1. Dhananjaya Perera, B.Sc. (Sp) Health Promotion, Post Graduate Diploma in Project Management.

2.  Single most important cause of preventable death world wide. ( US Surgeon Generals report 1982 )  5,000,000 global deaths annually ( WHO)  A product with no safe level of use.  Kills the customer when used as intended by the manufacturer.  Morbidity more widespread.

3.  Over Rs. 42,000,000,000 spent on purchase alone. (CTC annual report 2006)  15,000 – 20,000 die annually ( WHO )  Around 40% men and 2% women smoke  Rate of female smoking going up.

4.  Lung cancer  Cancer in Oropharynx, Esophagus, Bladder, Pancreases, Stomach, Cervix  MI  Strokes  Impotence  Asthma,  Congenital abnormalities

5.  Individual cost  Low productivity  Health expenditure  National cost  Environmental hazard  Passive smoking

6.  Removing the image  Counteracting the promotions  Helping users to quit  Awareness on the real extent of the harm  Policy measures

7.  Why a ‘Policy’ is important ? Above measures alone is not enough Specific issues could only addressed by policies Sustainability

8.  Reduce the demand for tobacco  Reduce the supply of tobacco

9.  Taxation  Consumer information  Advertising and promotion ban  Smoking restrictions  Cessation services

10.  Counteracting Smuggling  Selling restrictions

12. Tobacco is crucial to the economy. Without tobacco growing, cigarette manufacturing, and distribution and sale of tobacco products, a state’s or country’s economy will suffer job losses, falling tax revenues, and growing trade deficits.

13.  Whenever governments consider policy that would discourage tobacco consumption…especially in non -tobacco states and countries.  Intent: to frighten officials into believing that, regardless of their health benefits, tobacco control measures would exact a huge economic toll.

14.  If government adopts policy x, cigarette sales will drop.  People will lose jobs as a consequence (tobacco farmers, manufacturing plant employees, wholesalers, retail clerks).  The economy will suffer from lost tax revenues, including (where appropriate) income and sales taxes associated with reduced spending by the newly unemployed.

15. A significant economic presence does not imply significant economic dependence. Spending on tobacco is rarely important to an economy. – Money not spent on tobacco will be spent on other goods and services instead, thereby creating a comparable number of jobs.

17. A large tax increase is dangerous because it will reduce government revenues by decreasing legal cigarette sales. This will result due to decreased smoking and increased smuggling of lower-priced cigarettes from neighboring states or countries.

18.  Whenever governments consider a cigarette excise tax increase.  Intent: to frighten officials into believing that a policy intended to increase revenue will do the opposite, and that it will introduce organized crime into the state or country.

19.  Cigarette taxation will reduce cigarette sales. ◦ Increasing price is the most effective means of decreasing cigarette smoking, especially among children. ◦ 10% price increase will decrease cigarette consumption 4% in developed countries, 8% in developing countries. ◦ Smoking among children will fall by about twice as much. [Chaloupka et al., Ch. 10 in Jha and Chaloupka, 2000]

21. Increased taxes invariably increase government revenues. –The percentage decline in cigarette consumption is smaller than the percentage increase in price that induces it. –Further, tax is only a fraction of price, so a given tax increase will cause a far smaller decrease in cigarette sales.

22. Cigarette advertising and promotion have no effect on the amount of smoking. Their only function, and impact, is to permit the companies to vie for shares of a market of fixed size.

23.  Whenever the freedom of the tobacco industry to advertise is debated.  Intent: to convince officials that an ad ban would violate the right to free speech, as well as adult smokers’ right to information.

24. Cigarette advertising and promotion constitute one of the principal direct determinants of smoking, especially initiation of smoking by children.

25.  Whenever the freedom of the tobacco industry to advertise is debated.  Intent: to convince officials that the crucial issue is the seduction of children, who are not legal consumers of tobacco products. TC also challenges the idea of a right to commercial free speech.

26. Advertising and promotion (A/P) likely do increase smoking, including encouraging experimentation by kids. No evidence points to A/P as a principal direct determinant of smoking, however. –Peer and parental behavior and role modeling by music and movie stars likely more important.

27. A/P may increase smoking through indirect mechanisms, as well as direct. –E.g., media dependence on tobacco company ad revenues discourages coverage of the importance of smoking in disease. [Warner et al., New Engl. J. Med., 1992] A complete ban on A/P would be expected to decrease smoking by about 7%. [Saffer and Chaloupka, Journal of Health Economics, 2000]

28. The tobacco companies have moved into developing countries in recent years to compensate for declining markets in affluent nations. Tobacco control progress in rich countries will come at the price of increasingly aggressive invasion of poor countries by the multinational tobacco companies.

29. Multinationals have moved into developing countries, but not because other markets are declining. They see a market expansion opportunity in developing countries, due to –growing affluence in those countries; –reductions in trade restrictions; and –bulging treasuries the companies want to invest profitably.

30. Recent movement into developing countries would have occurred even if sales were not falling in developed countries.

31. Summery …..

32.  Removing the image  Counteracting the promotions  Helping users to quit  Awareness on the real extent of the harm  Policy measures

33. Thank you ….