Tobacco AND PUBLIC HEALTH Dr. Jim Arinaitwe Center Manager Kampala – Uganda 20th November 2017

Outline Burden of Tobacco use Globally A glance at tobacco growing in Africa Impact of Tobacco Use Burden of Disease in Africa Tobacco use and NCDs Tobacco Use and Communicable Diseases Burden of substance abuse Tobacco use and substance abuse Impact of Substance Abuse

Global Tobacco Use Burden Tobacco use is the leading cause of preventable death globally Global economic estimates indicate, tobacco will negatively affect the economy by almost USD 12.7 trillion in the next 20 years translating to about 1.3% of the global GDP. Un attended to, by 2030, tobacco will be causing over 8 million deaths per year of whom more than 80% will occur in low and middle income countries. Implementing TC is a priority on the African Continent and very critical to achieving the SDGs and attainment of the UHC. It worth noting that the annual deaths due to tobacco exceed those caused by HIV, tuberculosis and malaria combined

The Trend of Global Tobacco Use Burden …more than 7 million people each year Male: 5.5 M Female: 1.5 M 22% of global cancer deaths, 71% of all lung cancer deaths. 10% of cardiovascular disease death. TOBACCO FARMERS 60-70% Female 10-14% Children Currently: >7 million people die from tobacco use each year -- more than the number of deaths from tuberculosis, HIV/AIDS and malaria combined. By 2030: > 8 million people will die from tobacco use each year >80% of those deaths will occur in LMIC countries Source: World Health Organization (WHO). WHO Report on the global tobacco epidemic, 2011: Warning about the dangers of tobacco. Geneva: WHO; 2011.

Health Impact of Tobacco Use-1 Tobacco kills up to 50% of all its lifetime users when used correctly as recommended by the manufacturers On average, smokers die 15 years earlier than nonsmokers Half of tobacco-related deaths occur between the age of 30 and 69 Overall, about 1/3 of all adults are exposed to secondhand smoke Secondhand smoke is estimated to cause about 600,000 premature deaths per year worldwide 10% of all deaths due to tobacco use are attributed to second hand smoke, though preventable, affecting mainly women & children; 64% occur among women 31% occur among children

Health Impact of Tobacco Use-2 By 2030, NCDs are projected to account for more than 75% of deaths worldwide, 80% will occur in low and middle income countries. Tobacco use kills more than 15,000 people a day and accounts for one in six of all NCD deaths; 71% of all lung cancer deaths 42% of all chronic obstructive pulmonary disease 22% of cardiovascular diseases, 10% of which result in death 12% of all lower respiratory infection deaths and 7% of all tuberculosis deaths are attributable to tobacco use (WHO 2012). More than 20% of the global TB incidence is attributable to smoking Negative Sexual and Reproductive Health effects

The Magnitude of the problem It is projected every 6 seconds; A friend dies from tobacco Another heart is broken Another future is lost Yet all is preventable completely If tobacco use is stopped, we shall save; 10 lives per minute 3000 lives a day 480,000 lives a year

Comparison of Tobacco epidemic by region As tobacco use is the most common preventable cause of death, governments must implement effective policies to prevent tobacco use (reducing initiation and promoting cessation) and involuntary exposure to tobacco smoke in order to save lives.

Shift of the Tobacco Epidemic The tobacco epidemic is migrating from developed countries to Africa and Asia. Overall, the Africa region is at the early stages of the tobacco epidemic. The number of smokers in Africa is expected to more than double, from 84 million in 2000 to 208 million by 2030, if nothing is done (WHO, 2008). Currently, the prevalence of tobacco smokers among the youth in African countries ranges from 8% to 43% for boys and 5% to 30% for girls averaging at 27.5%. Tobacco use in Africa is more than a health problem: it exacerbates poverty with health expenditures for tobacco-related diseases, and through reductions in household productivity due to tobacco related morbidity and mortality.

