WHY TOBACCO
CONTROL?
glamorous sociable sophisticated relaxing fun calming romantic emancipated sexy liberating healthy rebellious sporty slimming fashionable cool
Smoking has been promoted as being:
Emancipated ?
Glamorous ?
Sexy ?
Nat
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Ad
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Tobacco Arrives in the Old World• 1492: Columbus brings tobacco back to Europe from his
first voyage• 1556–59: Tobacco introduced into France, Spain and
Portugal• 1560s: Jean Nicot praises tobacco’s medicinal properties to
the French queen
Early Marketing of Cigarettes
• October 13, 1913, R.J. Reynolds Tobacco Company introduced Camels, the first modern blended cigarette, and launched the first US cigarette-advertising campaign
• 1920s: women first became the targets of the tobacco companies
Early Efforts to Control Tobacco Use
King James I of England on active smoking:‘’Smoking is a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs,
and in the black, stinking fume thereof nearest resembling the horrible Stygian smoke of the pit that is
bottomless’’
King James I of England on passive smoking:‘’The wife must either take up smoking or resolve to
live in a perpetual stinking torment’’
Borio G. Tobacco Timeline, 1998
Early Indications of Tobacco-related Disease
• 1600s China: philosopher Fang Yizhi points out “long years of smoking scorches one’s lung”
• 1701: N. A Boiseregard warns that young people taking too much tobacco have trembling, unsteady hands, staggering feet and suffer a withering of “their noble parts”
• 1761: John Hill warns of cancer of the nose for snuff users
• 1795: Sammuel Thomas von Soemmering reports cancers of the lip in pipe smokers
Early Indications of Tobacco-related Disease
• 1954: Richard Doll and Bradford Hill’s study of British doctors published in the British Medical Journal
• 1962: Royal College of Physicians Report
• 1964: First Surgeon General’s Report on tobacco and health
• 1981: First major study on passive smoking and lung cancer by Takeshi Hirayama (Japan)
Borio G. Tobacco Timeline. 1998
Surgeon General Luther Terry holding the 1964
Report
Borio G. Tobacco Timeline, 1998
Survivorship of white males after 30 years of age according to
smoking habits
Pearl, 1938
100
30Age in years
90
80
70
60
50
40
30
Non-users
Th
ou
sa
nd
s o
f s
urv
ivo
rs
20
10
0
40 50 60 70 80 90 100
Moderate smokers
Heavy smokers
Early Indications that Tobacco Causes Disease
• 1938: Raymond Pearl reports smokers do not live as long as non-smokers
• 1950: Three key case-control studies link smoking with lung cancer
• 1953: Ernst Wynder’s study showed that tobacco painted on the backs of mice produced tumors
Borio G. Tobacco Timeline, 1998
The Rise of Cigarette Consumption• 1921: cigarettes became the main form of
tobacco consumed in the US
• 1964: Marlboro Man ad campaign launched, sales rise 10% a year
• 1970s: the tobacco industry marketed aggressively to countries in Africa, Asia and Latin America
• 1972: Marlboro becomes the best-selling cigarette in the world
Around the world tobacco kills:
560 people every hour 13,400 people per day
4.9 million people per year By the year 2030, 10
million people a year will die from tobacco.
70% of those deaths will occur in developing
countries
Approximately 500 million people alive today will die from tobacco-
related disease
Our future – literally – is at stake.
Tobacco and Health
• Reducing the global disease and economic burden of tobacco use is one of the greatest public health challenges of our time
• Effective tobacco control strategies exist that are cost effective
• Strong national and international actions are critical to stem the course of the tobacco pandemic
Health Consequences of Tobacco Use
• Each year tobacco kills 3 million people worldwide• WHO estimates that by 2020–2030, tobacco will be
responsible for 10 million deaths per year– 70% will occur in developing countries
• Half of all long-term smokers will be killed by tobacco– half of these will die in middle age, losing 20–25
years of life
Number of deaths (millions)
WHO, 1996
1990
2020
Leading Causes of Death Worldwide in 1990 and Estimated in 2020
2,2
0,9
1,2
2,5
8,4
2
2,4
2,9
4,3
3
0 2 4 6 8 10
Tuberculosis
Perinatal conditions
Diarrhoeal diseases
Lower respiratorytract infections
Tobacco
The Coming Epidemic
1,1
1,64
0
0,5
1
1,5
2
bill
ion
s o
f s
mo
ke
rs
2000 2025
Rise in Smokers Worldwide
Economic Consequences of Tobacco Use
• Medical costs• Productivity losses due to:
– morbidity– disability– premature mortality
• Global net loss of US$ 200 billion per year
Changing Trends in Tobacco Use
• Cigarette smoking is a 20th century phenomenon
• Cigarette smoking by females was very uncommon until the 1930s in countries like the US
• The smoking epidemic is spreading in low-income countries
• In most countries, the poor are more likely to smoke than the rich
WHO, 1997, cited in World Bank Report, 1999
The Changing Epidemic
1990–921970–72 1980–82
2000
2500
3000
1500
1000
500
Smoking is increasing in the developing worldTrends in per capita adult cigarette
consumption
An
nu
al c
igar
ette
co
nsu
mp
tio
np
er a
du
lt (
in c
igar
ette
s)
Year
Developed
Developing
World
“Tobacco use is unlike other threats to global health.
