The Tobacco Epidemic Worsening... Unless We Act Now

التابع آسيا بمشاركة المجلس االقتصادي واالجتماعيياالجتماع الوزاري لغرب آسيا، ياالجتماعية لغربو، ولجنة األمم المتحدة االقتصادية لألمم المتحدة

منظمة الصحة العالمية و"التصد2ي لألمراض غير السارية ولإلصابات: تحد2يات كبرى تواجه التنمية

والعشرين" المستدامة في القرن الحادي 2009 أيار/مايو 11 – 10 قطر في الدوحة، دولة تستضيفه

ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting “Addressing

noncommunicable diseases and injuries: major challenges to sustainable development in the 21st

century” (Hosted by the Government of Qatar in Doha, 10-

11 May 2009)

Dr Douglas Bettcher, Director, TFI, WHO

ECOSOC/UNESCWA/WHO Western Asia Ministerial MeetingAddressing noncommunicable diseases and injuries(Doha, Qatar, 10-11 May 2009)

The Tobacco Epidemic Worsening... Unless We Act Now

Smoking killed 0.1 billion for 20th Century, but for the 21st century, SMOKING WILL KILL A TOTAL OF 1 BILLION (half the deaths in middle age).

Tobacco currently kills: 5 million/yr Will increase to: 8.3 million/yr by 2030.


The Leading Preventable Cause of Death in the World

Source: WHO 2008


WHO Framework Convention on Tobacco Control (WHO FCTC)

• Foundation stone in the global fight against the tobacco epidemic.

• First global health treaty negotiated under auspices of WHO – adopted in 2003.

• Entry into force -27 Feb 2005.

• 164 parties as of 2009.


Status of the WHO FCTC in the region

EGYPT

LIBYAN ARAB JAMAHIRYA

ISL. REP. OF IRAN

SAUDI ARABIA

OMAN

YEMEN

SOMALIA

SUDAN

MOROCCO

TUNISIA

PAKISTAN

AFGHANISTANIRAQ

SYRIAN ARAB REP.

JORDAN

LEBANON

UAEBAHRAINQUATAR

KUWAIT

oPt

CONTRACTING PARTIES to THE WHO FCTC

COUNTRIES NON PARTIES THAT HAVE SIGNED THE WHO FCTC

COUNTRIES THAT HAVE NOT SIGNED THE WHO FCTC AND ARE NOT CONTRACTING PARTIES


• mpower: Six policies for tobacco control as part of WHO FCTC comprehensive implementation.– Key entry point for scaling up tobacco control. – Help countries build on WHO FCTC commitments.– Integral part of the WHO Action Plan for the

Prevention and Control of Non-Communicable Diseases.

– Matches WHO public health competency.

Global Level Implementation of WHO FCTC – Country-level


TFI : Bringing in Change

• monitor tobacco use and prevention policies

• protect people from tobacco smoke

• offer help to quit tobacco use• warn about the dangers of

tobacco• enforce bans on tobacco

advertising, promotion and sponsorship

• raise taxes on tobacco


WHO FCTC and MPOWER An evidence-based tool for tobacco control (demand and supply side

measures)

Article 13

e oArticle 14

mArticle 20, 21

Article 11, 12Article 8p w

Article 6, 15r


Tobacco use prevalence is higher among the poor

0 5 10 15 20 25

Q1

Q2

Q3

Q4

Q5

%Daily All smoking

Source: World Health Survey 2006

Note: Q1-Q5: Lowest-Highest income groups

Smoking prevalence in selected EMRO countries


• A recent study looking at systematic reviews to assess the impact of population-level tobacco control policies on social inequalities in smoking showed that: there was preliminary evidence that increases in the price of tobacco may have the potential to reduce smoking related health inequalities.

Tobacco control is good for developmentand for addressing social determinants of health



• With regards to taxation, poor groups respond more to price increases and reduce tobacco consumption to a greater extent than other groups do.



• Earmarking tobacco taxes – a pro-poor policy: Dedicating part (or all) of the revenues from tobacco taxes to develop NCD/health measures aiming at reaching vulnerable and poor populations is feasible and can render those measures more effective in reducing the burden of NCDs while at the same being pro-poor.

• At the time of financial crisis, tobacco tax increase is a good way to generate revenue.


