Global Tobacco Regulation as an Exemplar of NCD Risk Factor Prevention Terry F. Pechacek, Ph.D. 1
BEST BUYS FOR NCDS Tax increase Smoke free indoor workplaces and public places Health information and warnings Bans on tobacco advertising, promotion, and sponsorships Tax increase Restricted access to retailed alcohol Bans on alcohol advertising Reduce salt intake in foods Replacement of trans fats with polyunsaturated fat Public awareness through mass media Counseling and multidrug therapy with people in high risk of developing heart attacks and strokes (including those with established CVD) Treatment of heart attacks with aspirin Hepatitis B immunization to prevent liver cancer Screening and treatment of precancerous lesions to prevent cervical cancer PROVEN INTERVENTIONS
SCHOOL OF PUBLIC The Health HEALTH Impact Pyramid Frieden TR. N Engl J Med 2015;373:1748 54 3
SL OF PUBLIC HEALTH mpower Tobacco Other NCD Risk Factors Monitor Protect Offer Help Warn about Dangers Enforce Bans Raise taxes Global Tobacco Surveillance System Clean Indoor Air Policies Telephone quitlines, cessation counseling Warning Labels & Media Campaigns Bans on Advertising, Promotions, and Sponsorships Excise taxes on tobacco Global NCD Surveillance System Strict DUI laws; Urban designs promoting walking Health professional counseling and programs Warning Labels & Media Campaigns Bans on Advertising, Promotions, and Sponsorships Excise taxes on alcohol, sugary foods, and more 4
Using Behavioral Economic Approaches to Behavior Change: Libertarian Paternalism Making Healthy Options the Default Option Default Youth Food Options (e.g., Disney Example) Attractive Stairways at Building Entrances Influencing Choices by Information or Other Non-Price Factors Required Menu Labeling Options Increased Walkability of Neighborhood Increase Opportunity Cost of Less-Favored Option Less Healthy Foods Choices Made Less Convenient
Moving Upstream to Focus on Policies Impacting Lifestyle Risk Factors for Cardiovascular Disease Health Service Research Comparative Effectiveness Research Food Systems, Urban Form, Tobacco Use Policies Prevention Policy Research Adapted from Mozaffarian, D. et al. Circulation 2008;117:3031-3038
SL OF PUBLIC HEALTH WHO World No Tobacco Day Themes Packaging, Trade, Taxes, Advertising 2016 2015 2014 2013 7
Tobacco Use Tobacco Excise Taxes Widely Supported Youth and Young Adults More Price Sensitive Food Systems Multi-Pronged Approach Pricing Policies Taxing less healthy options (e.g., sugar sweetened drinks) Subsidizing healthy options (e.g., FSP at Farmers Market) Physical Activity Patterns Incentives for Walkable & Transit-supportive Development Support local infrastructure for physical activity
FRANCE: TRIPLE HALF DOUBLE 14 Government income from tobacco, 12 10 Billions, 2007 euros 8 6 4 2 0 1960 1970 1980 1990 2000 2010 Triple the price Halve the consumption Double the amount of money government makes Source: Jha, P., and Hill, C. (2012). Triple Tax, Double Revenue, Half-Smoking and Lung Cancer, France 1980-2010. Personal Powerpoint slide from Centre for Global Health Research Presentation. Reprinted with permission.
Importance of Quantifying Full Range of Externalities Tobacco Use Costs of secondhand smoke Costs of decreased productivity Food Systems Environmental & sustainability costs Costs of food safety Physical Activity Patterns Cost/benefit trade-offs of urban form and transportation investments & policies
Policies to Restrict Advertising and Promotions Tobacco Use 2013 World No Tobacco Day Uruguay s Comprehensive Ban upheld by WTO Food Systems Proposed advertising restrictions to protect youth Concerns over information asymmetry produced by industry advertising and promotional campaigns Physical Activity Patterns Focus on information efforts promoting increased activity rather government regulations Shape Up America (www.shapeup.org) America on the Move (www.americaonthemove.org)
Extending the reach of NCD surveillance through mobile phone surveys
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Global Tobacco Surveillance System WHAT GETS MEASURED GETS DONE To make people count, we first need to be able to count people. Dr. Lee Jong Wook, WHO Director General, July 2003