Infectious diseases do not employ multinational public
relations firms.
There are no front groups to promote the spread of
cholera.
Mosquitoes have no lobbyists.”
WHO Zeltner Report, 2000
Rationale for Tobacco Control• Smoking kills one in ten adults worldwide
• By 2030 the proportion has been predicted to be one in six
– more than any other single cause of mortality
• Half of all long-term smokers will be killed by tobacco
– half will die prematurely, losing 20–25 years of life
• The use of tobacco results in a global net loss of US$ 200 billion per year
Obstacles to Tobacco Control• Tobacco contains nicotine, which is
addictive• The tobacco industry uses its economic
and political influence to oppose tobacco control efforts
• Tobacco sales contribute to government revenues
• In some populations, there is a lack of knowledge of tobacco-related health risks
Policy Maker’s Concerns on Taking Action to
Control Tobacco Use
• Job losses• Loss of government
revenue• Increased smuggling• Disproportionate
impact of increased price measures on low-income tobacco users
World Bank, 1999
The Advocacy Institute, 1998
Tobacco Industry Strategies The tobacco industry:
– uses public relations to present itself in positive ways
– uses money to fund political events and access the political process
– gives money to various organizations that are sometimes used as more ‘credible’ advocates
– uses more respectable economic allies such as farmers and retailers to argue its case
– employs well-connected lobbyists– uses various intimidation tactics to frighten
advocates, law-makers and journalists away from pursuing tobacco control policies
Source: Philip Morris, World Bank
Philip Morris/Altria Tobacco Revenue
& Selected Country GDPs (2000)
0 10 20 30 40 50 60
Philip Morris
US$ billions
Czech Rep
Kenya
Senegal
Sri Lanka
Costa Rica
Hungary
Key Tobacco Control Strategies to Reduce Demand
• Raising the price of tobacco
• Banning advertising and promotion
• Creating smoke-free indoor environments
• Conducting mass media campaigns
• Including strong warning labels on all tobacco products
• Increasing access to treatment
• Implementing youth-based programs
– school-based programs
– media literacy
– youth advocacy
Raising the Price of Tobacco
• Price is probably the single most powerful factor influencing short-term tobacco consumption
• Price plays an important role in determining the number of young people who start smoking
• Tax should represent two-thirds of the selling price
Banning Advertisement and Promotion
• Advertising, sponsorship and promotion are all used to boost sales
• Bans on advertising and promotion are fiercely contested by the tobacco industry
• Sponsorship is the method most commonly used to circumvent advertising bans
• Brand stretching (using cigarette brand colors and logos on non-tobacco products) is the fastest growing form of indirect tobacco advertisement in Europe
• Comprehensive bans on advertising, sponsorship and promotion are most effective
Smoke-free Indoor Air
• Planes
• Workplace
• Schools
• Public places
• Restaurants
Rep
rodu
ced
with
per
mis
sion
from
the
Nat
iona
l Ins
titut
e of
Res
pira
tory
D
isea
ses
of M
exic
o (I
NE
R).
Regulation of Tobacco Products• Nicotine is currently most widely available in its deadliest
form
• Move to develop innovative regulatory approaches
• Suggestions for change include:
– establishing a single regulatory framework for all nicotine delivery products
– prohibiting the use of misleading terms such as ‘light’
– requirement that manufacturers disclose constituents and their effects
– seeking genuine harm reduction strategies
– studying reduction over time of nicotine and other potentially addictive constituents as harm reduction strategy
– increasing access to effective treatment
Tobacco Control Efforts to Reduce Supply
• Prohibition of tobacco
• Restrictions on youth access
• Crop substitution and diversification
• Restrictions on international trade
• Action against smuggling
Crop Substitution• Economies of some developing countries’ depend on tobacco
production
• Tobacco provides high net income per hectare
• Tobacco industry provides incentives to farmers
• Arguments for substitution have been made based on deforestation
Restrict Minors’ Access• Increase age for legal purchase of cigarettes and increase
compliance by vendors
• Restrict vending machine use
• Prohibit sales of single cigarettes
Smuggling
• Drives down prices and makes sought-after international brands more affordable
• 30% of internationally exported cigarettes lost to smuggling
• Industry involvement
• Anti-smuggling measures:
– increased penalties
– prominent tax stamps
– special packaging
Goal of Tobacco Control Programs
‘‘To reduce the mortality and morbidity caused by the use of tobacco products’’
Summary: WHO Recommendations for Comprehensive Tobacco Control
• Comprehensive national programs should employ
multiple strategies, including fiscal policy, information
policy, establishment of smoke-free public places and
provision of treatment
• Adequate support is critical and should include support
for capacity building, applied research, surveillance and
evaluation
• Public/media debate on tobacco control-related issues
should be encouraged