1. Republic of the Philippines DEPARTMENT OF HEALTH The Schizophrenic State of Tobacco Control in the Philippines

3. Category A Provinces 25 Provinces more than 1000 cases/year or situation worsened Category B Provinces 22 Provinces 100 to 1000 cases/year Category C Provinces 18 Provinces less than 100 cases/year Category D Provinces Provinces that are already malaria-free (no more indigenous cases for at least 3 years) GEOGRAPHICAL DISTRIBUTION OF MALARIA PHILIPPINES (Based on 10-year Ave, 1991 – 2000) Source: Malaria Control Program, 2000

4. The Situation - - Limited government resources for tobacco-related diseases - Increasing prevalence for tobacco use among children and women H High mortality and morbidity rates from tobacco-related disease

5. The Supply of Tobacco Tobacco production and sale is a source of income for poor families Tobacco tycoons are politically well- connected to members of the legislative and executive branches of government Tobacco is sold by single sticks on the streets by child vendors Tobacco industry is formidable

6. The Demand for Tobacco Entertainment industry “glamorizes” tobacco Culture of accommodation inhibits non-smokers from demanding a smoke-free environment Many political leaders are smokers Tobacco advertising is a major source of income for the broadcast and print media

7. The Schizophrenic State - Voted for the ratification of the FCTC - Enacted Tobacco Regulation Act of 2003 & Excise Tax Law of 2005 - Updated - Updated local ordinances against smoking – Makati, Davao, Mandaluyong, etc.

8. The Schizophrenic State Health professionals smoke in front of their patients – 1 out of 3 MDs National Tobacco Authority looking for alternative uses of tobacco Department of Trade & Industry chairing the IAC for Tobacco Control Department of Education accepts money for schools & lauds Phillip Morris for Youth Smoking Prevention Program OP inaugurates a Phillip Morris plant

9. The Shift in Strategy HEALTHPROMOTION HEALTHPROTECTION Public Empowerment For Policy Change

10. The Old Strategy - Focus on educational programs for children programs for children in schools in schools - Promote healthy lifestyle

11. The New Strategy - Aggressively mobilize a constituency to support the Tobacco Regulation Act of 2003, the Excise Tax Law of 2005 and local tobacco control legislation - Use the FCTC to buttress national tobacco control policies

12. FROM SCHIZOPHRENIA TO WHOLENESS EXTRA CHALLENGE

13. The Six Components of the NTCP - Media, Advocacy & Promotion - Smoking Cessation Program - Epidemiologic Surveillance & Research - Education Program - Economic Alternative Program for Tobacco Farmers - Legislation/ Public Policy Development

14. Media, Advocacy & Promotion - There is no such thing as industry vv health “balance” - Blacklist agencies, organizations, companies, individuals associated with tobacco industry

15. Media, Advocacy & Promotion - Case find patients cum victims of exposure to tobacco for litigation

16. Smoking Cessation Program - Set up smoking cessation clinics in all government retained hospitals & major medical centers

17. Surveillance & Research Global Youth Tobacco Survey Health Professionals’ Tobacco Survey Burden of Illness Studies Packaging & Labelling Tobacco Industry Activities Monitoring of Implementation of Tobacco Regulation Act, Excise Tax Law, FCTC, Ordinances

18. Education Program - Integrate TC in medical/allied health professionals’ curricula

19. Economic Alternative Program - Abolish the National Tobacco Authority

20. Legislation The Tobacco Regulation Act provides for: - prohibiting sale of cigarettes to minors - banning smoking in public places such as schools, health facilities, public conveyances, food preparation areas, etc.

21. Legislation - banning of tobacco ads, sponsorships taxation ban ads on TV & radio – 1 jan 2007 ban ads on cinema & outdoor ads – 1 july 2007 ban ads on mass media advs – 1 july 2008 - warning labels - economic alternative for tobacco farmers

22. Legislation / Public Policy Development A. National Step up implementation of the Tobacco Regulation Act by the IAC, chaired by the DTI and vice-chaired by the DOH - Provide incentives to local governments & groups deputized to catch offenders & collect fines

23. Legislation / Public Policy Development A. National - Push for implementation of the Excise Tax Law; plan to wisely spend monies earmarked for “disease prevention” - Increase levies to provide disincentives to ”sensitive”, perilous companies

24. Legislation / Public Policy Development A. National Push for an issuance to declare: - Tobacco as a hazardous substance - Nicotine-containing products as prescription drugs

25. Legislation B. International Treaty - Invoke the Framework Convention on Tobacco Control (FCTC) - a WHO initiative and international legal instrument which will circumscribe global tobacco consumption

26. In Summary - Tobacco control is in a state of ambuguity & schizophrenia - It is incumbent upon health professionals to bring the true picture clearly into focus

28. Thank You !