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Smoking: What Gulf Heart and Saudi Heart Must Do?

Dr. K. Srinath Reddy President, Public Health Foundation of India President, World Heart Foundation Bernard Lown Professor of Cardiovascular Health Harvard School of Public Health


Tobacco Use in Gulf Countries


Burden of Tobacco Epidemic

Source: a WHO global report, Noncommunicable diseases country profiles 2011 b The Tobacco Atlas, Fourth Edition, 2012, www. tobaccoatlas.org


Prevalence of Tobacco Smoking Among Adults

-

Data Not Available

Source: The Tobacco Atlas, Fourth Edition, 2012 www. tobaccoatlas.org


Age and Sex Standardized Adult Daily Smoking Prevalence (2009)

Source: WHO Report on the Global Tobacco Epidemic, 2011, http://www.who.int/tobacco/global_report/2011/en/index.html


Prevalence of Tobacco Use Global Youth Tobacco Survey (Age 13-15 years)

Source: Centers for Disease Control and Prevention, GTSS Data, http://apps.nccd.cdc.gov/gtssdata/Ancillary/DataReports.aspx?CAID=3


Framework Convention on Tobacco Control (FCTC)

* Accession (a) Source: Parties to the WHO Framework Convention on Tobacco Control http://www.who.int/fctc/signatories_parties/en/index.html


WHO MPOWER Strategy  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


Protect people from tobacco smoke Various venue types covered by 100% smoke-free policies in countries

Source: WHO Report on the Global Tobacco Epidemic, 2011 ď‚— Bahrain, Oman, Saudi Arabia and the United Arab Emirates have implemented

restrictions on tobacco use in enclosed places through ministerial decrees. However, designated smoking areas are allowed.


Protect people from tobacco smoke Status of smoke-free legislation and compliance

Source: WHO Report on the Global Tobacco Epidemic, 2009


Enforce bans on tobacco advertising, promotion and sponsorship

- Data not available

Source: WHO Report on the Global Tobacco Epidemic, 2011


Warn about the dangers of tobacco  The 1994 Gulf Cooperation Council (GCC) standard required text-only bilingual (Arabic and     

English) warnings on the package front only Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates are members of GCC and Yemen is a member of GCC Standardization Organization August 9, 2011- GCC adopted a standard, Labelling of Tobacco Product Packages. Picture Based health warning to cover 50% of the package front and back, with an Arabic warning on the front and an English warning on the back. The graphic warnings are mandatory on cigarette packages starting August 9, 2012 The new standard also specifically ban misleading terms including "light", "mild", "low tar", "extra light", "low"

Current Warnings on Tobacco Products Source: Health Warning Images, Tobacco Labelling Resource Centre, http://www.tobaccolabels.ca/healthwarningimages


Offer help to quit tobacco use Status of cessation programmes

The Dubai Health Authority (DHA) in collaboration with GlaxoSmithKline started a 24-hour toll-free number to guide smokers on quitting smoking. Source: http://www.dha.gov.ae/EN/Media/News/Pages/DHAlaunches%E2%80%98quitsmoking%E2%80%99hotline.aspx


Adopting Global Best Practices


Warn about the dangers of tobacco Uruguay mandates pictorial warning labels that cover most of the package, in line with WHO FCTC requirements In 2009, the size of warning labels was increased to 80% of primary pack

surface areas. Results from the Global Adult Tobacco Survey show that nearly half of Uruguay’s smokers are considering quitting because of these enhanced health warnings. Source: WHO Report on the Global Tobacco Epidemic, 2011


Warn about the dangers of tobacco Plain Packaging of Tobacco Products -Innovative new intervention ď‚— On August 15, 2012, through a landmark ruling by its High

Court, Australia became the first country to introduce mandatory plain packing for all tobacco products from December 1, 2012. ď‚— The Australia India Institute Taskforce on Tobacco Control

has been established to determine whether plain packaging legislation for all types of tobacco products is a viable tobacco control measure in India and to learn from Australian experiences.


