professor judith mackay plenary session 4 - chronic disease world congress of epidemiology...
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Professor Judith MackayPlenary Session 4 - Chronic Disease
World Congress of Epidemiology Edinburgh, Scotland; 9 August 2011
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Smoking prevalence
Male
Female
Same key
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Female smoking numbers: Top 20
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Youth smoking prevalence, 2000-2007, GYTS
Boys
Girls
Same key
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Health professionals
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↑ Tobacco epidemic (~ other NCD)
Number smokers1.4 b -> 1.6 b By 2030
Smoking prevalence
Tobacco consumption
Tobacco deaths 6m->8mp.a. by 2030
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Global Cigarette Consumption, 1880-2020
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Health risks known, but always moree.g. link with TB
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Deaths caused by tobacco 2015
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Deaths caused by Secondhand smoke
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Cumulative deaths from tobacco, global, 2005-2030
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Tobacco Costs
HEALTH COSTS OTHER ECONOMIC COSTS
Medical and healthcare costsHigher sickness and absence
ratesLoss of skilled workers by
premature deathIncreased early retirement due
to ill healthSecondhand smoke risks
Time off for “smoke breaks”Lost production and lower
productivityFires caused by careless
smokingDamage to building fabric
Litter of billions of cigarettes, matches, packets, lighters
Risk of being sued
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Costs to smoker: cig v. rice
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Lack of awareness of risk factorsPreoccupation with other diseasesTobacco may not yet cause many deathsFocus on curative medicine, not preventionSmoking, alcohol, diet seen as personal behaviourTobacco industry: promotion, distortion of health and
economic evidence, financial might, challenge/threats to governments other industries not far behind
Tobacco tax revenue (but not debit) seenMisperceived economic costsLack of funds for research and intervention
Obstacles to Tobacco Control
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HK resident smoking through SARS mask
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The tobacco industry: Not changed its spots…
Acknowledgement to http://www.wildlife-pictures-online.com/leopard-pictures-1.html
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Neo-libertarian groups – now gone global“Nanny state” “Less government” “Personal freedom”
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Medical Model Not Enough
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Tobacco Control:
WHO FCTC
WHO FCTC into effect 2005 Parties ratified: 174/ 192
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Tobacco Control:
FCTC Main Provisions
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Tobacco Control:
Ban Tobacco Promotion
People’s Republic of China
Las Palmas
Philippines
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Tobacco Control:
Smoke-Free Laws
Hong Kong RestaurantTax Receipts
Before ban and2 years later:
31%
Example: Hong Kong
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Tobacco Control:
Pack WarningsExample: Hong Kong 27 Oct 2006: Smoking (Public Health) Ordinance 2006 in effect 6 pictorial health warnings – all cigarettes to display 50% health
warning messages in both Chinese & English
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Tobacco Control:
Media Campaigns
worldlungfoundation.org/mmr
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For Smoker:Quitting Works
Tobacco Control:
Quitting Reduces NCD Risk
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Tobacco Control:
Raising TaxesKey Economic Messages
Tobacco is debit to the economy
Tobacco control is cost-effective
Price increases most effective
tobacco tax does not govt revenue
tobacco tax does not smuggling
tax on other NCD risk factors (e.g. alcohol, certain foods); tax on vegetables??
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Tobacco Control:
Raising Taxes, consumption
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Tobacco Control:
Raising Taxes: revenues up
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Tobacco Control:
Earmarked Tax for Health
Example: Thailand 2% of tobacco and alcohol tax
used for health promotion
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And now: Major private donorsMichael
Bloomberg
Bill Gates
But funding from governmentscompletely inadequate…
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NCDs: 60% Global DeathsNCD Modifiable Causative Risk Factors
Tobacco Use Unhealthy Diet
Physical Inactivity
Harmful Use of Alcohol
Heart Disease& Stroke √ √ √ √
Diabetes √ √ √ √
Cancer √ √ √ √
Chronic Lung Disease
√
Source: WHO, 2010
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Deaths fromCardiovascular Disease
Coronary heart disease
Stroke
* Different keys
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Cancer: Major Risk Factors
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7.9
13.0
19.0
82.0
7.1
85.067.0
17.0% total
Cancer Registries% of the population covered by cancer
registration
IARC, 2011
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Physicians Working in NCD
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C21 Epidemics:
New Paradigm Needed1. International law/ treaties for
public health• WHO support• Sound science/research• Comprehensive policies,
common risk factors• Enforcement after legislation
2. Crucial role of government and political will
3. Extraordinary reach of NCD issues, from corporate criminality to poverty alleviation new partners
• Key NGOs and individuals, coalitions
4. Political mapping of obstacles,esp. misperceived economic concerns, tactics of vested industries
• Effective advocacy targeting decision makers to the public
• The role of media
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Source: WHO, 2010
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UN Summit on NCDs 19-20 Sep 2011
28 such meetings at UN sinceend-WWII only 1 on health (AIDS)
This one: 135 co-sponsoring countries and unanimous approval
Outcome Document is critical
Call for addition of all NCDs into next round of UN MDGs in 2015
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Public health come of age
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