‫االجتماع الوزاري لغربي آسيا بمشاركة المجلس االقتصادي واالجتماعي التابع لألمم المتحدة‪ ،‬ولجنة األمم المتحدة‬
‫االقتصادية واالجتماعية لغربي آسيا‪ ،‬ومنظمة الصحة العالمية‬
‫"التصدِّي لألمراض غير السارية ولإلصابات‪ :‬تحدِّيات كبرى تواجه التنمية المستدامة في القرن الحادي والعشرين"‬
‫تستضيفه دولة قطر في الدوحة‪ 11 – 10 ،‬أيار‪/‬مايو ‪2009‬‬
‫‪ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting‬‬
‫‪“Addressing noncommunicable diseases and injuries: major‬‬
‫”‪challenges to sustainable development in the 21st century‬‬
‫)‪(Hosted by the Government of Qatar in Doha, 10-11 May 2009‬‬
‫‪Dr Douglas Bettcher, Director, TFI, WHO‬‬
The Tobacco Epidemic Worsening...
Unless We Act Now
Tobacco currently kills: 5 million/yr
Will increase to: 8.3 million/yr by 2030.
Smoking killed 0.1 billion for 20th
Century, but for the 21st century,
SMOKING WILL KILL A TOTAL
OF 1 BILLION (half the deaths in
middle age).
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
The Leading Preventable Cause of
Death in the World
Source: WHO 2008
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
WHO Framework Convention on
Tobacco Control (WHO FCTC)
• Foundation stone in the global fight
against the tobacco epidemic.
• First global health treaty negotiated
under auspices of WHO – adopted
in 2003.
• Entry into force -27 Feb 2005.
• 164 parties as of 2009.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Status of the WHO FCTC in the region
TUNISIA
MOROCCO
LEBANON
oPt
JORDAN
SYRIAN
ARAB
REP.
IRAQ
ISL.
REP.
OF IRAN
AFGHANISTAN
PAKISTAN
LIBYAN
ARAB
JAMAHIRYA
EGYPT
KUWAIT
QUATAR
BAHRAIN
UAE
OMAN
SAUDI
ARABIA
CONTRACTING PARTIES to THE WHO FCTC
COUNTRIES NON PARTIES THAT HAVE SIGNED
THE WHO FCTC
SUDAN
COUNTRIES THAT HAVE NOT SIGNED THE WHO
FCTC AND ARE NOT CONTRACTING PARTIES
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
YEMEN
SOMALIA
Global Level Implementation of
WHO FCTC – Country-level
• mpower: Six policies for tobacco control as
part of WHO FCTC comprehensive
implementation.
– Key entry point for scaling up tobacco control.
– Help countries build on WHO FCTC commitments.
– Integral part of the WHO Action Plan for the
Prevention and Control of Non-Communicable
Diseases.
– Matches WHO public health competency.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
TFI : Bringing in Change
• monitor tobacco use and
prevention policies
• protect people from tobacco
smoke
• offer help to quit tobacco use
• warn about the dangers of
tobacco
• enforce bans on tobacco
advertising, promotion and
sponsorship
• raise taxes on tobacco
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
WHO FCTC and MPOWER
An evidence-based tool for tobacco control (demand and supply side
measures)
r
p
Article 6, 15
w
Article 8
Article 11, 12
e
o
m
Article 13
Article 14
Article 20, 21
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Tobacco use prevalence
is higher among the poor
Smoking prevalence in selected EMRO countries
Q5
Q4
Q3
Q2
0
5
10
Daily
%
Q1
15
20
25
A ll smo king
Source: World Health Survey 2006
Note: Q1-Q5: Lowest-Highest income groups
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Tobacco control is good for development
and for addressing social determinants of health
• A recent study looking at systematic reviews to assess the
impact of population-level tobacco control policies on social
inequalities in smoking showed that: there was preliminary
evidence that increases in the price of tobacco may
have the potential to reduce smoking related health
inequalities.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Tobacco control is good for development
and for addressing social determinants of health
• With regards to taxation, poor
groups respond more to
price increases and reduce
tobacco consumption to a
greater extent than other
groups do.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Tobacco control is good for development
and for addressing social determinants of health
• Earmarking tobacco taxes – a pro-poor
policy: Dedicating part (or all) of the
revenues from tobacco taxes to
develop NCD/health measures aiming
at reaching vulnerable and poor
populations is feasible and can render
those measures more effective in
reducing the burden of NCDs while at the
same being pro-poor.
• At the time of financial crisis, tobacco tax
increase is a good way to generate
revenue.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Earmarking tobacco taxes:
examples from EMRO
• Egypt: 10 piasters per 20 cigarettes are devoted to the students health
insurance.
