Professor Judith Mackay Plenary Session 4 - Chronic Disease World Congress of Epidemiology Edinburgh, Scotland; 9 August 2011

Smoking prevalence Male Female Same key

Female smoking numbers: Top 20

Youth smoking prevalence, , GYTS Boys Girls Same key

Health professionals

↑ Tobacco epidemic (~ other NCD) Number smokers 1.4 b -> 1.6 b By 2030 Smoking prevalence Tobacco consumption Tobacco deaths 6m->8m p.a. by 2030

Global Cigarette Consumption,

Health risks known, but always more e.g. link with TB

Deaths caused by tobacco 2015

Deaths caused by Secondhand smoke

Cumulative deaths from tobacco, global,

Tobacco Costs HEALTH COSTS OTHER ECONOMIC COSTS Medical and healthcare costs Higher sickness and absence rates Loss of skilled workers by premature death Increased early retirement due to ill health Secondhand smoke risks Time off for “smoke breaks” Lost production and lower productivity Fires caused by careless smoking Damage to building fabric Litter of billions of cigarettes, matches, packets, lighters Risk of being sued

Costs to smoker: cig v. rice

Lack of awareness of risk factors Preoccupation with other diseases Tobacco may not yet cause many deaths Focus on curative medicine, not prevention Smoking, alcohol, diet seen as personal behaviour Tobacco industry: promotion, distortion of health and economic evidence, financial might, challenge/threats to governments  other industries not far behind Tobacco tax revenue (but not debit) seen Misperceived economic costs Lack of funds for research and intervention Obstacles to Tobacco Control

HK resident smoking through SARS mask

The tobacco industry: Not changed its spots… Acknowledgement to

Neo-libertarian groups – now gone global “Nanny state” “Less government” “Personal freedom”

Medical Model Not Enough

Tobacco Control: WHO FCTC WHO FCTC into effect 2005 Parties ratified: 174/ 192

Tobacco Control: FCTC Main Provisions

Tobacco Control: Ban Tobacco Promotion People’s Republic of China Las Palmas Philippines

Tobacco Control: Smoke-Free Laws Hong Kong Restaurant Tax Receipts Before ban and 2 years later:  31% Example: Hong Kong

Tobacco Control: Pack Warnings Example: Hong Kong 27 Oct 2006: Smoking (Public Health) Ordinance 2006 in effect 6 pictorial health warnings – all cigarettes to display 50% health warning messages in both Chinese & English

Tobacco Control: Media Campaigns worldlungfoundation.org/mmr

For Smoker: Quitting Works Tobacco Control: Quitting Reduces NCD Risk

Tobacco Control: Raising Taxes Key Economic Messages Tobacco is debit to the economy Tobacco control is cost-effective Price increases most effective  tobacco tax does not  govt revenue  tobacco tax does not  smuggling  tax on other NCD risk factors (e.g. alcohol, certain foods);  tax on vegetables??

Tobacco Control: Raising Taxes, consumption

Tobacco Control: Raising Taxes: revenues up

Tobacco Control: Earmarked Tax for Health Example: Thailand 2% of tobacco and alcohol tax used for health promotion

And now: Major private donors Michael Bloomberg Bill Gates But funding from governments completely inadequate…

NCDs: 60% Global Deaths NCDModifiable Causative Risk Factors Tobacco UseUnhealthy Diet Physical Inactivity Harmful Use of Alcohol Heart Disease & Stroke √√√√ Diabetes √√√√ Cancer √√√√ Chronic Lung Disease √ Source: WHO, 2010

Deaths from Cardiovascular Disease Coronary heart disease Stroke * Different keys

Cancer: Major Risk Factors

% total Cancer Registries % of the population covered by cancer registration IARC, 2011

Physicians Working in NCD

C21 Epidemics: New Paradigm Needed 1. International law/ treaties for public health WHO support Sound science/research Comprehensive policies, common risk factors Enforcement after legislation 2. Crucial role of government and political will 3. Extraordinary reach of NCD issues, from corporate criminality to poverty alleviation  new partners Key NGOs and individuals, coalitions 4. Political mapping of obstacles, esp. misperceived economic concerns, tactics of vested industries Effective advocacy targeting decision makers to the public The role of media

Source: WHO, 2010

UN Summit on NCDs Sep such meetings at UN since end-WWII  only 1 on health (AIDS) This one: 135 co-sponsoring countries and unanimous approval Outcome Document is critical Call for addition of all NCDs into next round of UN MDGs in 2015

Public health come of age

Professor Judith Mackay Senior Advisor