1. Research for International Tobacco Control (RITC) Tobacco as a Development Issue Insert your image here

2. 2 Why is Tobacco Unique as a Policy Issue?  Tobacco use sustained through addictive properties, low prices, social norms, vigorous marketing by powerful multinational corporations  Perceived by many to contribute to social and psychological well-being  Tobacco epidemic exacerbated by complex factors with cross border effects, including trade liberalization, foreign direct investment, global marketing; transnational advertising, promotion and sponsorship; international movement of contraband and counterfeit cigarettes.

3. 3 Global Tobacco Consumption  Approximately 1.3 billion people smoke cigarettes (1 in 5 of the world’s population; 1 in 3 of those over 15)  Global prevalence (2000) = 29% (47% men: 10% women)  One in two long-term smokers will die from a tobacco related disease - many before 65  Tobacco expected to be the leading global cause of death before age 65 by 2020

4. 4 Global Tobacco Consumption  Smoking (particularly amongst men) culturally accepted in many countries  GYTS shows many smokers in developing countries begin in their teens  Quitting rates low in low- and middle-income countries compared to developed countries  Advertising is ubiquitous and aggressive

5. 5 Advertising

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9. 9 Stages of the Tobacco Epidemic

10. 10 Past and Future Annual Deaths due to Tobacco Use Source: Who (2002) The Tobacco Atlas, p.36.

11. 11 Tobacco and Developing Countries  70 % of tobacco grown in developing countries  70 % of tobacco consumed in developing countries  In 2000 half of 5 million tobacco-related deaths occurred in developing countries  By 2030 70 % of tobacco–related deaths will occur in developing countries

12. 12 Global Burden of Non Communicable Diseases (NCDs)  Tobacco use linked causally to cancers, cardiovascular disease, respiratory diseases, tuberculosis, and diabetes  Population aging and changes in risk factors have accelerated the epidemic of NCDs in many developing countries  Burden of NCDs is increasing, accounting for nearly half of the global burden of disease (all ages)  Many developing countries now face a “double burden”

13. 13 Tobacco and Development  More than a health issue: economic, agricultural, environmental, socio-cultural, trade and marketing  Tobacco linked to poverty (up to 10% of household expenditures in poorest families)  Women and youth at particularly high risk  Tobacco kills people in their productive middle years  High economic costs – estimated $2.2 B direct medical costs; $5.4 B lost productivity in Canada (1992 USD)

14. Tobacco and Poverty “Each tobacco user represents one of more people – whether the smoker or his or her spouse or child – who is needlessly going hungry” (Efroymson et al, Tobacco Control 2001

15. 15 Tobacco and Poverty  Tobacco linked to poverty as household income is spent on tobacco rather than food or basic need  India/Bangladesh/Egypt: 2% - 4.5% of household expenditures on tobacco products  Bulgaria 10.4% of total income on tobacco products  China 17% of household income on tobacco  Even small amounts represent very high opportunity costs

16. 16 Tobacco and Poverty  Evidence in some countries that tobacco use is growing fastest amongst the poorest groups:  Indonesia:  1981 – lowest income groups spent 9% of their total expenditure on tobacco  1996 – lowest income groups spent 15% of their total expenditure on tobacco  In Bangladesh- smoking twice as high in the lowest income group as in the highest

17. 17 Tobacco and Poverty  Smoking exacerbates poverty in other ways:  Poor families are vulnerable to illness particularly the loss of a breadwinner  Paying for treatment further impoverishes families  Study of 20,000 poor men and women in 23 countries found that sickness or injury in a family is by far the most frequent trigger into (worse) poverty

18. 18 Poverty and Policies  Urban and rural Bangladesh per capita spending on tobacco higher than on milk  Spending by average smoker on cigarettes would buy 3000 calories of rice  Often men control the income and have first access to food. Women and children are most likely to go hungry.  Vietnam – annual household expenditure on tobacco 1.7 times expenditure on education  Advertising and low taxes encourage purchase of tobacco

19. 19 Cigarette prices and consumption South Africa

20. 20 Cigarette excise taxes and government revenue – South Africa

21. 21 WHO Commission on Macroeconomics and Health (CMH)  CMH emphasized the interconnectedness of health and sustainable development  Where national disease burden is high, national wealth and productivity are likely to be low  Two way relationship between economic development and health:  Poverty increases vulnerability to disease  People who are sick cannot work – affecting their income

22. 22 WHO Commission on Macroeconomics and Health (CMH)  CMH emphasized tobacco as a link between poverty and illness  CMH highlights tobacco consumption as one of the serious deleterious consequences of globalization  Significant changes can be achieved through modest investments in tax increases; ad bans; strong health warnings on cigarette packages; and use of primary health care services for advice and assistance to smokers

