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The Rising Tide of the Global Tobacco Epidemic

The Rising Tide of the Global Tobacco Epidemic. Sara Savage, MPH Program Manager UW Tobacco Studies Program. Acknowledgements. Ross Hammond, Campaign for Tobacco-Free Kids Kiyon Chung MD MPH, Cardiologist Abigail Halperin MD MPH, UW Tobacco Studies

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The Rising Tide of the Global Tobacco Epidemic

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  1. The Rising Tide of the Global Tobacco Epidemic Sara Savage, MPH Program Manager UW Tobacco Studies Program

  2. Acknowledgements Ross Hammond, Campaign for Tobacco-Free Kids Kiyon Chung MD MPH, Cardiologist Abigail Halperin MD MPH, UW Tobacco Studies WA State Dept of Health, Tobacco Prevention and Control Program

  3. Overview • Globalization and Expansion of the Tobacco Industry • Impacts on morbidity & mortality • Tobacco & Poverty • The International Response

  4. A Formidable Enemy In 2002, Philip Morris, BAT and Japan Tobacco operated in over 50 countrieseach and had combined tobacco sales of over $121 billion, a sum greater than the combined GDPs of these 27 countries: Albania, Bahrain, Belize, Bolivia, Botswana, Cambodia, Cameroon, Estonia, Georgia, Ghana, Honduras, Jamaica, Jordan, Macedonia, Malawi, Malta, Moldova, Mongolia, Namibia, Nepal, Paraguay, Senegal, Tajikistan, Togo, Uganda, Zambia and Zimbabwe

  5. “Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists.” -- WHO Zeltner Report, 2000

  6. Global Expansion Fueled By: • Opening up of trade with China, former Soviet Union, E. Europe • Increasing profit opportunities of a free market economy • Enhanced global communications & marketing

  7. “We are still in the foothills when it comes to exploring the full opportunities of many of our new markets.” -- Geoffrey Bible, Philip Morris CEO, 1996

  8. Global Expansion Through Marketing Thailand

  9. Traffic Lights in Bucharest, Romania

  10. “Give me an amerika” Czech slang for a good cigarette

  11. Sponsorship of sports & entertainment events Public relations (donations to organizations, scholarships, etc) Indirect Marketing

  12. The Coming Epidemic

  13. National Geo, ACS:2003, WHO:2002

  14. National Geo, ACS:2003, WHO:2002

  15. Global Deaths Currently: • 4.9 million people die per year • 13,400 people per day • 560 people every hour By 2030: • 10 million people a year will die from tobacco use • 70% of those deaths will occur in developing countries

  16. Tobacco-related Disease • Cancers (lung, bladder, kidney, stomach, pancreas, mouth, esophogus) • Cardiovascular Disease (heart disease, stroke, heart attack) • Respiratory Diseases (pneumonia, emphysema)

  17. Women & Tobacco • Cancer: Cervical & Breast (premenopausal women) • Low bonedensity osteoporosis & hip fractures • Secondhand smoke exposure • Maternal & child Pre-term delivery, preeclampsia, low birth weight, impaired lung function, ear infections, SIDS

  18. Tobacco and TB • Smoking increases incidence, morbidity & mortality of clinical TB • Decreases immune response • Causes structural changes in respiratory tract • India study (2003) • Ever smokers 3x more likely than never smokers to develop active TB • Smoking accounted for 50% of male TB deaths (Benowitz, Arch Int Med 2004; Gajallakshmi, Lancet 2003)

  19. Tobacco and HIV • Smoking doubled the risk of developing PCP and TB in HIV+ patients • Daily smoking reduced effectiveness of HAART (antiretroviral therapy) by 40% Miguez-Burbano et al, Addiction Biology, 2003.

  20. Deaths Due to Cardiovascular Disease vs. Infectious & Parasitic Diseases in Men age 30-69, 1990 In thousands Yusuf Circulation 2001:104:2746-2753

  21. Tobacco & Poverty 2004 Report by WHO

  22. The poor tend to smoke the most • Globally, 84% of smokers live in developing & transitional countries • High smoking rates strongly associated with less education • Study in Chennai India found 64% of illiterate smoke, while 21% of those with 12+ yrs of schooling smoke

  23. Tobacco use impoverishes individuals & families • In poorest households, 10% of household expenditures go to cigarettes. • In Bangladesh, over 10.5 million malnourished people could have an adequate diet if money spent on tobacco was instead spent on food.

  24. Tobacco Farming • Expensive inputs, low wages • Child labor = lost education opportunities • Pesticide & nicotine poisoning

  25. Tobacco Impoverishes Countries • Environmental Damage • Increased Health Care Costs • Lost productivity due to illness and premature death • Foreign exchange losses

  26. The International Response • WHO Framework Convention on Tobacco Control • Bloomberg Initiative • Bill & Melinda Gates Foundation

  27. Framework Convention on Tobacco Control (FCTC) • First international public health treaty • Countries support the treaty by ratifying • Objective: To protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke ...

  28. Key Provisions of the FCTC Enact comprehensive bans on tobacco advertising, promotion & sponsorship within 5 years of ratification

  29. Place rotating health warnings on packs that cover 30% or more of the package and can include pictures or pictograms Jordan Thailand Brazil

  30. Ban the use of misleading and deceptive terms such as "light" and "mild"

  31. Protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places

  32. Other Key Provisions • Encourage tobacco tax increases • Include cessation services in national health programs • Prohibit free distribution of tobacco • Prohibit sales to minors • Promote NGO participation • Establish & finance a national coordinating body

  33. WHO FCTC Entered into force 2/27/05 • 168 Countries Have Signed • 143 Parties (countries who have ratified) • U.S. refuses to ratify • Convention of the Parties - regulating body of the treaty

  34. Framework Convention Alliance Diverse group of over 250 NGOS from more than 100 countries working to support FCTC ratification and implementation WWW.FCTC.ORG

  35. In Conclusion The Dean of Harvard School of Public Health recently declared the control of tobacco advertising, sales, and addiction as the first of eight public health priorities that would significantly improve global health outcomes. Bloom BR. Public Health in Transition. Sci Am 2005; 293(3): 92-99

  36. To learn more… HSERV 590B Tobacco and Public Health Spring Q: Wednesdays 2-3 credits 1:00 - 2:50 pm UW Tobacco Interest Listserv tobaccointerest@u.washington.edu

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