Johanna Birckmayer, PhD, MPH
Campaign for Tobacco Free Kids
 2011 Johns Hopkins Bloomberg School of Public Health

The Global Tobacco Problem
Almost one billion men and 250 million women are daily smokers
Currently:

1 in 10 deaths linked to tobacco

4.9 million people die each year from tobacco use
By 2030:

8 million people a year will die from tobacco use

80% of those deaths will occur in developing countries
 2011 Johns Hopkins Bloomberg School of Public Health 2

Global Adult Tobacco Survey (GATS)
The GATS has been conducted in 14 countries between
2008 and 2010
Consistent, high quality methodology produced reliable rates within and across countries
GATS: Tobacco Use,
2008-2010
30%
25%
20%
15%
10%
5%
0%
50%
45% 43.3*
40%
35%
17%
28%
19%
34.6*
16%
28%
30%
39%
24%
31%
29%
25%
24%
* Bangladesh and India prevalence for tobacco users
Source: GATS. (2008-2010)
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Framework Convention on Tobacco Control (FCTC)
As the world’s first public health treaty, the FCTC is the key legal instrument guiding tobacco control worldwide
Negotiated by the
192 member states of the
World Health
Organization in
2003, almost all parties have now ratified
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Adding Momentum to the Tobacco Control Movement
The Global Non-Communicable Disease (NCD) Burden

By 2030, NCDs are projected to
Tobacco Unhealthy use diets inactivity account for more
Physical
Harmful use of alcohol than 75% of deaths worldwide

Tobacco use is a risk factor for all
Cardiovascular
Diabetes
Cancer
   







 major NCDs, causing 1 in 6 of
NCD deaths
Chronic respiratory


UN High Level Meeting on NCDs calls for accelerated implementation of the FCTC as key component of NCD action plan (September 2011)
Source: World Health Organization (WHO). (2008). The global burden of disease: 2004 update. Geneva: WHO. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf
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Key Tobacco Control Policies
100% smoke-free policies
Graphic warning labels
Bans on tobacco advertising, promotion, and sponsorship (TAPS)
Increase in tobacco price through taxation
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Smoke-Free Policies
New evidence of impact of smoke-free laws

Meta-analysis conducted by the United States Institute of
Medicine concluded that smoke-free laws decrease acute coronary events, such as myocardial infarction

Average hospital admissions for asthma dropped 15% among schoolchildren after Scotland’s 2006 smoke-free legislation
Exposure to secondhand smoke estimated to cause over 600,000 premature deaths worldwide each year

47% of premature deaths occur among nonsmoking women and
28% occur among nonsmoking children
Source: Institute of Medicine.(2009); Mackay, D. et al. (2010); Öberg, M. et al. (2011).
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Countries with 100% Indoor Smoke-Free Policies
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Strong Public Support for Smoke-Free Laws: Turkey
In Turkey, 48% of men smoke
In 2008, the Turkish National
Tobacco Control Law made all indoor public places, workplaces, educational institutions, and public transportation smoke-free
In 2010, 7 out of 10 places were complying with the law
In 2010, 92% of Turks and 77% of daily smokers supported the law
Source
:
Quirk Global Strategies. Results from opinion research in Turkey: Support for smoke-free legislation. 2010.
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Warning Labels
As of September 2011, more than 40 countries have mandated graphic warning labels on cigarette packs
And the list keeps growing …
Malaysia - 2010 Pakistan - 2010 United States - 2012
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Plain Packaging
A few years ago, tobacco control partners considered plain packaging unlikely to be seen in near future
Instead, legislation in Australia currently under consideration to require plain packaging, and the country appears poised to implement plain packaging
Plain packaging standardizes the appearance of cigarette packages, removes all brand imagery, allowing only the brand name in a mandated size, font, and position

Government-mandated information, such as health warnings, would remain
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Tobacco Advertising, Promotion, and Sponsorship Bans
In 2008, the US National Cancer Institute released a comprehensive monograph on tobacco advertising

