WHY TOBACCO CONTROL?

glamorous sociable sophisticated relaxing fun calming romantic emancipated sexy liberating healthy rebellious sporty slimming fashionable cool Smoking has been promoted as being:

Emancipated ? Glamorous ? Sexy ?

National Archives and Records Administration Tobacco Arrives in the Old World 1492: Columbus brings tobacco back to Europe from his first voyage 1556–59: Tobacco introduced into France, Spain and Portugal 1560s: Jean Nicot praises tobacco’s medicinal properties to the French queen

Early Marketing of Cigarettes October 13, 1913, R.J. Reynolds Tobacco Company introduced Camels, the first modern blended cigarette, and launched the first US cigarette- advertising campaign 1920s: women first became the targets of the tobacco companies JM Samet

Early Efforts to Control Tobacco Use King James I of England on active smoking: ‘’Smoking is a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof nearest resembling the horrible Stygian smoke of the pit that is bottomless’’ King James I of England on passive smoking: ‘’The wife must either take up smoking or resolve to live in a perpetual stinking torment’’

Borio G. Tobacco Timeline, 1998 Early Indications of Tobacco-related Disease 1600s China: philosopher Fang Yizhi points out “long years of smoking scorches one’s lung” 1701: N. A Boiseregard warns that young people taking too much tobacco have trembling, unsteady hands, staggering feet and suffer a withering of “their noble parts” 1761: John Hill warns of cancer of the nose for snuff users 1795: Sammuel Thomas von Soemmering reports cancers of the lip in pipe smokers

Early Indications of Tobacco-related Disease 1954: Richard Doll and Bradford Hill’s study of British doctors published in the British Medical Journal 1962: Royal College of Physicians Report 1964: First Surgeon General’s Report on tobacco and health 1981: First major study on passive smoking and lung cancer by Takeshi Hirayama (Japan) Borio G. Tobacco Timeline Surgeon General Luther Terry holding the 1964 Report

Borio G. Tobacco Timeline, 1998 Survivorship of white males after 30 years of age according to smoking habits Pearl, Age in years Non-users Thousands of survivors Moderate smokers Heavy smokers Early Indications that Tobacco Causes Disease 1938: Raymond Pearl reports smokers do not live as long as non- smokers 1950: Three key case- control studies link smoking with lung cancer 1953: Ernst Wynder’s study showed that tobacco painted on the backs of mice produced tumors

Borio G. Tobacco Timeline, 1998 JM Samet The Rise of Cigarette Consumption 1921: cigarettes became the main form of tobacco consumed in the US 1964: Marlboro Man ad campaign launched, sales rise 10% a year 1970s: the tobacco industry marketed aggressively to countries in Africa, Asia and Latin America 1972: Marlboro becomes the best-selling cigarette in the world

Around the world tobacco kills:  560 people every hour  13,400 people per day  4.9 million people per year  By the year 2030, 10 million people a year will die from tobacco.  70% of those deaths will occur in developing countries

Approximately 500 million people alive today will die from tobacco-related disease Our future – literally – is at stake.

Tobacco and Health Reducing the global disease and economic burden of tobacco use is one of the greatest public health challenges of our time Effective tobacco control strategies exist that are cost effective Strong national and international actions are critical to stem the course of the tobacco pandemic

Health Consequences of Tobacco Use Each year tobacco kills 3 million people worldwide WHO estimates that by 2020–2030, tobacco will be responsible for 10 million deaths per year –70% will occur in developing countries Half of all long-term smokers will be killed by tobacco –half of these will die in middle age, losing 20–25 years of life

Number of deaths (millions) WHO, Leading Causes of Death Worldwide in 1990 and Estimated in 2020

The Coming Epidemic

Economic Consequences of Tobacco Use Medical costs Productivity losses due to: –morbidity –disability –premature mortality Global net loss of US$ 200 billion per year

Changing Trends in Tobacco Use Cigarette smoking is a 20th century phenomenon Cigarette smoking by females was very uncommon until the 1930s in countries like the US The smoking epidemic is spreading in low- income countries In most countries, the poor are more likely to smoke than the rich

