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’