This was the first major scientific review to conclude that tobacco advertising has a causal impact on use
GATS data from countries with strong and enforced tobacco advertising, promotion, and sponsorship (TAPS) bans show low rates of exposure to marketing, compared to countries without strong bans

12.4% of adults reporting exposure to tobacco marketing in
Turkey vs. 58.7% of Russian adults

Turkey has a strong, well-enforced tobacco marketing ban while in Russia many forms of marketing are allowed
Sources: National Cancer Institute. (June 2008). The role of the media in promoting and reducing tobacco use.
Tobacco Control Monograph No.19.; Global Adult Tobacco Survey. Turkey (2008) and Russia (2009) Factsheets.
Available from: http://www.who.int/tobacco/surveillance/gats/en/index.html
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Focus on Point of Sale (POS) Advertising
Tobacco companies spend significant marketing dollars at POS
Relatively few countries ban POS advertising and many are trying to close the loophole or include it in comprehensive TAPS bans
Tobacco companies fight fiercely to exempt advertising and promotion at the
POS
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Tobacco Taxes and Price
Prices and taxes for tobacco products vary considerably around the world
Source
:
Euromonitor International. (2011). Global briefing- Global tobacco findings 2011: Battle intensifies.
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Tobacco Taxes and Price
The growing concern about the devastating impact of tobacco and the need for government revenue means more governments are turning to increased tobacco tax to raise revenue, decrease consumption, and save lives
Countries raising tobacco tax in 2010 include Turkey, Egypt,
Mexico, and the United States
Source
:
Euromonitor International. (2011). Global briefing- Global tobacco findings 2011: Battle intensifies.
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Challenge—Affordability
Affordability of tobacco products varies across countries
Over time, cigarettes have become much less affordable in some countries, while in others they have become much more affordable
Source: Blecher, E., Van Walbeek, C. (2008).
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New Technical Guidance
A new technical manual from WHO provides a set of key recommendations for increasing taxes with the goal of increasing affordability
A new presentation by Frank Chaloupka provides an overview of this guide
Source: World Health Organization. (2010).
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Advances in Tobacco Product Regulation
In 2009, the United States Food and Drug Administration gained the authority to regulate tobacco under the Family Smoking Prevention and Tobacco Control Act

Over time, this will provide a model for other countries to consider
In 2010, Parties approved partial guidelines for FCTC Articles 9 and
10

Articles 9 and 10 require Parties to regulate the contents of tobacco products and tobacco product disclosures
Countries taking steps to curb the use of additives in tobacco products include Australia, Canada, France, the EU, Singapore,
Thailand, and the United States
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New Frontiers: Trade Rules
Liberalized trade is designed to make products more available to more consumers at lower prices to expand their use
Trade rules are increasingly being used to challenge FCTC measures, examples include:

2009: PMI v. Ireland in EU over retail display ban

2010: PMI v. Uruguay under BIT over packaging

2010: Indonesia v. US under WTO over cloves

2010: PMI v. Norway in EU over retail display ban

2011: PMI threatens Australia over plain packaging
Tobacco control partners cannot allow trade rules to become another tool for the industry to challenge legitimate public health measures
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Unending Challenge: Tobacco Industry Opposition
In 2009, Parties to the FCTC unanimously approved Article 5.3 of the Convention

Principle 1: there is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests
The industry continues to seek to:

Legitimize itself where it operates

Interfere with the policy making process

Create new users and keep existing ones
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Unending Challenge: Tobacco Industry Opposition
Tobacco companies increasingly engage in litigation challenging strong tobacco control policies; examples include:

Smoke-free laws in Argentina and Turkey

Advertising, promotion, and sponsorship laws in Brazil,
Scotland, and South Africa

Warning labels in Indonesia and Philippines
“In common with all other global consumer products companies, we will continue to focus on [emerging] markets going forward as they generally offer favorable demographic trends, economic growth, and increasing consumer purchasing power.”
—PMI CEO Louis C Camilleri
November 2010
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Tobacco Control Policies Reduce Use
Source: NYC.gov. (2011).
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