global perspectives to tobacco controlkarelian medical days petrozavods 6.-7.10.2016 global...

Karelian Medical days

Petrozavods 6.-7.10.2016

Global perspectives to tobaccocontrol

Pekka Puska, MD, PhD, MPolSc

Director General Emeritas, National Institute for Health and Welfare (THL),

Finland

11.10.2016

TOBACCO

Huge harm to

– individual health

–public health

–Social and economic development (incl. burden to health services)

11.10.2016 Pekka Puska

Smoking attributable risk in main tobacco related diseases: Tobacco kills in great numbers

Disease Risk ratio (RR) Attributable

fraction (AF)

Lag time

CHD 2-4 15-20% 1-10 years

Stroke 2-4 15-20% 1-10 years

Lung cancer 15-20 80-90% 20-30 years

COPD 3-6 40-80%* 20-30 years

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Every second smoker dies from smoking

11.10.2016 Esityksen nimi / Tekijä 4

CURBING THE TOBACCO EPIDEMIC

(World Bank)

WHO REGION

DEATHS ATTRIBUTED

TO TOBACCO (%)

SMOKING

PREVALENCE (%)

Europe 16 28

Americas 16 20

Western Pacific 13 25

South East Asia 10 19

Eastern Mediterranean 7 22

Africa 3 15


Tobacco kills in Europe about 1,6 million people annually!

It is time to stop the mass killing!

Tobacco deaths:

• 1900’s 100 million

• 2000’s 1.000 million (with currentfigures)


International/global collaboration is vital for successfull tobacco control

”No single country alone can get rid of tobacco”

(Dr. G. H. Brundtland as DG of WHO)

Maximum use of the FCTC instrument!

11.10.2016 Esityksen nimi / Tekijä 7

Framework Convention on Tobacco Control

• WHO Framework Convention on Tobacco Control (FCTC) is the sole public health treaty

• 180 member states are parties to FCTC

• Landmark binding international treaty specifically agreed upon for the fight against the global health tobacco epidemic

• Signatory states are obligated to implement requirements of FCTC

11.10.2016 Pekka Puska 8

The Convention: principal provisions

• Measures to reduce the demand for tobacco

• Measures to reduce the supply of tobacco

• International cooperation

• General obligations

• Reporting


Framework Convention on Tobacco Control

Obligations under FCTC

•Limitations on lobbying from industry

•Tax measures for demand reduction and addiction/cessation programs

•Limit passive smoking (i.e. 2nd hand smoke)

•Regulation of contents and emissions

•Advertising ban and raising awareness/additional research

•Restrict sales to minors and eliminate smuggling

•Health warnings/labelling on tobacco products


Conference of Parties (CoP)

• Geneva 2006

• Bangkok 2007

• Durban 2008

• Punta del Este 2010

• Seoul 2012

• Moscow, Oct 2014

• Delhi, Nov 2016


EU tobacco directive (Febr. 2014)

• Requires member states to develop legislation

• Picture and text warnings covering at least 65% of frontand back of package

• Minimum 20 cigarettes per package

• Prohibiting flavours (e.g. menthol)

• Maintaining ban of snus (except Sweden)

EUROPEAN HEALTH MINISTERS (Ashgabat 2013)

• Full implementation of FCTC

• Working towards tobacco-free Europe


Key elements in national tobacco policy• Price, tax

• Completely free indoor places (restaurants, work sites)

• Complete ban on advertizing and sales promotion

• Sale to minors prohibited

#

• Pictorial health warnings or plain packaging

• Tobacco sale by licence

• Tobacco products not at display

• Support to cessation and campaigns

• Prohibition of smokeless tobacco and control of e-cigarettes

11.10.2016 Pekka Puska, Director General 13

Positive developments

• FCTC: Framework convention on Tobacco Control, 2003

• Most countries have ratified

• Rapidly developing legislation

• Decline in tobacco use in manycountries (esp. high income)

• The problem is still huge


Independent Expert Group:

IMPACT ASSESSMENT OF THE WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL

Pekka Puska, Chair

On behalf of the Group (P.Puska, M.Daube, G.Fong, S.Gupta, T.McInerty, C.Walbeek, G.Zaatari)

MAIN EVIDENCE SOURCES

• 1. Global evidence review of scientific studies (by ITC Project)

• 2. Commissioned reports, government reports and otherliterature

• 3. Missions to 12 selected countries ( 2 per WHO Region, 3 per World Bank economic group)

*****

Countries visited:

Bangladesh, Brazil, Iran, Kenya, Philippines, Republic of Korea, Madagaskar, Pakistan, Sri Lanka, Turkey, Uruguay, UK


IMPACT ON SMOKING PREVALENCE


Main findings

• The ten years of FCTC have seen some remarkabledevelopments in global tobacco control.

