1. Advocating Policies for Waterpipe & Cigarettes Cynthia Callard
Intro:
Thank you for opportunity
What can we learn from the past that will help us move faster to improve waterpipe tobacco?
I’m not too sure of the answer. This ignorance, if you like, is built on 25 years experience.
Abu Dhabi a great place to be reminded that you have to think big before you can build big *
Worked on tobacco issues since 1985
Advocating Policies for Waterpipe & Cigarettes
Cynthia Callard
October 2013

2. Since 1962: A steady decline!!
Adult per capita cigarette consumption, the United States, 1900–2006.
USA annual adult per capita cigarette consumption
I took this slide, with its encouraging steady drop in per capita consumption among US smokers over 50 years from one of the many fine publications by our colleague Ken Warner.
I could have picked one of dozen similar for Canada, Australia the U.K. or other countries that are in the 4th stage of the epidemic, to use Alan Lopez’s famous model. They all look pretty much the same.
They all show steady declines in tobacco use since the big reveals of the Royal College of Physicians 50 years ago this year, or the 1964 Surgeon General’s report -
Since the start of modern tobacco control. Since the first world conference on tobacco and health.
You can almost feel the momentum of that downward slide – pulling us towards the horizontal axis.
But there are other ways of looking at the progress of tobacco control that are less encouraging.
Warner K E , Mendez D Nicotine Tob Res 2010;12:

3. After 50 years, we’re back where started
1987 = 1,537
1960 = 1,129
2010 = 1,141
Using the same metric as the previous slide – number of cigarettes smoked per adult each year, progress appears much more modest if we expand our measurement to a global scale.
50 years ago, the average adult human living on this planet smoked a package of cigarettes a week.
Today, the average adult human living on this planet smokes a package of cigarettes a week.
We are nonetheless making some progress -- each year consumption falls by about one fewer cigarette per week is smoked per human adult.
From a global perspective, we have, as my mother would say, lost on the swings much of what we made on the merry go rounds. The progress we have made in some countries has been offset by losses elsewhere.
Okay, I can hear you thinking, this doesn’t mean that conventional tobacco control isn’t working well enough – it just means that it hasn’t been implemented in enough places. Or that the dose hasn’t been high enough.
Global annual adult (15+) per capita cigarette consumption
Sources: Averaged values, Maxwell, Euromonitor, USDA: population over 15 years from World Bank.

4. A shifting epidemic
*new communities
*new patterns of use

5. So many similarities Health Rationale Political systems
Legal structures
(FCTC and related regulation)
Societies
Public health community
Tobacco users

6. Same vector?

7. Same proven tools available
Warnings
Youth Access
Tax/Prices
Advertising bans
Smoke-free spaces
Flavour bans
Mass media
Public education
Clinical practice

8. Yet so many aren’t used *
Warnings
Youth Access
Tax/Prices
Advertising bans
Smoke-free spaces
Flavour bans
Mass media
Public education
Clinical practice
*(Canada)

9. Different outcomes Cigarette use & exposure go down
Before CTUMS 2011, "ever tried a water-pipe" had been asked only once in In 2012, 10% or about 2.8 million Canadians aged 15 years and older reported having ever tried a water-pipe, higher than in 2011 (8%) and in 2006 (4%). Thirteen percent (13% or about 282,000) of Canadian youth aged 15 to 19 and 28% (about 662,000) of young adults aged 20 to 24 reported having ever tried a water-pipe, unchanged from 2011 (12% for youth and 24% for young adults in 2011), but higher than in 2006 (6% for youth and 11% for young adults aged 20-24).
In 2012, under 1% of Canadians 15 years and older (about 251,000), 3% (about 61,000) of youth aged 15-19, and 4% (about 104,000) of young adults aged reported smoking a water-pipe in the past 30 days. These results were the same as in 2011, the first time past 30 day use of a water pipe was asked.
When Canadians who reported using a water-pipe during the past 30-days were asked about their beliefs regarding the risks and benefits associated with smoking a water-pipe compared to cigarettes, 40% thought that smoking tobacco in a water-pipe was more harmful, 32% thought it was neither more harmful or less harmful and 27% thought it was less harmful.
CTUMS