Enforce bans on tobacco advertising Recommendations Article 13 of WHO FCTC- Tobacco advertising, promotion and sponsorship

Impose a total prohibition on any kind of direct and indirect TAPS including Direct advertising bans National television and radio Local magazines and newspapers Billboards and outdoor advertising Point of sale Indirect advertising bans Free distribution of tobacco products in the mail or through other means Promotional discounts Non-tobacco goods and services identified with tobacco brand names (brand extension) Brand names of non-tobacco products used for tobacco products; Appearance of tobacco products in television and/ or films  Sponsored events


Enforce bans on tobacco advertising

Global Actions on TAPS  United Kingdom restricted internet advertising and promotion of all tobacco products  Sri Lanka completely prohibited Corporate Social Responsibility activities by tobacco

industries  Myanmar banned tobacco advertising on Satellite TV  Thailand prohibited display and promotion of tobacco products at point of sale


Other Global Actions in Tobacco Control  Aiming for the end of tobacco the WHO, while proposing targets for reducing NCD

burden, proposes a 30% reduction in tobacco use globally by 2025 

Countries like Finland and Norway propose to become tobacco-free within next three decades

Singapore and Tasmania have proposed to restrict sale of tobacco products to individuals born after the year 2000

 Bhutan totally bans manufacture and sale of tobacco


Role of Cardiac Societies and Heart Foundations

Associations

Settings

Professionals

Tobacco Free Norms

Direct

Patients

Effective Counseling

Media

Other Contact

Public

Policy Makers

Impactful Education

Persuasive Advocacy


Interventions for Tobacco control

 Policy Level (Environment)  Community Level (Norms)  Cessation Related (Behaviour change)


Cumulative deaths (millions)

Premature Deaths From Tobacco Use, Projections For 2000-2024 And 2025-2049 300

140

250 200 150 100 50

30 116

140

2000-2024

2025-2049

0

Preventable if adults quit (halving global cigarette consumption by 2020) Preventable if young adults do not start (halving global uptake of smoking by 2020) Other premature deaths from tobaccorelated causes

Years Source: World Health Report, 1999


CESSATION  PHC Model for Cessation o o

Health services Social Networks

Individual Factors  Youth Cessation Programmes o Identification of key elements (content; settings; providers) Services Available /Needed (Situational Analysis) o Evaluation of Interventions  Cessation Strategies for smokeless tobacco products- do they need to be different? o


CESSATION  Which gender specific cessation strategies are

effective in women?  What interventions are required to counter industry actions which hinder cessation?  Which interventions, directed at health professionals, will improve their knowledge, motivation and skills for promoting cessation?  Economic evaluation of interventions


Tobacco Cessation in Primary Health Care  Involve All Categories of Health Care Providers  Integrate Into All Existing Health Programmes  ‘Opportunistic Screening’ to minimize Missed Opportunities  Institutionalize Cessation Services - Facility Based - Community Based


Targeted Programs  Worksite Based

- Onsite Facilities For: Education; Counseling; Other Therapies, Referral  Youth Focused

- At locations of Easy Youth Access; IT enabled Counseling Services


Tobacco Cessation Services are Complemenatry to Smoke Free Policies • Smokers motivated to quit by strict implementation of

smoke free policies

• Smoke free policies can be more effectively enforced if

smokers are supported by cessation services


Tobacco Taxes Can Support Cessation Services • Tobacco Taxes can promote cessation through price

mechanism • Tax Revenues can be used to fund cessation services

(Treatment of Tobacco Dependence)


Barriers to Overcome


Community Interventions  Review of socio-cultural norms and practices related to tobacco use  Identifying tobacco industry tactics that encourage initiation and

devising strategies to counter them through community mobilization  Review of accumulated experience on tobacco control to identify the

factors preventing initiation.  Identifying active ingredients, including context specific

modification to guide interventions  Identifying evaluative methods appropriate for studying these

interventions.


Research to Enable Policy and Programmes


Policy  FCTC Implementation: Identifying the barriers at country

level  Enforcement of legislation: Identifying weaknesses and

methods for strengthening (eg., Ad Bans, Health Warnings, Product Regulation)  Policy research for smoke-free environments  Economics of Tobacco control: Macroeconomic effects

modeled at different levels of control


POLICY ď‚— Research on role enhancement for NGOs (civil society) in tobacco

control (as partners, as independent agents) ď‚— Level of participation and performance of health care systems in

tobacco control programmes (eg. adherence of health care personnel to guidelines on counseling and cessation)


‘1st International Conference on Public Health in the 21st Century: The End-Game for Tobacco’


SHA24/067002