effective interventions to reduce tobacco use
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Effective Interventions to Reduce Tobacco Use. Joy de Beyer Tobacco Control Coordinator World Bank Meeting of Mediterranean Countries, Malta, September 2001. Outline. Why intervene to reduce tobacco use ? Which interventions are effective, and how do we know? - PowerPoint PPT PresentationTRANSCRIPT
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Effective Interventions to Reduce Tobacco Use
Joy de BeyerTobacco Control Coordinator
World Bank
Meeting of Mediterranean Countries, Malta, September 2001
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Outline
• Why intervene to reduce tobacco use ?
• Which interventions are effective, and how do we know?
• Which interventions are not effective?
• Who are the key stakeholders ?
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Why intervene to reduce tobacco use ?Large and growing number of deaths from tobacco
World: Annual Tobacco Deaths (millions)
2000 2030Developed 2 ~3Developing ~2 ~7World Total 4 ~10
1 in 2 of long-term smokers killed by their addiction 1/2 of deaths in middle age (35-69)
Source: Peto, Lopez, and others 1997; WDR 1993
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Tobacco Attributable Deaths in EU Countries in the Mediterranean Region
Smoking Attributable Deaths in All Ages in EU Mediterranean Countries 1955-2000
7
51
61
33
715
7566
1210
3
5758
21
0
10
20
30
40
50
60
70
80
1955 1965 1975 1985 1990 1995 2000
Ann
ual M
ale
Sm
okin
g de
aths
(100
0s)
PortugalSpainItalyGreeceFrance
Source: Peto, Lopez, 2001
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Tobacco Related Deaths in Mediterranean Countries in 1990
Tracheal, Lung & Bronchial Cancer per 100,000 deaths
153229 241
368
704
992
1390
0
200
400
600
800
1000
1200
1400
Libya Lebanon Jordan Tunisia Egypt Algeria Morocco
MaleFemale
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1.1 Billion Smokers Worldwide(1990-1995 estimate, million)
Males Females Total Developed 200 100 300 Developing 700 100 800
World 900 200 1.1 Bil.
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Why should governments intervene?Economic rationale – “market failures”
• People do not know the risks of tobacco use• Most smokers start young – protect youth• Nicotine is VERY addictive • Tobacco users impose costs on others
– second hand smoke harms non-smokers– children and infants need protection– health care costs (families and government)– opportunity cost for families
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3 strong reasons for governments to intervene
• Deter children from smoking
• Protect non-smokers from others’ smoke
• Provide adults with good information so they can make well-informed choices
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Heavy Smokers and High Prevalence Rate in EU in 1999
542
382 398
261
454
243
51%
37%33%
33%
25%19%
Portugal Italy Spain France Greece Turkey
Packs/smoker Prevalence
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Smoking Prevalence (1990s) and Consumption (1999) in Selected Mediterranean Countries
207 217 227 213173
256
243
20% 24% 25% 25%31% 33%
53%
Morocco Egypt Jordan Algeria Syria Tunisia Lebanon
Packs/smoker Prevalence
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Protect YouthSmoking and Addiction Starts Young
Smoking Prevalence (%)among Youth in Selected EU Mediterranean Countries in 1990s
8%
6%6%5%5%
10%
5%4%
7%
5%
Greece (11-15) 1998
Spain (11-15) 1994
Italy (13-14)
1994
Portugal(11-15)1998
France(11-15)1998
Boys
Girls
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Protect Youth:Smoking and Addiction Starts Young
Smoking Prevalence among Youth in Selected Mediterranean Countries 32%
16%14%13%11%
4%
11%7%9%
3%1%
Algeria (15 yrs) 1999
Lebanon(15-18)
1997 total
Egypt (14-18) 1998
Turkey (7-13) 1996
Syria (16) 1997
Jordan (12-18) 1997
Boys
Girls
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Allocating Tobacco Expenditure to Other Goods and Services
Better Nutrition, Better Health: Evidence from Hungary
Additional Food a Smoker Could Buy Per Week if He/She Did Not Smoke in 1999
2.0 2.1 3.1
9.8
25.6
21.0
Pork Beef Chicken Apple Potato Flour
Kg/Week
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High opportunity Cost: Evidence from Belarus
Smoking Expenditure as % of Total Income for a Typical Belarus Smoker
7% 10%
37%42%
0%
10%
20%
30%
40%
50%
1996 1999
If smoke only domestic brands If smoke only foreign brands
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High opportunity cost: Evidence from Bulgaria
Tobacco expenditure as % of gross income and wages&salaries in Bulgaria
1997
1.8%
4.9%
1.6%
3.6%
1.1%
3.1%
0%
1%
2%
3%
4%
5%
6%
as % of gross income as% of wages &salaries
Low Middle High
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Effective interventions to reduce tobacco use
• Higher cigarette taxes• Non-price measures: Consumer information, large clear warning labels Comprehensive bans on cigarette advertising and
promotion, or counter-advertising Restrictions and bans on smoking in workplaces and
other public places• Help for people who want to quit Better access to cessation therapies such as nicotine
replacement (NRT), etc
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Interventions that are not effective in reducing tobacco use
Most “supply side” measures:– Prohibition– Youth access restrictions– Crop substitution– Trade restrictions
Control of smuggling is the exception.
It is the key supply-side measure.
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An effective measure:Complete Ban on Tobacco Advertising and Promotion Consumption trends in countries with such bans v. those with no bans n=102 countries)
1
No Ban
Ban
1450
1500
1550
1600
1650
1700
1750
1981 1991Year
Cig
aret
te c
onsu
mpt
ion
per c
apita
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Current smokers need help! Cessation Treatments
• Cessation support from health professionals is key • NRTs double the effectiveness of cessation efforts• Quit lines, community support, etc., also work • Governments may increase accessibility and affordability
of NRTs by: OTC sales, allowing advertising, licensing Conducting more studies on cost-effectiveness (especially in
low/middle income countries) Considering NRT subsidies for poorest smokers
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Cessation Efforts: Health Care Professionals First
Smoking Prevalence Among Health Professionals and Medical Students in Mediterranean Countries 1990s
14
3034 37 37 39
4450 53
17
1
34
5 2
1713
29 3241
Prev
alen
ce ra
te %
Males Females
Physician rate: Greece, Italy, Malta, Spain, Turkey, Egypt, SyriaMedical Student rate: Algeria (male+female), Morocco, Tunisia,Cardiologist: France
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Key stakeholders – Ministry of Finance: Tobacco Tax Revenues
– Customs Administration: Smuggling, Border Control
– Ministry of Labor: Farmers and Manufacturing Labor
– Ministry of Agriculture: Tobacco Production
– Ministry of Education: Youth education on tobacco
– Smokers: Low prices, variety and appealing products
– Producers: Profit, market share, sales
– Ministry of Trade: Export earnings from tobacco
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Ministry of Finance: Tobacco is a good source of government tax revenue
Tobacco Excise Tax Revenue in 1999
3.0
18.4
02468
101214161820
Other Med. EU Med.
Billi
on U
S $
EU Med: France, Greece, Italy, Portugal, SpainOther Med: Algeria, Cyprus, Egypt, Morocco, Jordan,Lebanon, Syria, Turkey, Tunisia,
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Summary:
Modest action could achieve great gains for
public health
without hurting the economy