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Promoting health, preventing disease is there an economic case - tobacco smoking

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Promoting health, preventing disease is there an economic case - tobacco smoking

  1. 1. Promoting  health,preventing  disease:  is  there  an  economic  case?  -­‐   Tobacco  smoking  (in)   Merkur S., Sassi F., McDaid D. Policy Summary 2013; 6:2-5 Sintesi a cura di: Giuseppe fattori, Giuseppina De Angelis          
  2. 2. Promoting health, preventing disease: is there an economic case? Tobacco smoking Policy Summary 2013; 6:2-5   Fumare provoca enormi danni fisici. Numerose fonti documentano la molteplicità di rischi, gli alti costi pubblici e i mezzi efficaci per controllarne il consumo. Il fumo causa 1.250.000 morti di cittadini europei ogni anno, il 21% di tutte le morti. Nella Regione Europea dell’OMS, i tassi di fumo sono tra i più alti del mondo, con il 40 % degli uomini fumatori, il 18 % delle donne e il 24 % dei giovani sui 15 anni ( WHO, 2011d). Per controllare i consumi possono essere adottate misure fiscali, misure per la dismissione all'abitudine tabagica, divieti di pubblicità, campagne sui mass media. Aumentare il prezzo delle sigarette in tutta Europa, permetterebbe di risparmiare centinaia di migliaia di vite ogni anno. Le differenze di prezzo rappresentano gran parte delle differenze nei tassi di consumo tra i paesi europei, che sono più alti nei paesi in cui i prezzi sono più bassi, tra i gruppi socioeconomici più disagiati, disoccupati e genitori single. Tra le misure per la dismissione all'abitudine tabagica, una consulenza telefonica (o con materiali di supporto) con un medico generico ( GP ) è efficace dal punto di vista dei costi. Anche un consiglio da un GP o da un infermiere in ospedale ( B ). Infine la NRT (Nicotine replacement therapy) ( C ) è ancora efficace ma a quattro volte il costo di B e otto volte il costo di A ( Parrott , Godfrey & Kind, 2006). I metodi più efficaci, essendo costosi, non sono i più convenienti e si discute se la NRT funzioni a livello della popolazione. Gli approcci basati sulla popolazione, che utilizzano campagne sui mass media sono importanti perché aumentano la consapevolezza e cambiano gli atteggiamenti sui rischi del consumo di tabacco e sui benefici di smettere; Tuttavia, queste tendono ad essere trascurate così da perdere importanti opportunità di controllo ( Lawrence , Mitrou & Zubrick , 2011; Flay , 1987; WHO, 2003). Le segnalazioni dei media sono state particolarmente efficaci dove non c’erano molte conoscenze sulle conseguenze che l’uso del tabacco può avere sulla salute, come spesso accade nei paesi emergenti ( Jha & Chaloupka , 1999 ). I divieti di pubblicità sul tabacco sono state le prime risposte alla necessità di controllo del fumo. È stimato che il divieto di pubblicità sul tabacco in Nuova Zelanda ha ridotto il consumo del 5,5 % ( Dipartimento della Salute, 1989), in Canada del 4%, ( Department of Health , 1992 ), in Finlandia del 7% ( Pekurinen, 1989 ), e in Norvegia del 16% ( Laugesen & Meads , 1991). Uno studio dell' OCSE su 22 paesi ha riportato un effetto significativo dei diversi livelli della restrizione pubblicitaria, valutato da 1 a 10, con ciascun punto associato a una diminuzione dell’ 1,5 % del consumo ( Laugesen & Meads , 1991). In media, si stima che vietare la pubblicità riduce il fumo di circa il 7 %.
  3. 3. Altre azioni volte a migliorare l'informazione dei consumatori, compresa l'etichettatura sui pacchetti di sigarette, i divieti di fumo in luoghi pubblici e i divieti di pubblicità, spesso generano un risparmio nelle spese sanitarie che compensano gli eventuali costi di implementazione. Le etichette di avvertimento sui pacchetti di sigarette, un requisito per i paesi europei, sono raccomandate dalla Convenzione Quadro sul Controllo del Tabacco dell'OMS, e sono tra i mezzi più diretti e importanti di comunicare con i fumatori ( Hammond, 2011). La prevenzione nei luoghi pubblici ha dimostrato una riduzione del fumo. Alcuni Paesi hanno riportato la riduzione di morti da malattie cardiache seguendo una legislazione “libera dal fumo” smoke-free. Il modo più efficace di ridurre il fumo tra i giovani è quello di ridurre il fumo tra gli adulti, sia attraverso il meccanismo dell’aumento dei prezzi, sia attraverso politiche antifumo, facendo anche uso di programmi multimediali. Table 1: Tobacco Studies Description Economic Strenght impact of economic Cross-national Comments application evidence Fiscal measures (Jha &Chaloupka, 1999; Various Multiple Multiple Economic Ranson et al., 2002; increases in Efficient studies with countries with modelling and Ortegon et al., 2012; taxes on consistent different levels econometric Chisholm et al., 2006; Vos et tobacco findings of income analyses. Some al., 2010) studies suggest actions are costsaving Smoking cessation measures (Vos et al., 2010; Ranson et Cessation al., 2002; Parrott, Godfrey & Kind, 2006; Chisholm et al., Efficient Multiple Multiple Economic support studies with countries with modelling and including NRT consistent different levels econometric findings of income analyses Single study One high- Economic income country modelling Multiple Multiple Economic studies with countries with modelling and consistent different levels econometric 2006; Public Health Research Consortium, 2010) (Parrott, Godfrey & Kind, Brief GP advice 2006) Efficient plus with and without self-help advice Advertising bans (Chisholm et al.,2006; Lai et Comprehensive al., 2007) advertising ban Efficient
  4. 4. findings of income analyses Multiple Multiple Modelling used to Ratcliffe, Cairns & Platt, 1997; media studies with countries with project long-term Secker-Walker et al., 1997; consistent different levels benefits of findings of income quitting smoking. Mass media campaigns (Hurley & Matthews, 2008; Intensive mass Efficient campaigns Ha & Chisholm, 2011) Some observational studies. Some studies. Some studies costsaving Environmental measures (Chisholm et al., 2006) Clean air Efficient Single study Multiple Modelling used to countries with project long-term different levels costs and of income benefits Two studies Multiple Economic legislation Combinations of interventions (Lai et al., 2007; Ortegon et Taxation and Efficient al., 2012; Chisholm et al., clean air with countries with modelling 2006) legislation, consistent different levels analysis. tobacco findings of income Inefficient advertising ban, compared to information and taxation alone labelling, brief advice and counselling, NRT

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