TOBACCO GROWING AREAS IN AFRICA[1] [1] http://www.universalcorp.com/UniversalLeaf/Africa

Tobacco Use in Africa Regional average of Tobacco use is estimated at 16.8% for adult male and female (WHO 2015) Regional average of Tobacco use is estimated at 27.5% for youth male and female (WHO 2015) Smoking prevalence is estimated to increase by nearly 39% by 2030 from 15.8%(2010) to 21.9%(2030), the largest expected regional increase globally. (Blecher and Ross, 2013; Mendez et al., 2013)

Proportion of deaths by cause in SSA, 2010 Source: Global Burden of Disease study, IHME 2013

Further shift expected in relative disease burden Burden of Disease (% total DALYs) by Groups of Disorders and Conditions, SSA, 2008 and 2030 Source: Global Burden of Disease study: 2004 update (2008) (estimates; pending new projections from GBD/IHME 2013)

Africa is experiencing increasing death rate from NCDs Age-standardized Mortality Rates by Cause, WHO Regions, 2008 Source: World Health Statistics 2013, World Health Organization

Out look of NCD funding in SSA The Sub-Saharan Africa region accounts for 11% of the world’s population and 24 percent of the global disease burden, yet commands less than one percent of global health expenditure Over the last decade bilateral and multilateral donors combined have provided about $8 billion in aid to Sub-Saharan Africa. Overall, approximately 10% of Africa’s health care expenditure is financed directly by donor aid. Donor funding for NCDs is negligible, comprising only about 2-3% of overall development assistance for health in 2007

Tobacco use & link to NCDS & Communicable diseases Tobacco use is a risk factor for 6 of the 8 primary causes of death in the world. By 2020 tobacco is expected to kill more people than any single disease, even HIV/AIDS. The single largest cause of preventable death in the world today More than ¾ of CVD results from its use. Over 100 million people died from use in 20th century. May kill more than 1 billion in 21st century. Currently 70% of tobacco use is in LIC. Source: WHO Report on Global Tobacco Epidemic, 2008, used by permission

Tobacco Use and substance abuse Substance use disorders are strongly related to smoking. Compared to non-smokers, current smokers are; 4 times more likely to have an alcohol use disorder (95%CI 3.4, 4.7), 8 times more likely to have a cannabis use disorder (95%CI 5.7, 10.2), 5 times more likely to have another drug use disorder (sedative, stimulant or opiate; 95%CI 3.1, 7.1). These relationships are evidently significant even after accounting for demographics, neuroticism and other drug use. These observations show that tobacco use and other substance abuse are strongly related to mental health problems even after controlling confounding variables. Source: The relationship between tobacco use, substance use disorders and mental disorders: results from the National Survey of Mental Health and Well-Being

Burden of Substance Abuse Source: United Nations Office on Drugs and Crime, World Drug Report 2014

Impact of substance abuse WHO ATLAS 2010: First global report on substance use disorders launched Alcohol and illicit drug use account for 5.4% of the world's annual disease burden, with tobacco being responsible for 3.7%. Illicit drugs kill 4 people per every 100,000 people Two-thirds of countries have a government unit or official responsible for treating substance use disorders, and under 50% have a specific budget for treating such disorders In Africa, out-of-pocket payments are the main funding method for treating alcohol and drug use disorders. Africa is also the only WHO region with the fewest countries with substance abuse policies.

Conclusion The burden of tobacco and other substances is real There is need for a holistic approach to TC and substance abuse to address NCDs and avert the double burden affecting Africa We need to consolidate our tobacco control efforts through a well coordinated sustainable response. We need to expand our resource enveloped We need to innovate and propagate an African research agenda to generate data for action

Call for the Media Create public awareness about the dangers of tobacco use Support the Tobacco Control legislation process Put tobacco control on top of health media agenda Create impact on all tobacco control intervention targeted outcomes

THANK YOU