• Qatar: 2% of revenues from import duties on tobacco products allocated
for health awareness activities and tobacco control activities.
• Jordan: 20 Flus (1/1000 of Jordanian Dinar) National Fund to support
youth movement.
• Tunisia: Rate varying by tobacco product between 10 and 170 millimes
(millime=1/1000 Tunisian Dinar) per tobacco product to the activities of
the Solidarity National Fund.
• Iraq: 5% of imported value of cigarettes for reconstruction activities.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Earmarking tobacco taxes, a pro-poor policy
Success story: Thailand
• Health Promotion Foundation
(ThaiHealth) set up in 2001 by the
Government.
• Receiving 2% of the total revenues from
alcohol and tobacco (about 35 million$
per year).
• Acts as a catalyst and supports groups
and organizations already working on
public health.
• Inspired neighbouring countries: Mongolia adopted the
same structure and received technical assistance from
ThaiHealth in the process of setting up the policy.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Applying best practices in all countries
Capacity
building
Surveillance
Advocacy and
Communications
Country-level
partnerships
Economics
Legal
National
tobacco
control plans
Global
networks and
partnerships
TFI works with countries for
building managerial, technical and policy infrastructure.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Applying best practices in all countries
• Capacity Building - assessment of
national capacity and support for
policy development.
• Monitoring and Evaluation –
strengthen population based
comparable surveillance (e.g. GATS).
• Economics - technical support for economic research
and interventions.
• Advocacy and Communications - promote effective
policies with partners using global and country media.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Trade unions
Health Professionals
Media NGOs
PUBLIC AWARENESS
JHBSPH
IARC
WHO Collaborating Centres
Working together
CDC
WLF
Bloomberg Philanthropies
INTERNATIONAL SUPPORT
SCIENTIFIC EVIDENCE
to curb the
Researchers
Gates foundation
Donor countries
tobacco epidemic
Ministry of Health
Ministry of Agriculture
Ministry of Finance
Ministry of Justice
Ministry of Education
POLITICAL WILL
WHO Headquarter (TFI)
WHO Framework Convention
on Tobacco Control
INTERGOVERNMENTAL WORK
WHO Regional Office
WHO Country offices
UN task force
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Knowing is not enough; we must apply.
Willing is not enough; we must do.
Johann Wolfgang von Goethe
(1749–1832)
Thank you
for your attention!
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Policy impact of country work
Mpower (supporting Article 20 & 21)
•Egypt: Currently half way through GATS data
collection. GATS national level data release is
planned for September 2009.
•Turkey: Launch of Turkish-language
translation of the WHO Report on the Global
Tobacco Epidemic - 2008 sparked considerable
media attention. In 2009 - launch of the first
GATS set analysed data.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Policy Impact of country work
mPower (supporting Article 8)
•Egypt : The 2007 tobacco control law declared
all public places to be free of tobacco, and was
implemented except for restaurants and cafes.
Similarly examples in Jordan, Bahrain and UAE.
•SA: The only two tobacco free cities in the region.
•Ireland: Adopted and implemented the first
comprehensive smoke free law in 2004, changing
the face of the smoke free policies in the 21st
century.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Policy Impact of country work
mpOwer (supporting Article 14)
• Iran - Lots of work on cessation training
- national training of trainers workshop on
cessation, over 100 cessation centers set
up. An area that needs further advancing
in the region.
• Nepal: Incorporation of brief cessation
advice into PHC for chronic respiratory
diseases and tuberculosis (2007- June
2008).
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Policy Impact of country work
mpoWer (supporting Article 11 & 12)
• Jordan is first country to have
pictorial health warnings(30%);
Egypt is first country to have 50% of
the pack size, followed by Iran,
Djibouti. All GCC countries are in
process of selecting their pictorial
health warnings.
• Australia: Strong picture health
warnings on both covers front (30%)
and back (90%).
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Policy Impact of country work
mpowEr (supporting Article 13)
•Total ban on advertising exists
and is implemented in 9 MS of
EMRO: Djibouti, IRAN, Jordan,
Kuwait, Qatar, Sudan, UAE,
Yemen, EGY.
•Thailand: In addition to ban of
advertisement, product display
at point-of-sale is banned.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)
Policy Impact of country work
mpoweR (supporting Article 6)
• Thailand: A high percentage of the price of
a pack of cigarettes goes to taxes in
Thailand (64%), and 2% of total revenues
from tobacco and alcohol are used for
health promotion.
ECOSOC/UNESCWA/WHO Western Asia Ministerial Meeting
Addressing noncommunicable diseases and injuries
(Doha, Qatar, 10-11 May 2009)