23. 23 Millennium Development Goals (MDGS)  Overlap between the MDGs and CMH:  Both seek to reduce the impact of health- related problems as an element of economic development  Both focus on alleviation of poverty as a key determinant of future economic development

24. 24 Tobacco Cultivation  Given the growth in world population, the tobacco industry will not decline rapidly enough to cause workers to lose their jobs  Trans-national companies are increasingly replacing less efficient local operations. Manufacture of foreign cigarettes is highly mechanized  Most job losses result from increasing mechanization.  Farm families reap little profit from tobacco cultivation

25. 25 Tobacco Cultivation  Tobacco farmers in cycle of debt to repay farm input loans  Farm income vulnerable in case of bad crop year or low tobacco prices  Harm to farm families and the environment through heavy use of pesticides.  Labour intensive crop often involving women and children  Curing process harmful to health and involves extensive deforestation

26. 26 Tobacco Manufacturing and Marketing  Those working in tobacco factories or selling tobacco on the streets earn starvation wages.  Beedi workers in India among the most exploited in India  Young children often involved in the production of beedis

27. 27 The Framework Convention on Tobacco Control (FCTC) A Global Treaty for a Global Problem  First global treaty to focus on a health issue  Negotiated under the auspices of the WHO  Came into force in Feb. 2005 following ratification by 40 countries  Includes demand and supply reduction strategies

28. 28 The FCTC: includes a variety of policy measures:  Advertising, promotion and sponsorship  Price and tax measures  Passive smoking and smoke-free environments  Packaging and labelling  Product regulation  Tobacco sales to and by young people  Treatment of tobacco dependence  Education, communication and public awareness

29. 29 Research for International Tobacco Control (RITC)  IDRC a pioneer in responding to this issue via RITC in1995 (with Health Canada & Sida)  Limited support from CIDA and Rockefeller Foundation  IDRC has recently renewed and expanded its funding to RITC  Continued funding from Health Canada; a new partnership with DFID  Focus on research, dissemination, capacity building and networking

30. 30 New Directions for RITC  Continued focus on research, capacity building, dissemination and networking  “Responsive” funding will respond to local needs and emerging topics globally  “Focused” funding will focus on Tobacco and Development issues  Allocated funding for fellowships to promote new researchers  Focus on priority countries and regions

31. 31 RITC Focused Research Priority Topics  Poverty and Tobacco  Tobacco Farming: Health, Livelihoods, Economics and the Environment  Health Systems Interventions  Globalization, Trade and Tobacco  Alternate Forms of Tobacco Use

32. 32 Research for Action on the FCTC  Public health issues cannot be contained within national borders; require greater collaboration and coordination  FCTC responds to:  The tobacco epidemic in developing countries;  Globalization;  Trade liberalization  Highlights the need for:  Multi-sectoral action and  Trans-national cooperation

33. 33 Research for Action on the FCTC  This meeting focuses on transcending national borders, working toward greater collaboration, and building networks.  Purpose of the meeting:  To capture lessons learned from the research;  To discuss the policy implications of the research;  To strengthen research capacity through interaction with peers and through specific workshops;  To provide an opportunity to network and for the development of networks

34. 34 Moving Forward  While tobacco use contributes to the entrenchment of individuals and nations in poverty, economic growth in the world’s poorest nations is likely to fuel, if unchecked, an increase in tobacco use.  Tobacco use is not a personal choice, freely made. Tobacco control should be a part of initiatives designed to improve health and reduce poverty.  Lack of statistical information results in poor evidence for the individual and national health and economic impacts of tobacco use.

35. 35 Moving Forward  Tobacco industry greatly overstates its contribution to national economies and understates the costs tobacco imposes.  Price and tax measures in coordination with measures to reduce smuggling will increase government revenues (and reduce poverty) and decrease tobacco use.  Action to reduce exposure to ETS will beneficial for health and the environment

36. 36 Moving Forward  4. Tobacco industry greatly overstates its contribution to national economies and understates the costs tobacco imposes.  5. Price and tax measures in coordination with measures to reduce smuggling will increase government revenues (and reduce poverty) and decrease tobacco use.

37. 37 Moving Forward  Controls on labelling and packaging, limits on advertising and sales to minors, education and public information will increase awareness of the dangers of smoking.  Support for alternative crops and the environment will limit the negative effects of tobacco cultivation and may alleviate poverty.

38. 38 Thank You Linda Waverley http://www.idrc.ca/ritc