Preventive Interventions: The cost-effective “Best-Buys”

2,297 views

Published on

- Global advances in Tobacco Control -

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,297
On SlideShare
0
From Embeds
0
Number of Embeds
202
Actions
Shares
0
Downloads
59
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • In the age group 30 to 69 (= 14.2 million people who die from NCDs):14% die in high-income countries16% die in upper-middle income countries59% die in lower-middle income countries11% die in low-income countries
  • Huge disparities exist across countries in relation to the probability of death from an NCD between the ages of 30-70.Japan10%San Marino10%Switzerland10%Iceland10%Australia11%Italy11%Cyprus11%Andorra11%Israel11%Sweden11%USA 15%World average22%Swaziland35%Kyrgyzstan35%Cote d'Ivoire35%Malawi36%Afghanistan38%Kazakhstan38%Tuvalu39%Turkmenistan41%Nauru47%Marshall Islands60%
  • All figures are current smoking for total adults.Turkey: GATS 2012, GATS 2008, World Health Survey 2003Uruguay: GATS 2009, STEPS 2006, World Health Survey 2003Australia: National Drug Strategy Household Survey 2010, 2007 and 2004
  • Plain packaging is a highly effective way to counter industry’s ruthless marketing tactics. It is also fully in line with the WHO Framework Convention on Tobacco Control. …what we hope to see is a domino effect for the good of public health.The evidence on the positive health impact of plain packaging compiled by Australia’s High Court will benefit other countries in their efforts to develop and implement strong tobacco control measures to protect the health of their people and to stand resolute against the advances of the tobacco industry.Picture taken without permission from http://www.guardian.co.uk/business/2012/aug/15/tobacco-plain-packaging-australia-court
  • DECIDED to adopt a global target of a 25% reduction in premature mortality from NCDs by 2025EXPRESSED strong support for additional work aimed at reaching consensus on targets relating to the four main risk factors, namely tobacco use, harmful use of alcohol, unhealthy diet, and physical inactivityDECIDED to note wide support expressed by Member States and other stakeholders around global voluntary targets considered so far including those relating to raised blood pressure, tobacco, salt/sodium and physical inactivityFURTHER noted that consultations to date, including discussions during the Sixty-fifth World Health Assembly, indicated support from among Member States development of targets relating to obesity, fat intake, alcohol, cholesterol and health system responses such as availability of essential medicines for noncommunicable diseasesNOTED that other targets or indicators may emerge in the remainder of the process established by resolution EB130.R7
  • Preventive Interventions: The cost-effective “Best-Buys”

    1. 1. Preventive Interventions: The cost-effective “Best-Buys” - Global advances in Tobacco Control - Riyadh, 10 -12 September 2012 Douglas Bettcher, MD, PhD, MPH Director, Tobacco Free InitiativeDirector Ad Interim, Chronic Diseases and Health Promotion
    2. 2. WHY TOBACCO CONTROLPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    3. 3. Tobacco and the NCD action plan:4 risk factors, 4 noncommunicable diseases, 2 conditions Cancer Chronic respiratory Diabetes diseasesNoncommunicable Cardiovascular Mental disordersDiseases and disease InjuriesConditions PhysicalRisk factors inactivity Harmful use of alcohol Unhealthy Tobacco diets Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    4. 4. 86% of people who die from NCDs between the ages of 30 and 70 live in a developing country Low-income High-income countries countries 1.5 million 2.0 million (11%) (14%) Upper middle- income countries 2.3 million (16%) Lower middle- income countries 8.3 million (59%) Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    5. 5. Huge disparities exist across countries in relation to the probability of death from an NCD between the ages of 30-70Preventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    6. 6. The Tobacco Epidemic - Today Source: WHO 2008Preventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    7. 7. Tobacco kills… Tobacco kills ... About 90% of all 22% of global deaths from …nearly cancer chronic 6 million deaths, 71% obstructive lung of all lung diseases and 42% people cancer of all chronic respiratory each deaths. disease are attributable to year. • 10% of cardiovascular disease deaths cigarette smoking. Source: WHO Global status report on noncommunicable diseases, 2010, http://www.who.int/nmh/publications/ncd_report2010 /en/Preventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    8. 