Earmarking tobacco taxes: examples from EMRO

• Egypt: 10 piasters per 20 cigarettes are devoted to the students health insurance.

• Qatar: 2% of revenues from import duties on tobacco products allocated for health awareness activities and tobacco control activities.

• Jordan: 20 Flus (1/1000 of Jordanian Dinar) National Fund to support youth movement.

• Tunisia: Rate varying by tobacco product between 10 and 170 millimes (millime=1/1000 Tunisian Dinar) per tobacco product to the activities of the Solidarity National Fund.

• Iraq: 5% of imported value of cigarettes for reconstruction activities.


Earmarking tobacco taxes, a pro-poor policy

Success story: Thailand• Health Promotion Foundation

(ThaiHealth) set up in 2001 by the Government.

• Receiving 2% of the total revenues from alcohol and tobacco (about 35 million$ per year).

• Acts as a catalyst and supports groups and organizations already working on public health.

• Inspired neighbouring countries: Mongolia adopted the same structure and received technical assistance from ThaiHealth in the process of setting up the policy.


Applying best practices in all countries

Global networks and partnerships

Advocacy and Communications National

tobacco control plansCountry-level

partnerships

SurveillanceEconomics

Legal

Capacity building

TFI works with countries for building managerial, technical and policy infrastructure.


Applying best practices in all countries

• Capacity Building - assessment of national capacity and support for policy development.

• Monitoring and Evaluation – strengthen population based comparable surveillance (e.g. GATS).

• Economics - technical support for economic research and interventions.

• Advocacy and Communications - promote effective policies with partners using global and country media.


POLITICAL WILL

Ministry of Health

Ministry of FinanceMinistry of Justice

Ministry of Education

Ministry of Agriculture

PUBLIC AWARENESSNGOsMedia

Health ProfessionalsTrade unions

INTERNATIONAL SUPPORT

WLF

Bloomberg Philanthropies

CDC

Donor countriesGates foundation

INTERGOVERNMENTAL WORK

WHO Headquarter (TFI)

WHO Country offices

WHO Regional Office

UN task force

SCIENTIFIC EVIDENCE

JHBSPH

Researchers

IARC

WHO Collaborating Centres

WHO Framework Convention on Tobacco Control

Working together

to curb the

tobacco epidemic


Knowing is not enough; we must apply.Willing is not enough; we must do.

Johann Wolfgang von Goethe(1749–1832)

Thank you for your attention!


Mpower (supporting Article 20 & 21)

Policy impact of country work

•Egypt: Currently half way through GATS data collection. GATS national level data release is planned for September 2009.

•Turkey: Launch of Turkish-language translation of the WHO Report on the Global Tobacco Epidemic - 2008 sparked considerable media attention. In 2009 - launch of the first GATS set analysed data.


mPower (supporting Article 8)

Policy Impact of country work

•Egypt : The 2007 tobacco control law declared all public places to be free of tobacco, and was implemented except for restaurants and cafes. Similarly examples in Jordan, Bahrain and UAE.

•SA: The only two tobacco free cities in the region.

•Ireland: Adopted and implemented the first comprehensive smoke free law in 2004, changing the face of the smoke free policies in the 21st century.


mpOwer (supporting Article 14)


• Iran - Lots of work on cessation training - national training of trainers workshop on cessation, over 100 cessation centers set up. An area that needs further advancing in the region.

• Nepal: Incorporation of brief cessation advice into PHC for chronic respiratory diseases and tuberculosis (2007- June 2008).


• Jordan is first country to have pictorial health warnings(30%); Egypt is first country to have 50% of the pack size, followed by Iran, Djibouti. All GCC countries are in process of selecting their pictorial health warnings.

• Australia: Strong picture health warnings on both covers front (30%) and back (90%).


mpoWer (supporting Article 11 & 12)


mpowEr (supporting Article 13)


•Total ban on advertising exists and is implemented in 9 MS of EMRO: Djibouti, IRAN, Jordan, Kuwait, Qatar, Sudan, UAE, Yemen, EGY.

•Thailand: In addition to ban of advertisement, product display at point-of-sale is banned.


mpoweR (supporting Article 6)


• Thailand: A high percentage of the price of a pack of cigarettes goes to taxes in Thailand (64%), and 2% of total revenues from tobacco and alcohol are used for health promotion.

Documents

The Tobacco Epidemic Worsening... Unless We Act Now