, 9(4); 136-137. Global Partnerships for Tobacco Control (n.d.). Essential Action. Available online at http://www.essentialaction.org/tobacco/ Accessed on November 4, 2006. GlobaLink (2006). Do Smokers Know their Risks and Bear Their Costs? Avaialable online at http://www.globalink.org/tobacco/wb/wb03.shtml Accessed on November 1, 2006. Green L., Kreuter M. (1990). "Health Promotion as a Public Health Strategy for 1990s". Annual Review of Public Health, Volume 11, p313-334. Haviland, M. (2005). Global Brands, Global Priorities. American Journal of Public Health, 95(6); 935. Lando, H., Borrelli, L., Klein, L., Waverly, L. & Warner, E. (2005). The Landscape in Global Tobacco Control Research: A guide to Gaining Foothold. American Journal of Public Health, 95(6); 939-941.