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Tobacco Control Research: Local Priority Setting and a Global Vision
Confronting the Epidemic: A Global Agenda for Tobacco Control Research
RITC Focused Research Priority Topics
Integrating Research into a Global Vision: What Have We Learned in Tobacco Control?
Example from South Africa
3
Confronting the Epidemic: A Global Agenda for Tobacco Control Research
(
http://www.who.int/tobacco/resources/publications/general/en/)
Published by RITC-WHO in 1999
Based on RITC-sponsored agenda-setting meetings in Africa, Latin America and the Caribbean, and South and Southeast Asia; review of previous agendas
4
Research ThemesCountry-Specific Research
Lack of standardized and comparable data; need for county and regional data on:Prevalence and consumptionKnowledge of health risksAttitudes and behaviours with respect to
tobacco use especially in specific population sub-groups
Pricing and tax policies
5
Research ThemesPolicy Interventions
Economic policy research:Elasticity of demand studies to determine
optimal levels of taxation according to social class, age and geographic conditions
The determinants, process and impact of illegal trafficking and the influence of smuggling on tobacco use
Opportunities and barriers for harmonization of prices at the regional level
6
Research ThemesPolicy Interventions
Legislative research:Effect of international trade agreements
on the production, trade and marketing of tobacco products
Empirical and theoretical research to assist in drafting, implementing and evaluating policies (including those outlined in the FCTC)
7
Research ThemesProgramme Interventions
Opportunities/barriers to tobacco control
Optimal components (programs and policies) for a comprehensive tobacco control strategy
Development of effective messages to counter tobacco industry promotions
Behavioural research to test prevention and treatment programmes for specific age/ethnic/cultural groups
Strategies for high risk groups
8
Research ThemesTreatment of Tobacco Dependence
Development of a range of approaches to increase cessation in specific populations
Evaluation of pharmaceutical interventions and delivery mechanisms, their cost-effectiveness, and their impact in diverse socio-cultural subgroups.
9
Research ThemesTobacco Product Design and
Regulation The biology of tobacco addiction
Characterization of additives of tobacco products
Examination of alternative labelling for tobacco products
Examination of public expectations and behaviour with respect to existing and new tobacco products
A research base for regulation of tobacco products
10
Research ThemesTobacco Industry Analysis
Overview of ownership, corporate structure, and regulation of the tobacco industry at local and international level
Tobacco production as an international and regional trade issue in terms of foreign exchange, employment, imports and exports, trafficking
Tobacco industry relationships with government (including lobbying)
Tobacco industry involvement in illegal trade
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Research ThemesTobacco Industry Analysis
Tobacco industry advertising, marketing and promotion activities (particularly with respect to women, children and other high risk groups)
The impact of changes in advertising on consumption and public perceptions
Industry representation of the health consequences of tobacco use and addiction (including their influence on the content and direction of research.)
12
Research ThemesTobacco Farming
Relationship of tobacco production to destruction of the ecosystem
Attitudes and beliefs of tobacco farmers and the underlying historical/cultural context
Economic impact of tobacco control in countries that grow and manufacture tobacco or tobacco products for domestic or foreign markets
Opportunities for alternative crops and livelihoods; information on crop options employment for all family members
13
Research ThemesTobacco Farming
Cultivation and curing practices at the country and local level
Occupational hazards related to cultivating, curing and handling tobacco
Impact of tobacco cultivation on women and children
The feasibility of diversification in countries heavily dependent on tobacco farming and manufacturing and the mechanisms for supporting these countries in their diversification efforts
14
Research ThemesThe FCTC
Research to support specific provisions of the FCTC
Monitoring mechanisms to evaluate the implementation and effectiveness of the FCTC and related protocols
15
Cross-cutting Themes
High risk populations
Country readiness
Dissemination
Capacity Development
Mobilization of Human and Financial Resources
16
RITC Focused ResearchPriority Topics
Poverty and Tobacco
Tobacco Farming: Health, Livelihoods, Economics and the Environment
Health Systems Interventions
Globalization, Trade and Tobacco
Alternate Forms of Tobacco Use
What have we learned from tobacco?
