Advocating Policies for
Waterpipe & Cigarettes
Cynthia Callard
October 2013
Adult per capita cigarette consumption, the United States, 1900–2006.
USA annual adult
per capita cigarette
consumption
Warner K E , Mendez D Nicotine Tob Res 2010;12:876-887
1,800
1,600
1,400
1,200
1,000
800
1960 =
1,129
1987 =
1,537
2010 =
1,141
600
200
-
Global annual adult (15+)
per capita cigarette consumption
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
400
Sources: Averaged values, Maxwell, Euromonitor, USDA: population over 15 years from World Bank.
A shifting epidemic
*new communities
*new patterns of use



Health Rationale
Political systems
Legal structures
 (FCTC and related regulation)



Societies
Public health community
Tobacco users





Warnings
Youth Access
Tax/Prices
Advertising bans
Smoke-free spaces




Flavour bans
Mass media
Public education
Clinical practice





Warnings
Youth Access
Tax/Prices
Advertising bans
Smoke-free spaces




Flavour bans
Mass media
Public education
Clinical practice
*(Canada)
25
21
21
20
20
19
19
19
18
18
17
16
15
17
16
14
12
9
10
9
7
6
5
5
4
4
2010
2011
3
0
2002 20032 2004
Smoking prevalence
2005
2006
2007
2008
2009
Children exposed at home
2012
Ever used waterpipe
CTUMS
25
21
21
20
20
19
19
Flavour
ban
19
18
18
17
16
15
17
16
14
12
12
9
10
9
7
8
6
5
4
5
4
4
2010
2011
3
0
2002 20032 2004
Smoking prevalence
2005
2006
2007
2008
2009
Children exposed at home
2012
Ever used waterpipe
CTUMS
Victory or Defeat?
?
?
Brazil: RESOLUTION - RDC Nº
14, OF MARCH 15, 2012

Additive ban covers all tobacco
products.
 “Art. 2 This Resolution applies to all
tobacco products sold in Brazil,
whether made in Brazil or
imported.”

BUT Currently challenged at
Supreme Court.
http://www.tobaccocontrollaws.org/files/live/Brazil/Brazil%20%20RDC%20No.%2014_2012.pdf
European Union Tobacco
Directive
original

Considering the Directive's focus
on young people, tobacco
products other than cigarettes,
roll-your-own tobacco
and smokeless tobacco which
are mainly consumed by older
consumers, should be granted
an exemption from …
European Union Tobacco
Directive
as amended by EP.

Considering the Directive's focus
on young people, tobacco
products other than cigarettes,
roll-your-own tobacco
and water-pipe tobacco which
are mainly consumed by older
consumers, should be granted
an exemption from …
http://www.europarl.europa.eu/sides/getDoc.do?type=TA&reference=P7-TA-20130398&language=EN&ring=A7-2013-0276
Widespread TC consensus:



Science
Policy
Strategy
Broad-based TC community



Pan-partisan
Multi-sectoral
International
 What do we want?
 Who can give it to us?
 What do they need to hear?
 Who do they need to hear it from?
 How can we get them to hear it?
#1:
Get on the Agenda
#2:
Get Favourable Decisions
#3:
Protect gains/ address
vulnerabilities
(repeat as necessary)
Same
Vulnerabilities
same, same
Publish
or Perish
#1
same, same
Need
Multiple
Points
of
Contact
Multisectoral
•
•
•
Finance
Health
Education
Multi-jurisdictional
•
•
International, National,
subnational
Corporate, CSO & home
same, same
Need to
understand the
decision
maker
Canadian MPs:
•
•
•
•
•
•
Live in the moment
Are competitive and tribal
Don’t want to be disliked
Barter policies
Think locally
Are not overly numerate
“Which side are you
on?”
same, same
Need
for
sustained
resources
It’s not a part-time
job.
same, same
Need
to take
risks
There is a reason we
are an unbranded
movement.
Same Same
Barriers
The capacity of
decision makers to:
Deflect responsibility
Deny the problem
Discredit the evidence
Delay action
Somewhat different
Barriers
(perception is
reality)
Tobacco control is
understood to mean
“cigarette control”
Prevents instant adoption of
Economic rationale, health
rationale, cultural acceptance,
priority over other health
concerns.
Same same
Mutable
Problem
Money is the root of
all smoking!
Suppliers are driven to adapt or
overcome regulatory and other
barriers.
same, same
Challenge
to find
the right
“ask”
What do we want
NOW?
What will we want
NEXT?
“Tobacco Control is a
changing game.”
Scott Sherman,
October 21, 2013
“We face the challenge of …
unimpeded emergence of
new products.”
Cheryl Healton
October 21, 2013
“If we can’t do it, no
one can.”
Omniyat Al Hajeri
October 21, 2013