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Professor Judith MackayPlenary Session 4 - Chronic Disease
World Congress of Epidemiology Edinburgh, Scotland; 9 August 2011
Smoking prevalence
Male
Female
Same key
Female smoking numbers: Top 20
Youth smoking prevalence, 2000-2007, GYTS
Boys
Girls
Same key
Health professionals
↑ Tobacco epidemic (~ other NCD)
Number smokers1.4 b -> 1.6 b By 2030
Smoking prevalence
Tobacco consumption
Tobacco deaths 6m->8mp.a. by 2030
Global Cigarette Consumption, 1880-2020
Health risks known, but always moree.g. link with TB
Deaths caused by tobacco 2015
Deaths caused by Secondhand smoke
Cumulative deaths from tobacco, global, 2005-2030
Tobacco Costs
HEALTH COSTS OTHER ECONOMIC COSTS
Medical and healthcare costsHigher sickness and absence
ratesLoss of skilled workers by
premature deathIncreased early retirement due
to ill healthSecondhand smoke risks
Time off for “smoke breaks”Lost production and lower
productivityFires caused by careless
smokingDamage to building fabric
Litter of billions of cigarettes, matches, packets, lighters
Risk of being sued
Costs to smoker: cig v. rice
Lack of awareness of risk factorsPreoccupation with other diseasesTobacco may not yet cause many deathsFocus on curative medicine, not preventionSmoking, alcohol, diet seen as personal behaviourTobacco industry: promotion, distortion of health and
economic evidence, financial might, challenge/threats to governments other industries not far behind
Tobacco tax revenue (but not debit) seenMisperceived economic costsLack of funds for research and intervention
Obstacles to Tobacco Control
HK resident smoking through SARS mask
The tobacco industry: Not changed its spots…
Acknowledgement to http://www.wildlife-pictures-online.com/leopard-pictures-1.html
Neo-libertarian groups – now gone global“Nanny state” “Less government” “Personal freedom”
Medical Model Not Enough
Tobacco Control:
WHO FCTC
WHO FCTC into effect 2005 Parties ratified: 174/ 192
Tobacco Control:
FCTC Main Provisions
Tobacco Control:
Ban Tobacco Promotion
People’s Republic of China
Las Palmas
Philippines
Tobacco Control:
Smoke-Free Laws
Hong Kong RestaurantTax Receipts
Before ban and2 years later:
31%
Example: Hong Kong
Tobacco Control:
Pack WarningsExample: Hong Kong 27 Oct 2006: Smoking (Public Health) Ordinance 2006 in effect 6 pictorial health warnings – all cigarettes to display 50% health
warning messages in both Chinese & English
Tobacco Control:
Media Campaigns
worldlungfoundation.org/mmr
For Smoker:Quitting Works
Tobacco Control:
Quitting Reduces NCD Risk
Tobacco Control:
Raising TaxesKey Economic Messages
Tobacco is debit to the economy
Tobacco control is cost-effective
Price increases most effective
tobacco tax does not govt revenue
tobacco tax does not smuggling
tax on other NCD risk factors (e.g. alcohol, certain foods); tax on vegetables??
Tobacco Control:
Raising Taxes, consumption
Tobacco Control:
Raising Taxes: revenues up
Tobacco Control:
Earmarked Tax for Health
Example: Thailand 2% of tobacco and alcohol tax
used for health promotion
And now: Major private donorsMichael
Bloomberg
Bill Gates
But funding from governmentscompletely inadequate…
NCDs: 60% Global DeathsNCD Modifiable Causative Risk Factors
Tobacco Use Unhealthy Diet
Physical Inactivity
Harmful Use of Alcohol
Heart Disease& Stroke √ √ √ √
Diabetes √ √ √ √
Cancer √ √ √ √
Chronic Lung Disease
√
Source: WHO, 2010
Deaths fromCardiovascular Disease
Coronary heart disease
Stroke
* Different keys
Cancer: Major Risk Factors
7.9
13.0
19.0
82.0
7.1
85.067.0
17.0% total
Cancer Registries% of the population covered by cancer
registration
IARC, 2011
Physicians Working in NCD
C21 Epidemics:
New Paradigm Needed1. International law/ treaties for
public health• WHO support• Sound science/research• Comprehensive policies,
common risk factors• Enforcement after legislation
2. Crucial role of government and political will
3. Extraordinary reach of NCD issues, from corporate criminality to poverty alleviation new partners
• Key NGOs and individuals, coalitions
4. Political mapping of obstacles,esp. misperceived economic concerns, tactics of vested industries
• Effective advocacy targeting decision makers to the public
• The role of media
Source: WHO, 2010
UN Summit on NCDs 19-20 Sep 2011
28 such meetings at UN sinceend-WWII only 1 on health (AIDS)
This one: 135 co-sponsoring countries and unanimous approval
Outcome Document is critical
Call for addition of all NCDs into next round of UN MDGs in 2015
Public health come of age
