1. Tobacco Control: developing and implementing a national program
E Tursan d’Espaignet
S Pujari
Comprehensive Information Systems for Tobacco Control Tobacco Free Initiative WHO Geneva

2. A property of tobacco
"… tobacco is the only legal product that maims and kills a large proportion of its users when used exactly as intended by the manufacturer"

3. Set of 9 voluntary global targets
Raised blood pressure
25%
Salt/
sodium intake
30%
Tobacco
Physical inactivity
10%
Harmful use of alcohol
Drug therapy and counseling
50%
Premature mortality from NCDs
25% reduction
Mortality
morbidity
and
Risk
factors
National
systems
response
Diabetes/obesity 0%
25% relative reduction in overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases
Indicator
Unconditional probability of dying between ages 30 and 70 from, cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases

4. Set of 9 voluntary global targets
Raised blood pressure
25%
Salt/
sodium intake
30%
Tobacco
Physical inactivity
10%
Harmful use of alcohol
Drug therapy and counseling
50%
Premature mortality from NCDs
25% reduction
Mortality
morbidity
and
Risk
factors
National
systems
response
Diabetes/obesity 0%
30% relative reduction in prevalence of current tobacco use in persons aged 15+ years
Indicators
1. Prevalence of current tobacco use among adolescents
2. Age-standardized prevalence of current tobacco among persons aged 18+ years

5. Global monitoring framework, including indicators (paragraph 61)
and voluntary global targets (paragraph 62)
Mortality between ages 30 and 70 due to
CVD, cancer, diabetes, or chronic respiratory disease
25% relative reduction
Indicators
with
targets
Raised Blood Pressure
25% relative reduction
Tobacco
30% relative reduction
Salt/sodium
30% relative reduction
until 5gm/day
Physical
inactivity
10% relative reduction
Overweight/obesity (adult, child, adolescent)
Policies to virtually eliminate trans fats and to reduce marketing of unhealthy foods to children
Raised total cholesterol
Other
WHO
core
indicators
Cervical cancer screening
Raised blood glucose/diabetes
Vaccination: HPV, Hepatitis B
Adult per capita consumption of alcohol and heavy episodic drinking
Availability of basic technologies and medicines
Low fruit and vegetable intake
Access to palliative care
Cancer incidence, by type
Multidrug therapy for CVD risk reduction
Other country-specific indicators of NCD and related issues including social determinants of health

6. Proposed global tobacco target under consideration by Member States
Indicator: Prevalence of current tobacco smoking among persons aged 15+ years
Target: 30% relative reduction in prevalence of current tobacco smoking between 2010 and 2025
Example: Prevalence for country X in 2010 = 20% Absolute reduction by 2025 = 30% of 20% = 6% Target for 2025 = = 14%

7. The Antidote: The WHO FCTC
Carefully constructed comprehensive antidote aimed at controlling demand for and supply of tobacco products
The target to be achieved through full implementation of the WHO FCTC and, (in particular, demand reduction measures including high tobacco product tax, large pictorial health warning labels, comprehensive smoke-free legislation, and bans on all forms of tobacco advertising, promotion and sponsorship).

8. Protect people from tobacco smoke through smokefree environments 14
mpower: A package of measures each reflecting one or more provisions of the WHO FCTC
Articles
Description 20
Monitoring 8
Protect people from tobacco smoke through smokefree environments 14
Offering help to quit
11 & 12
Warning about dangers of tobacco 13
Enforcing bans on promotion, sponsorship and advertising 6
Raising taxes on tobacco

9. Assessing implementation of demand reduction tobacco control policies
WHO report on the global tobacco epidemic, 2011
                                             
Assessing implementation of demand reduction tobacco control policies
2008 Report
2009 Report
2011 Report

11. m: HOW TO GET TO THE TOP AND STAY THERE
WHO and CDC provide assistance with surveys such as
- Global Youth Tobacco Survey
Global School Health Survey
Global Adult Tobacco Survey
STEPwise Survey
- Tobacco Questions for Surveys (to be included in other surveys) 11

12. m: Evaluation of Monitoring Status12

13. m: How would you assess monitoring status in 2008 Global Report
Your country has done:
a national Youth Tobacco Survey in and 2004
A national Adult tobacco survey in and 2007 (Global Adult Tobacco Survey, STEPS, National Health Survey) 13

14. m: Example of Monitoring status in 2008 Global Report
Your country has done:
a national Youth Tobacco Survey in and 2004
A national Adult tobacco survey in and 2007 (Global Adult Tobacco Survey, STEPS, National Health Survey) 14