8. Exposure to second-hand smoke also kills Distribution ofOne third of adults are regularly total deaths attributable toexposed to second-hand tobacco SHS, 2004smoke.About 600 000 people die each yearas a result of exposure to second-hand smoke.• 430 000 are adults, of whom 64% are women• 28% of the second-hand smoke deaths are among children Source: Global estimate of the burden of disease Mattias Oberg … [et al], WHO 2010, http://www.who.int/tobacco/publications/second_hand/global_estimate_burden_disease/en/index.html . Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    9. 9. The Tobacco Epidemic is About to Get Much Worse… Tobacco could kill up to If current 1 Billion smoking patterns persons in the Tobacco continue, the 21st Century currently kills death toll from unless urgent nearly 6 tobacco use will action is taken Million/year but be: this will increase • 2000–2025~150M to over 8 • 2025 – 2050 ~ 300 M • 2050 – 2100 > 500 M Million/year in a few decades.Preventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    10. 10. THE SOCIO-ECONOMIC IMPACTPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    11. 11. New perspectives The poorest people in developing countries are affected the most: Example: Poorest people smoke the most 45 Smoking prevalence (2004) Lowest household 40 income quintiles 35 30(percentage) 25 Highest household income quintiles 20 15 10 5 0 Low-income Lower-middle Upper-middle- High-income countries Income income Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    12. 12. OPPORTUNITIES AND GLOBAL RESPONSEPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    13. 13. Mechanisms for Tobacco Control WHO Framework Convention on Tobacco Control (WHO FCTC)Preventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    14. 14. WHO Framework Convention on Tobacco Control:An evidence-based tool to save lives Objective: “To protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke … to reduce continually and substantially the prevalence of tobacco use and World No Tobacco Day Poster 2011 exposure to tobacco smoke.”Preventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    15. 15. What is the WHO FCTC? First global health treaty negotiated 176 under the auspices of WHO 176  Establishes tobacco control as a priority on the public health agenda  Provides a political and legal platform Parties for adoption of sound, evidence based tobacco control measures  Introduces a mechanism for firm country commitment and accountability Entry into force 27 Feb 2005 176 parties covering about 87% of the world’s population Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    16. 16. Demand reduction Supply reduction provisions provisions Price and tax measures (Art.6)  Elimination of illicit trade (Art.15) Protection from secondhand smoke  Prohibition of sales to and by minors (Art.8) (Art.16) Contents regulation (Art.9)  Support for viable crops for growers Disclosure of contents (Art.10) (Art.17) Packaging and labelling (Art.11) Education and awareness-raising (Art.12) Advertising, promotion and sponsorship (Art.13) Cessation programmes (Art.14)Preventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    17. 17. BEST BUYS AND GOOD BUYSPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    18. 18. Rationale – Why "best buys" for NCDs? Consequent need to develop: NCD "best buy" interventions that are cost- effective, feasible, low-cost Public health and Cost-effectiveness – and appropriate to economic burden – show indicates solutions but not implement within thethe size of the problem, but their constraints of the local not how to address and feasibility, affordability and health system reduce it acceptability Financial planning tool for identifying resource needs Price tag analysis to inform global resource mobilisation Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    19. 19. The cost of action vs inaction (in developing countries over the next fifteen years) Cost of action: Cost of inaction: US$ 170B US$ 7T is the overall cost for all developing countries is the cumulative to scale up action lost output in by implementing a set of developing countries "best buy" interventions associated with NCDs between 2011 and 2025, between 2011-2025 identified as priority action by WHO Reports are available at www.who.int/ncdPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    20. 