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

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
• WA State Dept of Health, Tobacco Prevention
and Control Program
Overview
• Globalization and Expansion of the
Tobacco Industry
• Impacts on morbidity
& mortality
• Tobacco & Poverty
• The International Response
A Formidable Enemy
In 2002, Philip Morris, BAT and Japan
Tobacco operated in over 50 countries each
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
“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
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
“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
Global Expansion Through Marketing
Thailand
Traffic Lights in Bucharest, Romania
“Give me an amerika”
Czech slang for a good cigarette
Indirect Marketing
• Sponsorship of
sports &
entertainment
events
• Public relations
(donations to
organizations,
scholarships, etc)
The Coming Epidemic
National Geo, ACS:2003, WHO:2002
National Geo, ACS:2003, WHO:2002
Global Deaths
8
10
7
millions of 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
6
5
4
4.9
3
2
1
0
2000
2030
Developed Countries
Developing Countries
Tobacco-related Disease
• Cancers
(lung, bladder, kidney, stomach,
pancreas, mouth, esophogus)
• Cardiovascular Disease
(heart disease, stroke, heart attack)
• Respiratory Diseases
(pneumonia, emphysema)
Women & Tobacco
• Cancer: Cervical & Breast
(premenopausal women)
• Low bone density
osteoporosis & hip fractures
• Secondhand smoke exposure
• Maternal & child
Pre-term delivery, preeclampsia, low
birth weight, impaired lung function,
ear infections, SIDS
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)
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.
Deaths Due to Cardiovascular Disease vs.
Infectious & Parasitic Diseases
in Men age 30-69, 1990
700
In thousands
600
500
400
CVD
IPD
300
200
100
0
EME
FSE
India
China
OAI
SSA
LAC
MEC
Yusuf Circulation 2001:104:2746-2753
Tobacco & Poverty
2004 Report by WHO
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
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.
Tobacco Farming
Expensive inputs, low wages
Child labor = lost education
opportunities
Pesticide & nicotine poisoning
Tobacco Impoverishes Countries
Environmental Damage
Increased Health Care Costs
Lost productivity due to
illness and premature death
Foreign exchange losses
The International Response
WHO Framework Convention on
Tobacco Control
Bloomberg Initiative
Bill & Melinda Gates
Foundation
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 ...
Key Provisions of the FCTC
Enact comprehensive bans on tobacco
advertising, promotion & sponsorship
within 5 years of ratification
Place rotating health warnings on packs that
cover 30% or more of the package and can
include pictures or pictograms
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
Thailand
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TIFF (U ncompressed) decompressor
are needed to see this picture.
Jordan
Brazil
Ban the use of misleading and deceptive
terms such as "light" and "mild"
Protect citizens from exposure to tobacco
smoke in workplaces, public transport and
indoor public places
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
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
Framework Convention Alliance
Diverse group of over 250 NGOS
from more than 100 countries
working to support FCTC
ratification and implementation
WWW.FCTC.ORG
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
To learn more…
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Tobacco and Public Health
Spring Q: Wednesdays
2-3 credits
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UW Tobacco Interest Listserv
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