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

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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 2030
• Developed 2 3
• Developing 2 7
• World 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
Source Peto, Lopez, 2001
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Tobacco Related Deaths in Mediterranean Countries
in 1990Tracheal, Lung Bronchial Cancer per
100,000 deaths
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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
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Smoking Prevalence (1990s) and Consumption
(1999) in Selected Mediterranean Countries
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Protect YouthSmoking and Addiction Starts Young
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Protect YouthSmoking and Addiction Starts Young
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Allocating Tobacco Expenditure to Other Goods and
ServicesBetter Nutrition, Better Health
Evidence from Hungary
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High opportunity Cost Evidence from Belarus
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High opportunity cost Evidence from Bulgaria
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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 measureComplete
Ban on Tobacco Advertising and Promotion
Consumption trends in countries with such bans v.
those with no bans n102 countries)

• 1

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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
Physician rate Greece, Italy, Malta, Spain,
Turkey, Egypt, Syria Medical Student rate
Algeria (malefemale), 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
EU Med France, Greece, Italy, Portugal,
Spain Other 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