Dr Dongbo Fu

The Global Tobacco Epidemic and WHO Tobacco Control Policies

09/14/2011

Outline

• The Global Tobacco Epidemic

• Mechanisms for tobacco control

• The role of treatment of tobacco dependence in reversing the global tobacco epidemic

• WHO strategies and activities to promote greater access to treatment of tobacco dependence

The tobacco epidemic- Today

Tobacco currently kills more than 5 million/year

Source: the WHO Report on the Global Tobacco Epidemic, 2008

Smokers are not the only ones sickened and killed by tobacco• Globally, one third of adults are regularly

exposed to second-hand smoke• More than 600 000 people die each year

prematurely from exposure to second-hand smoke.– Of the 600 000 deaths, 430 000 are among

adults, of whom 64% are women– 28% of the second-hand smoke deaths are

among children.

Source: Oberg M et al. The Lancet. 2011; 377:139-146.

Cigarettes

The tobacco epidemic is about to get much worse……

• Unless we act, the epidemic could kill over 8 million per year in a few decades

• If current smoking patterns continue, the death toll from tobacco use will be:

2000 – 2025 ~ 150 M2025 – 2050 ~ 300M2050 – 2100 > 500M

TOTAL for 21st Century 1 billion (half the deaths in middle age)

Source: Peto, WHA 2008

Tobacco use is growing fastest in developing countries

Source: the WHO Report on the Global Tobacco Epidemic, 2008

80% of the tobacco-related deaths will occur in developing countries

Source: the WHO Report on the Global Tobacco Epidemic, 2008

Mechanisms for Tobacco Control• WHO Framework Convention on

Tobacco Control (WHO FCTC)- Foundation stone in the global fight

against the tobacco epidemic

• MPOWER - A technical assistance package of

six cost-effective tobacco control policies to help countries implement the demand reduction measures of the WHO FCTC

WHO FCTC - A Landmark in Public Health

• First global health treaty negotiated under auspices of WHO – adopted in 2003, entered into force on 27 Feb 2005

• 174 parties, covering about 90% of the world population

Core provisions in the WHO FCTCAt the population level:• Price and tax measures to reduce the demand for

tobacco (Article 6) and smuggling control (Article 15)• Protection from exposure to tobacco smoke (Article 8)• Packaging and labeling of tobacco products (Article

11,12)• Ban of tobacco advertising, promotion and sponsorship

(Article 13)• Monitoring and evaluation (Articles 20, 21)At the individual level:• Tobacco dependence reduction and cessation

(Article 14)– Guidelines for implementation of Article 14 was adopted by

the Conference of Parties at its fourth session to assist Parties in meeting their obligations under Article 14 of the WHO FCTC

MPOWER: Six interventions to reverse the tobacco epidemic

MPOWER: Six interventions to reverse the tobacco epidemic

P:-cut absolute smoking prevalence by 4% -reduce tobacco consumption by 29%O:-brief advice from physician increases the

quit rate by 66% -quit line increases the quit rate by 41% W: pictorial warning makes 44-67% of

smokers want to quit; 28% of smokers reduce consumption

E: reduce tobacco consumption by up to 16%

R: increasing tobacco taxes by 10% will decrease tobacco consumption by 4%-8%

Source:1. the WHO Report on the Global Tobacco Epidemic, 2008; 2.Cochrane Reviews

Article 6, 15 Article 8

Article 20, 21Article 13

r p w

e o mArticle 14

Article 11, 12

MPOWER: a resource for the implementation of the WHO FCTC

MPOWER: a resource for the implementation of the WHO FCTC

WHO's vision on treatment of tobacco dependence

• Only a comprehensive tobacco control strategy can reverse the global tobacco epidemic

• Treatment of tobacco dependence should be a key component of this comprehensive tobacco control strategy, which will reinforce other tobacco control policies and maximize their impact

• The US had a US$ 0.62 increase in federal cigarette tax in spring 2009

• The impact of the tax increase on calls to US quitlines was significant

Example: why TTD should be implemented synergistically with other tobacco control measures

The potential of tobacco cessation to save lives globally

• If adult consumption were to decrease by 50% by the year 2020, approximately 180 million tobacco-related deaths could be avoided

Source: Jha, Prabhat et al. Curbing the epidemic: governments and the economics of tobacco control. World Bank. Washington DC. 1999

WHO recommendationsThree types of treatment should be

included in any tobacco prevention effort

• Tobacco cessation advice incorporated into primary health-care services (feasible, effective and efficient)

• Easily accessible and free quit lines

• Access to free or low-cost cessation medicines.

– Based on the WHO Health System Framework

– Targets three key actors in a health system

– Focuses on taking the existing entry points in PHC settings

WHO activities to support the integration of brief tobacco advice into PHC services• Developed training package on strengthening

PHC systems to improve the delivery of tobacco dependence treatment

The outline of the training packageThe complete training package

consists of three parts:1. Trainer's manual and trainee's workbook

for training policy makers;2. Trainer's manual and trainee's workbook

for training health service managers;3. Trainer's manual and trainee's workbook

for training health care providers to deliver brief tobacco interventions

The package has been piloted in six countries

• In 2009, WHO/TFI had a successful application, which led to two forms of nicotine replacement therapy (nicotine gum and nicotine patch) having been placed on the 16th WHO Model List of Essential Medicines

WHO activities to improve access to cessation medicines

WHO activities to promote national toll-free quit line services

• In collaboration with Alere Wellbeing (formerly Free & Clear Inc.), WHO developed a manual on establishing and improving national toll-free tobacco quit line services

We need to redouble our efforts!

Source: the WHO Report on the Global Tobacco Epidemic, 2011

• Currently, 19 countries provide access to comprehensive help to quit smoking

• 56 countries have toll-free quit lines

Thank You