Advocating Policies for Waterpipe & Cigarettes

Cynthia CallardOctober 2013

Adult per capita cigarette consumption, the United States, 1900–2006.

Warner K E , Mendez D Nicotine Tob Res 2010;12:876-887

Since 1962: A steady decline!!

USA annual adult per capita cigarette

consumption

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800

After 50 years, we’re back where started

Sources: Averaged values, Maxwell, Euromonitor, USDA: population over 15 years from World Bank.

Global annual adult (15+) per capita cigarette consumption

1960 = 1,129

1987 = 1,537 2010 =

1,141

A shifting epidemic

*new communities*new patterns of use

So many similarities

Health Rationale Political systems Legal structures

(FCTC and related regulation) Societies Public health community Tobacco users

Same vector?

Same proven tools available Warnings Youth Access Tax/Prices Advertising bans Smoke-free spaces

Flavour bans Mass media Public education Clinical practice

Yet so many aren’t used *

Warnings Youth Access Tax/Prices Advertising bans Smoke-free spaces

Flavour bans Mass media Public education Clinical practice

*(Canada)

Different outcomesCigarette use & exposure go down

2002

2003

2

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

5

10

15

20

2521 21 20 19 19 19 18 18 17 17 1616

1412

9 97 6 5 4 4 3

Smoking prevalence Children exposed at homeEver used waterpipe

CTUMS

Different outcomesWaterpipe trials increase

2002

2003

2

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

5

10

15

20

2521 21 20 19 19 19 18 18 17 17 1616

1412

9 97 6 5 4 4 34

8

12

Smoking prevalence Children exposed at homeEver used waterpipe

Fla-vour ban

CTUMS

Victory or Defeat?

? ?

Brazil: RESOLUTION - RDC Nº 14, OF MARCH 15, 2012

Additive ban covers all tobacco products. “Art. 2 This Resolution

applies to all tobacco products sold in Brazil, whether made in Brazil or imported.”

BUT Currently challenged at Supreme Court.

http://www.tobaccocontrollaws.org/files/live/Brazil/Brazil%20-%20RDC%20No.%2014_2012.pdf

European Union Tobacco Directiveoriginal Considering the

Directive's focus on young people, tobacco products other than cigarettes, roll-your-own tobacco and smokeless tobacco which are mainly consumed by older consumers, should be granted an exemption from …

http://www.tobaccocontrollaws.org/files/live/Brazil/Brazil%20-%20RDC%20No.%2014_2012.pdf

European Union Tobacco Directiveas amended by EP. Considering the

Directive's focus on young people, tobacco products other than cigarettes, roll-your-own tobacco and water-pipe tobacco which are mainly consumed by older consumers, should be granted an exemption from …

http://www.europarl.europa.eu/sides/getDoc.do?type=TA&reference=P7-TA-2013-0398&language=EN&ring=A7-2013-0276

LOBBYIN

G

Same

UNITY

Widespread TC consensus: Science Policy Strategy

Broad-based TC community Pan-partisan Multi-sectoral International

Same

ORGANIZING PRINCIPLESWhat do we want?Who can give it to us?What do they need to hear?Who do they need to hear it from?

How can we get them to hear it?

Same

MODUS OPERANDI

#1:

Get on the Agenda

#2:

Get Favourable Decisions

#3:

Protect gains/ address vulnerabilities

(repeat as necessary)

SameVulnerabiliti

es

#1same, same

Publish or

Perish

Multisectoral• Finance• Health• Education

Multi-jurisdictional

• International, National, subnational

• Corporate, CSO & home

same, same

NeedMultiplePoints

ofContact

Canadian MPs:• Live in the moment• Are competitive and

tribal• Don’t want to be

disliked• Barter policies • Think locally• Are not overly numerate

“Which side are you on?”

same, same

Need to under-stand the

decision maker

It’s not a part-time job.

same, same

Need for

sustained

resources

There is a reason we are an unbranded movement.

same, same

Need to take risks

The capacity of decision makers to:Deflect responsibilityDeny the problemDiscredit the evidenceDelay action

Same Same

Barriers

Tobacco control is understood to mean “cigarette control”

Prevents instant adoption of Economic rationale, health rationale, cultural acceptance, priority over other health concerns.

Somewhat different

Barriers

(perception is reality)

Money is the root of all smoking!

Suppliers are driven to adapt or overcome regulatory and other barriers.

Same same

Mutable

Problem

What do we want NOW?

What will we want NEXT?

same, same

Challenge

to find the

right “ask”

“Tobacco Control is a changing game.”

Scott Sherman, October 21, 2013

“We face the challenge of … unimpeded

emergence of new products.”

Cheryl Healton October 21, 2013

“If we can’t do it, no one can.”

Omniyat Al Hajeri October 21, 2013