Lesson # 1
There is no “magic bullet”
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Lesson #1
A comprehensive strategy is needed to change social norms and support individual behaviour change
This consists of: Programming Policy Mass media Research Community development Industry “denormalization”
What have we learned from tobacco?
Lesson # 2
All sectors must work together
20
Coordination of All Sectors
Researchers
Policy-makers
Advocates
Practitioners
The media
Private sector
Public
The Media
Public Opinion
Main Policy
SectorsVOLUNTARYPRIVATE
Policy Sectors in Tobacco Control
PUBLIC
Source: Waverley Brigden, L. (1997) after Spicker, P. (1995) & Kingdon, J.W. (1995)
What have we learned from tobacco?
Lesson # 3
Understand the politics
23
Politics
Multinational industries have enormous resources and the ability to influence policy-makers
They can argue on economic grounds as well as from a health standpoint (e.g., loss of jobs)
Ability to provide jobs and manufacturing
A problem “solved” in the developed world may emerge in developing countries
They are always several steps ahead of us (e.g., waterpipe, harm-reduction tobacco products)
Industries will often challenge “health” research
24
South Africa
A “policy window”
A “champion” in the Minister of Health
Strong advocacy
A sound research base
“Framing” as both a health and economic issue
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Cigarette prices and consumptionSouth Africa
0
100
200
300
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600
700
1961
1963
1965
1967
1969
1971
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1975
1977
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1981
1983
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1993
1995
1997
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2001
Real
pri
ce p
er
pack o
f 20 (
1995
cen
ts)
0
500
1000
1500
2000
2500
Cig
are
tte c
on
su
mp
tio
n (
mil
lio
ns
of
packs)
Real price of cigarettes Consumption of cigarettes
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Cigarette excise taxes and government revenue – South Africa
0
50
100
150
200
250
19
61
19
63
19
65
19
67
19
69
19
71
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73
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75
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77
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79
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81
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99
20
01
Re
al
ex
cis
e r
ate
0
500
1000
1500
2000
2500
3000
Re
al
ex
cis
e r
eve
nu
e
Real excise rate (1995 prices, cents/pack of 20)
Real excise revenue (1995 prices, R million)
27
Trends in Cigarette Consumption and Smoking Prevalence
Year
1993 2000
Cigarette consumption (millions of packs)
1,802 1,333
Per capita consumption (packs p.a. aged 15+)
72.6 45.7
Smoking prevalence percentage (15+)
32.6 27.1
Avg. consumption per smoker (packs p.a.)
223 169
28
Changes in Smoking Prevalence by Gender and Age Group
1993 2000 Change
Male 51.4 43.8 -7.6
Female 12.9 11.7 -1.2
Aged 16–24 24.0 18.7 -5.3
Aged 25–34 38.7 31.9 -6.8
Aged 35–49 38.5 35.2 -3.3
Aged 50+ 23.4 22.5 -0.9
29
Lessons Learned: 6 Case Studies
Legislative successes won in the face of vigorous opposition from an industry striving to protect its profits and market
Key role played by NGOs and charismatic individuals with commitment and dedication
Coalitions brought new skills and perspectives
Effective advocacy has to be learned
Lack of an organizational home and minimal level of funding make it hard to operate effectively
30
Lessons Learned: 6 Case Studies (cont’d)
Strong political support and political champions are crucial to success
Significant transformations in social norms can occur
The media can have a powerful role in influencing popular opinion
Understand the political framework and legislative timetable of the country
Legislation must be coupled with attention to implementation and enforcement
31
Lessons Learned: 6 Case Studies (cont’d)
Sound research is needed for good policy decisions
Policies and strategies must be comprehensive
It may be necessary to bring together diverse interest groups (e.g., Ministries of Health and Finance)
Even when the situation has seemed hopeless, progress has been made
Persistence is essential
32
Thank You
Linda Waverley
http://www.idrc.ca/ritc