WHO, 1997, cited in World Bank Report, 1999 The Changing Epidemic 1990–921970–721980– Smoking is increasing in the developing world Trends in per capita adult cigarette consumption Annual cigarette consumption per adult (in cigarettes) Year Developed Developing World

“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

Rationale for Tobacco Control Smoking kills one in ten adults worldwide By 2030 the proportion has been predicted to be one in six –more than any other single cause of mortality Half of all long-term smokers will be killed by tobacco –half will die prematurely, losing 20–25 years of life The use of tobacco results in a global net loss of US$ 200 billion per year

Obstacles to Tobacco Control Tobacco contains nicotine, which is addictive The tobacco industry uses its economic and political influence to oppose tobacco control efforts Tobacco sales contribute to government revenues In some populations, there is a lack of knowledge of tobacco-related health risks

Policy Maker’s Concerns on Taking Action to Control Tobacco Use Job losses Loss of government revenue Increased smuggling Disproportionate impact of increased price measures on low- income tobacco users World Bank, 1999

The Advocacy Institute, 1998 Tobacco Industry Strategies The tobacco industry: –uses public relations to present itself in positive ways –uses money to fund political events and access the political process –gives money to various organizations that are sometimes used as more ‘credible’ advocates –uses more respectable economic allies such as farmers and retailers to argue its case –employs well-connected lobbyists –uses various intimidation tactics to frighten advocates, law-makers and journalists away from pursuing tobacco control policies

Source: Philip Morris, World Bank Philip Morris/Altria Tobacco Revenue & Selected Country GDPs (2000) Philip Morris US$ billions Czech Rep Kenya Senegal Sri Lanka Costa Rica Hungary

Key Tobacco Control Strategies to Reduce Demand Raising the price of tobacco Banning advertising and promotion Creating smoke-free indoor environments Conducting mass media campaigns Including strong warning labels on all tobacco products Increasing access to treatment Implementing youth-based programs –school-based programs –media literacy –youth advocacy

Raising the Price of Tobacco Price is probably the single most powerful factor influencing short-term tobacco consumption Price plays an important role in determining the number of young people who start smoking Tax should represent two-thirds of the selling price

Banning Advertisement and Promotion Advertising, sponsorship and promotion are all used to boost sales Bans on advertising and promotion are fiercely contested by the tobacco industry Sponsorship is the method most commonly used to circumvent advertising bans Brand stretching (using cigarette brand colors and logos on non-tobacco products) is the fastest growing form of indirect tobacco advertisement in Europe Comprehensive bans on advertising, sponsorship and promotion are most effective

Smoke-free Indoor Air Planes Workplace Schools Public places Restaurants Reproduced with permission from the National Institute of Respiratory Diseases of Mexico (INER).

Regulation of Tobacco Products Nicotine is currently most widely available in its deadliest form Move to develop innovative regulatory approaches Suggestions for change include: –establishing a single regulatory framework for all nicotine delivery products –prohibiting the use of misleading terms such as ‘light’ –requirement that manufacturers disclose constituents and their effects –seeking genuine harm reduction strategies –studying reduction over time of nicotine and other potentially addictive constituents as harm reduction strategy –increasing access to effective treatment

Tobacco Control Efforts to Reduce Supply Prohibition of tobacco Restrictions on youth access Crop substitution and diversification Restrictions on international trade Action against smuggling

Crop Substitution Economies of some developing countries’ depend on tobacco production Tobacco provides high net income per hectare Tobacco industry provides incentives to farmers Arguments for substitution have been made based on deforestation Restrict Minors’ Access Increase age for legal purchase of cigarettes and increase compliance by vendors Restrict vending machine use Prohibit sales of single cigarettes

Smuggling Drives down prices and makes sought-after international brands more affordable 30% of internationally exported cigarettes lost to smuggling Industry involvement Anti-smuggling measures: –increased penalties –prominent tax stamps –special packaging

Goal of Tobacco Control Programs ‘‘ To reduce the mortality and morbidity caused by the use of tobacco products’’

Summary: WHO Recommendations for Comprehensive Tobacco Control Comprehensive national programs should employ multiple strategies, including fiscal policy, information policy, establishment of smoke-free public places and provision of treatment Adequate support is critical and should include support for capacity building, applied research, surveillance and evaluation Public/media debate on tobacco control-related issues should be encouraged