10. Different outcomes Waterpipe trials increase
Before CTUMS 2011, "ever tried a water-pipe" had been asked only once in In 2012, 10% or about 2.8 million Canadians aged 15 years and older reported having ever tried a water-pipe, higher than in 2011 (8%) and in 2006 (4%). Thirteen percent (13% or about 282,000) of Canadian youth aged 15 to 19 and 28% (about 662,000) of young adults aged 20 to 24 reported having ever tried a water-pipe, unchanged from 2011 (12% for youth and 24% for young adults in 2011), but higher than in 2006 (6% for youth and 11% for young adults aged 20-24).
In 2012, under 1% of Canadians 15 years and older (about 251,000), 3% (about 61,000) of youth aged 15-19, and 4% (about 104,000) of young adults aged reported smoking a water-pipe in the past 30 days. These results were the same as in 2011, the first time past 30 day use of a water pipe was asked.
When Canadians who reported using a water-pipe during the past 30-days were asked about their beliefs regarding the risks and benefits associated with smoking a water-pipe compared to cigarettes, 40% thought that smoking tobacco in a water-pipe was more harmful, 32% thought it was neither more harmful or less harmful and 27% thought it was less harmful.
CTUMS

11. Victory or Defeat? ? ?

12. ? Brazil: RESOLUTION - RDC Nº 14, OF MARCH 15, 2012
Additive ban covers all tobacco products.
“Art. 2 This Resolution applies to all tobacco products sold in Brazil, whether made in Brazil or imported.”
BUT Currently challenged at Supreme Court.
Paula Johns:

13. ? European Union Tobacco Directive original
Considering the Directive's focus on young people, tobacco products other than cigarettes, roll-your-own tobacco and smokeless tobacco which are mainly consumed by older consumers, should be granted an exemption from …
Paula Johns:

14. ? European Union Tobacco Directive as amended by EP.
Considering the Directive's focus on young people, tobacco products other than cigarettes, roll-your-own tobacco and water-pipe tobacco which are mainly consumed by older consumers, should be granted an exemption from …
Paula Johns:

15. LOBBYING
No recipe for success. Creating a healthy society is not like baking a cake. It is more like raising a child. – Its complex, and messy, and uncertain and controversial – but nonetheless there are some tried and true guidelines.
Often, your strengths are your weaknesses

16. Widespread TC consensus:
Same UNITY
Widespread TC consensus:
Science
Policy
Strategy
Broad-based TC community
Pan-partisan
Multi-sectoral
International

17. Same ORGANIZING PRINCIPLES
What do we want?
Who can give it to us?
What do they need to hear?
Who do they need to hear it from?
How can we get them to hear it?

18. Same MODUS OPERANDI #1: Get on the Agenda #2: Get Favourable Decisions
#3: Protect gains/ address vulnerabilities
(repeat as necessary)

19. Same Vulnerabilities

20. Publish or Perish #1 same, same
"Health Canada will continue to monitor emerging trends of other tobacco products and take action in the future when warranted."
A spokesman for Health Minister Leona Aglukkaq said Health Canada is not considering a ban on shisha at this time.

21. Need Multiple Points of Contact
same, same
Need
Multiple
Points of
Contact
Multisectoral
Finance
Health
Education
Multi-jurisdictional
International, National, subnational
Corporate, CSO & home

22. Need to under-stand the decision maker
same, same
Need to under-stand the decision maker
Canadian MPs:
Live in the moment
Are competitive and tribal
Don’t want to be disliked
Barter policies
Think locally
Are not overly numerate
“Which side are you on?”

23. Need for sustained resources
same, same
Need
for sustained
resources
It’s not a part-time job.

24. Need to take risks There is a reason we are an unbranded movement.
same, same
Need
to take risks
There is a reason we are an unbranded movement.

25. Barriers The capacity of decision makers to: Deflect responsibility
Same Same
Barriers
The capacity of decision makers to:
Deflect responsibility
Deny the problem
Discredit the evidence
Delay action

26. (perception is reality)
Somewhat different
Barriers
(perception is reality)
Tobacco control is understood to mean “cigarette control”
Prevents instant adoption of Economic rationale, health rationale, cultural acceptance, priority over other health concerns.

27. Mutable Problem Money is the root of all smoking!
Same same
Mutable
Problem
Money is the root of all smoking!
Suppliers are driven to adapt or overcome regulatory and other barriers.

28. Challenge to find the right “ask”
same, same
Challenge
to find the right “ask”
What do we want NOW?
What will we want NEXT?

29. “Tobacco Control is a changing game.”
Scott Sherman,
October 21, 2013

30. “We face the challenge of … unimpeded emergence of new products.”
Cheryl Healton
October 21, 2013

31. “If we can’t do it, no one can.”
Omniyat Al Hajeri
October 21, 2013