20. MPOWER: Six policies whichbuild on the WHO FCTCand are an integral part of theNCD Global Strategy Action Plan 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 Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    21. 21. Tobacco control is cost-effectiveUS$0.6 billion for all low- and middle-incomecountries (US$0.11 per capita) Monitor tobacco use and prevention BEST BUYS Protect people from tobacco smoke & Offer help to quit tobacco use Warn about the dangers of tobacco GOOD BUYS Enforce bans on tobacco advertising Raise taxes on tobaccoPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    22. 22. Tobacco control is cost-effective 5·5 million deaths could be averted over 10 years if these elements of the WHO FCTC were implemented in countries: • increased taxes on tobacco products; • enforcement of smoke-free workplaces; • WHO FCTC-compliant packaging and labelling, with public awareness campaigns about health risks; • comprehensive ban on tobacco advertising, promotion, and sponsorship. at a cost of less than US$ 0.40 per person in low income and lower-middle income countriesPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    23. 23. Estimates for the average annual cost of tobacco control best buy interventions in all low- and middle-income countries (US$ 2008) P R W E W A study that modelled P, W, E, R for 23 countries5.5 million deaths could be averted at less than US$ 0.40/person /year in low- and lower-middle- income countries, and US$ 0.5–1.00 in upper-middle-income countries. Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    24. 24. Status of MPOWER measures Number of highest achieving countries in 2010 59 23M 31 19 19P 19 27OWER Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    25. 25. Progress is being made 3.8 billion people (55% of the world’s population) are covered by at least one MPOWER measure at the highest level of achievement, including 1.1 billion peopleM covered by a new policyP since 2008OWER Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    26. 26. MPOWER measures bring smoking rates down rapidlyPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    27. 27. EMRO – countries with MPOWER measures at the highest level of achievement M Djibouti, Iran, Jordan, Lebanon, Morocco P Iran, Libya, Pakistan O Bahrain, Iran, Saudi Arabia, United Arab Emirates W – labels: Djibouti, Egypt, Iran W – campaigns: Egypt, Lebanon, Morocco E Djibouti, Iran, Jordan, Kuwait, Qatar, Sudan, Syria, UAE R West Bank and Gaza StripPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    28. 28. Iran implements strong pack warning labels The Islamic Republic of Iran enacted a comprehensive tobacco control law in 2006. In 2008, the law was strengthened to require pictorial warnings on all cigarette packages. Warning labels cover 50% of the pack and include graphic images of diseases caused by smoking. Use of misleading terms, such as “mild” and “light” are also banned. As a result, Iran’s requirements fully meet the WHO FCTC Article 11 guidelines and thus effectively warn smokers about the risks to their health. Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    29. 29. Jordan strengthens prohibitions on tobaccoadvertising, promotion and sponsorship Tobacco advertising and marketing had in theory been banned in Jordan since 1977, but the enforcement was weak. The 2008 legislation clarified and strengthened the law and added new provisions to limit point-of-sale tobacco marketing, including bans on the sale of individual cigarettes and sales through vending machines. To strengthen enforcement, the Ministry of Health trained 35 health promotion coordinators on practical and suitable methods for enforcing and implementing the law and on procedures for inspections. This successful model for enforcing advertising and marketing bans is ready to be expanded to the rest of the region. Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    30. 30. Egypt restructures and increases tobacco excise taxes andearmarks additional revenues to fund health programmesIn 2010, Egypt replaced its tiered tax system with a uniformly applied 40% ad valorem excisetax as well as a single specific tax rate of Egyptian £ 1.25 (USD 0.20) per pack of cigarettes.Total taxes per pack by an average of 87%, which increased the average retail price by anestimated 44%. This increase on cigarettes could reduce cigarette consumption by 21% andsmoking prevalence by more than 10%, and hence reduce the number of adult smokers byabout 893 000 and prevent about 208 000 premature deaths. Egypt’s approach to reaching the dualgoals of reduced tobacco consumption and increased resources to spend on health can provide invaluable lessons for other countries. Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    31. 31. Plain packaging initiative takes off Australia’s High Court dismissed a legal challenge from the tobacco industry. From December 2012, Australia will be the first country to sell cigarettes only in drab, olive-green plain packaging.Preventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    32. 32. UN High-level Meeting on NCDs (New York, 19-20 September 2011)LANDMARK EVENT ATTENDED BY:113 Member States34 Presidents and Prime-Ministers54 Vice-Presidents, Deputy Prime-Ministers,Ministers of Foreign Affairs and Health11 Heads of UN AgenciesHundreds of representatives from civil society Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    33. 33. The UN POLITICAL DECLARATION ON NCDsWe, Heads of State and Government and representatives of States and Governments,assembled at the United Nations from 19 to 20 September 2011, to address theprevention and control of non-communicable diseases worldwide, with a particularfocus on developmental and other challenges and social and economic impacts,particularly for developing countries,38. Recognize the fundamental conflict of interest between the tobacco industry and public health;43.(c) We therefore commit to: Accelerate implementation by States parties of the WHO Framework Convention on Tobacco ControlPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    34. 34. The UN POLITICAL DECLARATION ON NCDs commits Member States Advance the implementation of multisectoral, cost-effective population-wide interventions in order to reduce the impact of the common NCD risk factors Tobacco use Unhealthy Diet Physical Inactivity Harmful Use of Alcohol Interventions: Population- or individual- based measures (best-buys) that are very cost-effective, feasible and low-costPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    35. 35. 11 voluntary global targets presented in the revised WHO Discussion Paper Premature mortality from NCDs 25% reduction Raised blood Salt/ pressure Tobacco smoking Physical inactivity sodium intake 25% 30% 10% 30% Generic Drug therapy RaisedObesity Fat intake Alcohol medicines and and cholesterol technologies counselling 0% 15% 10% 20% 80% 50% Target adopted by the World Health AssemblyPreventive interventions: the cost-effective “best-buys”| Targets with wide supportRiyadh| 10-12 September, 2012 Targets with support for further development
    36. 36. Tobacco Industry - A Mutating Vector Epidemiological models - Tobacco use & Malaria infectionPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012
    37. 37. WHO FCTC ARTICLE 5.3 In setting and implementing their public health policies with respect to tobaccocontrol, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law. Forms of Tobacco Industry InterferenceManoeuvering Exaggerating Manipulating Fabricating Discrediting Intimidatingto hijack the the economic public opinion support proven governmentspolitical and importance of to gain the through front science with litigation legislative the industry appearance of groups or the threat process respectability of litigation Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    38. 38. "We have evidence, and we have instruments" Dr Margaret Chan, Director-General of the World Health Organization Keynote address at the 15th World Conference on Tobacco or Health, Singapore, 20 March 2012 "As a tool for fighting back, we "And we have an enemy, […] the have the WHO FCTC. We have a tobacco industry, has changed its face practical, cost-effective way to and its tactics. Tactics aimed at scale up implementation of undermining anti-tobacco provisions in the treaty on the campaigns, and subverting the WHO ground. […] the best-buy and FCTC, are no longer covert or cloaked good-buy measures for by an image of corporate social reducing tobacco use set out in responsibility. They are out in the open the MPOWER package." and they are extremely aggressive" "[…] full implementation of the "I called on heads of state and WHO FCTC would deliver the government to stand rock-hardsingle biggest preventive blow to against the despicable efforts of heart disease, cancer, diabetes, the tobacco industry to subvert and respiratory disease." this treaty." Preventive interventions: the cost-effective “best-buys”| Riyadh| 10-12 September, 2012
    39. 39. TOBACCO FREE INITIATIVE TOWARDS A TOBACCO FREE WORLDPreventive interventions: the cost-effective “best-buys”|Riyadh| 10-12 September, 2012

    ×