• The FCTC has undoubtedly played a critical role as catalyst and framework for action.

• The FCTC has played a pivotal role in countries whereeffective tobacco control was nor previously in place, and helped to strengthen to strengthen policies in countries where it was in place before ratification.

• The FCTC has contributed to reductions in prevalenceamong Parties that have implemmented FCTC policiesat high levels, thus contributing to reductions in tobaccorelated mortality and morbidity.


OBSTACLESThere are substantial remaining obstacles, especially

- Aggressive action by the tobacco industry.

- Need for continuous recognition of important needs to act further.

- Recognition the the FCTC applies to all sectors of government.

- Low awareness for non-cigarette products, insufficient action on

vulnerable groups and insufficient support for low

and middle income countries.

TOBACCO

• FINLAND: STILL A BIG ISSUE

• RUSSIA: HUGE PROBLEM


Daily smoking in Finland 1950 - 2014

17%

14%

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

1950 1960 1970 1980 1990 2000 2010

Men

Women

Adolescent smoking has almost halved during the 21st century. Experiments with smoking and subsequent regular smoking have moved to an older age.

2014

Adolescent daily cigarette smoking

11.10.2016

Prevalence of daily cigarette smoking (%) among 1218-year-olds 19812013. Adolescent Health and Lifestyle Survey 2013.

0

5

14

18

0

5

10

15

20

25

30

35

40

45

50

%

Girls

12 14 16 18

1

3

13

19

0

5

10

15

20

25

30

35

40

45

50

%

Boys

12 14 16 18

Pekka Puska 22

Tobacco Legislation in Finland

• The Tobacco Act in 1976:

incl. smokefree public places, publictransportation, sales ban to under 16, totaltobacco ad ban 1978

• Smokefree workplaces 1995

• ETS carcinogenic 2000

• Smokefree bars and restaurants 2009

• Licensing system 2009

• Endgame 2010

• Display ban in stores 2012

• Reform 2016

Other nicotine products

Smokeless

tobacco• The typical form is

Swedish snus.

• The daily use was

3% among adult

men in 2014.

Women do not

typically use snus

E-cigarettes• 3 % of men and

women used e-

cigarettes daily of

occasionally in

2014.

• 20 % of 14-16-year-

old adolescents

have tried them

at least once.

Waterpipe• Of the 18-year-old

Finns, around 30 %

have tried smoking

waterpipe.

• The popularity of

waterpipe is

growing worldwide.

The Goal

In 2030, five percent or less of

the Finnish population will use tobacco products.

Plans for the near future

• Free of charge, low-threshold services for quitting

• Regular price increases through taxation

• Nationwide, continuous and tailored massmedia campaigns

• Standardised (plain) packaging

• Restrict the private import of tobacco, tax-free

• Smoke-free parks, beaches

• Less retail outlets for tobacco and nicotine products

• Tobacco companies responsible for health hazards

Standardisedpackaging

gainingpopularityworldwide.

Possibilities for endgame?• The reduction in smoking in many

countries has gone so far that manycountries are considering this

• Finland, New Zealand, Norway, Australia etc.

• International Conference on Endgame of Tobacco, New Delhi 2013 -> declaration

• Increasing number of articles on the topic

• Ashgabat declaration 2013 (Europeanhealth ministers)


60

65

70

75

80

85

1970 1980 1990 2000 2010 2020

FinlandNorwayRussian FederationSwedenUnited Kingdom

Life expectancy at birth, in years

Life expectancy at birth, in years (males and females)

Source: WHO, HFADB, 2012


Tobacco use in Russia (Gats 2009)

MEN WOMEN

Current smokers 60% 21%

Former smokers 13% 4%

Current smokeless

users 0,3% 0%


RECOMMENDATIONS

• Although the FCTC has made a critical contribution to global tobaccocontrol, the Parties should strongly support action towards swifter and stronger implementation.

• Article 5.3. shouold be fully observed by all sectors of government.

• Increasing tax and aligning the taxation with article 6 guidelines is the single most effective tobacco control measure.

• Individual countries, especially LMICs should be provided

more technical support in key areas (eg. taxation) and

to respond to emerging challenges (esp. non-cigarette,

new products).

• Parties should develop national surveillance systems

to assess trends, to evaluate measures and to make

full use of the information.

Endgame of tobacco is a profoundsocial change process where changesin people’s habits, intentions and attitudes go hand in hand with respective regulatory and legislativechanges!


11.10.2016

Thank you

Pekka Puska

global perspectives to tobacco controlkarelian medical days petrozavods 6.-7.10.2016 global...

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