15. m: How would you assess the same information for the 2010 Global Report
Your country has done:
a national Youth Tobacco Survey in and 2004
A national Adult tobacco survey in and 2007 (Global Adult Tobacco Survey, STEPS, National Health Survey) 15

16. m: Example of Monitoring status in 2010
Your country has done:
a national Youth Tobacco Survey in and 2004
A national Adult tobacco survey in and 2007 (Global Adult Tobacco Survey, STEPS, National Health Survey) 16

22. p: Evaluation of Smoke free Status22

23. Examples of Protection against SHS interventions
Smokefree public places - restaurants, bars, public transport, health care facilities, indoor work places, etc
Examples: Australia: Illegal to smoke in a (private) vehicle with a minor present Mauritius; Illegal to smoke in a (private) vehicle if another person present 23

24. Evidence on support for protection against SHS
Legislation implemented
Legislation passed

25. o: Evaluation of Dependence Treatment Status25

26. Warning against dangers of tobacco exposure
Legislate for adequate warnings on packets of cigarettes - both sides covering average of 50% - selected effective fonts and colours and all local languages - rotating images

27. Attitude Towards Warnings
Pack warnings are effective, especially with pictures and covering half of pack
Most people are unaware of full range of health risks from tobacco use, second-hand smoke exposure
Anti-tobacco ads help change image of smoking
Latest approaches: Consideration of plain packaging Australia and moves in France for same
3/4 approve of warnings
More than half changed opinions
2/3 want to quit
Most tobacco users do not understand the full extent of their health risk – because they haven’t been told
People may know generally that tobacco use is harmful, but they thing they can reduce or stop tobacco use before health problems occur. The reality is that most tobacco users will be unable to quit, and up to half will die from tobacco-related illnesses
Comprehensive, graphic warnings about the dangers of tobacco can change tobacco’s image, especially among adolescents and young adults
Governments and NGOs should launch anti-tobacco counter-advertising campaigns in all forms of media to publicize the full extent of tobacco’s dangers
Pictorial health warnings on the packaging of all tobacco products are one of the most effective types of warning. Use of pictures with graphic depictions of disease and other negative images has greater impact than words alone, and is critical in reaching the large number of people worldwide who cannot read.
Strong health warnings on tobacco packages, particularly pictorial warnings, are an important information source for young people
Impact of pack warnings in Brazil

28. Database of Images
WHO Tobacco Free Initiative 18 28

29. w: Evaluation of Health Warnings Status29

30. Enforce legislation prohibiting advertising, promotion and sponsorship
Adopt and apply effective and efficient legislation that prohibits all forms of advertising, promotion, and sponsorship, both Direct, and Indirect forms

31. Evidence on Impact of banning advertising
Comprehensive advertising bans amplify effects of other interventions
9 times faster reduction in consumption with
ban after 10 yrs

32. Examples of bans on advertising
No billboards
No television, radio, internet (difficult)
No print media
In Turkey, not allowed to show cigarette smoking on television - smoking blotted out 20 32

33. e: Evaluation of Bans on Advertising, Promotion & Sponsorship33

34. Monitoring enforcement of banning ad bans
Only 9% of the worlds population live in countries with strong advertising bans and other forms of promotion and sponsorship

35. Raise taxes: Increase price of tobacco through tax increases
TFI led initiative: Assist Member States to increase the rate of taxation (two thirds to four fifths of the retail price)
Increase in price
Increase in revenues
Reduction in consumption
Examples Singapore (68%), Thailand (62%), Australia (62%)
Only 6% of the world population live in countries where taxes account for more than 75% of the retail price
WHO reviews the current tax structures and the potential to increase and improve (simpler, easy to administer) it with a view to decrease consumption and increase revenues. The World Bank recommends a tax of between two thirds to three quarters of the retail price.

36. Evidence of raising taxes on consumption and tax revenues
Consumption of cigarettes
Excise tax rate
Excise tax revenues

37. r: Evaluation of Tobacco Tax levels37

38. How can WHO-TFI help countries?
Assess and build capacity to take action across:
Monitoring of prevalence and outcomes
Protect against second hand smoke
Offer help to quit
Warn against dangers of tobacco
Enforce legislation against advertising and promoting tobacco
Raise taxes so that they make up at least 75% of retail price 25 38

39. The Tobacco Epidemic
Using data from 2004 mortality recoWHO currently estimates just under six million deaths each year or one death every six seconds
Will cause the death of more than 8 million people in the year 2030 or one death every four seconds
Likely result in more than one billion deaths (1,000,000,000 deaths) during the 21st century

40. Thank you tursandespaignet@who.int37 40