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G. Kovács
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ED03 - Global Tobacco Control Policies: Advances & Challenges (ID 266)
- Event: WCLC 2016
- Type: Education Session
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 4
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ED03.01 - Tobacco Control in the Middle East (ID 6437)
14:30 - 14:50 | Author(s): F. Hawari
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Despite many countries signing and ratifying the Framework Convention on Tobacco Control (FCTC), the prevalence of tobacco continues to be on the rise in the Middle East. For example, in countries like Jordan and Tunisia, tobacco prevalence among males is close to 5o% and in Jordan specifically it is estimated to increase to 88% over the next 5 years according to the World Health Organization (WHO). In 2008 it was estimated that five million people died due to tobacco related illnesses. This number is expected to increase to eight million in the year 2030 with individuals from low- and middle-income countries making up approximately 80% of these deaths. Tobacco is a risk factor for all major non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, pulmonary diseases and diabetes mellitus. The developing countries and the Middle East in particular is bracing for at least a 25% increase in such diseases over the next few years. The world economic forum estimates that the cost for such chronic disabling diseases will exceed USD 15 trillion with cancer costs specifically reaching close to USD 3 trillion. The WHO outlined six strategies that, when implemented simultaneously, will result in significant reduction in tobacco prevalence and its related morbidity and mortality. Those strategies known as MPOWER (Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco) when implemented in a country like Jordan, for example, close to 180,000 deaths can be prevented over 5 years. Despite the documented benefits of these six strategies, compliance with implementing them across the Middle East remains low. Only few countries have pictorial warnings, exposure to second hand smoke (SHS) is high, tobacco prices remain low and smoking cessation services are scarce. As the population in the Middle East age and with the ongoing rise in tobacco prevalence and obesity, cancer is expected to be on top of the list of diseases causing death and disability in the region. For that reason, King Hussein Cancer Center (KHCC), one of the leading cancer centers in the region, took on the challenge of fighting tobacco across the region in collaboration with regional and international partners. KHCC became the regional host for Global Bridges (an international TDT healthcare alliance co-founded by the Mayo Clinic, the American Cancer Society, and the University of Arizona). The main mission of this collaboration is to address the implementation of article 14 of the FCTC agreement and design and implement effective programmes to promote the cessation of tobacco use and provide adequate treatment for tobacco dependence (TDT). This will also serve to address one of the six strategies recommended by the WHO; Offer help to quit tobacco use. Tobacco dependence in the region is severe. The high number of cigarettes smoked per capita and the significant exposure to SHS make people less capable of quitting on their own. Availing TDT across the region would respond to the high demand for such service (more than 65% of smokers are interested in quitting) and help curb the expected epidemic of NCDs. Long term, quitting tobacco generally reduces the risk of disease and premature death by 90% for those who quit before the age of 30 and by 50% for those who quit before the age of 50. In addition, TDT will optimize the management of certain NCDs such as cancer resulting in better treatment outcomes and long-term survivals. Over the past 5 years, KHCC developed partnership with countries across the Middle East and worked on training healthcare providers (HCPs) on how to treat tobacco dependence (figure 1). More than 2000 HCPS were trained to date (figure 2). Furthermore, 4 hubs designated for TDT training were established in Oman, Egypt, Tunisia and Morocco. In addition, an evidence-based TDT training curriculum specifically designed for the Middle East was developed and in the process of being made available in 3 languages; Arabic, English and French. In conclusion, tobacco dependence represents a major threat to the health and wellbeing of the people in the Middle East. Significant rise in NCDs including cancer is expected over the next few years. Many collaborative initiatives are underway to address this sever epidemic. Figure 1
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ED03.02 - The Australian Tobacco Control Strategy: Lessons Learned (ID 6438)
14:50 - 15:10 | Author(s): M. Daube
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This presentation will outline the developments that have led the international tobacco industry to describe Australia as "the darkest market in the world". This will be presented in the context of international developments, with implications and recommendations for other countries, and researchers, clinicians, health professionals,health organisations and governments There will be discussion of the origins and early history of tobacco control in Australia; the components of comprehensive tobacco control programs; policy-relevant research; successes, failures and distractions; and the roles of key organisations and individuals. This will be followed by an outline of major developments, including the establishment of a consensus approach; national and local approaches; activity by key groups; progress across a range of key areas including public education, advocacy, tobacco advertising bans, taxation, health warnings, smoke-free, exposing tobacco industry activities, cessation supports; and other measures. There will be discussion of the Australian world-leading tobacco plain packaging legislation, which is now being replicated in many other countries, and the very encouraging resultant trends. The Australian experience and successes will be presented in a global context, with recognition that the tobacco industry will always oppose any measures that might reduce smoking and is constantly looking for new ways to resist action and promote its products. From this conclusions will be drawn and recommendations made for all concerned to reduce smoking, with consideration of next possible developments.
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ED03.03 - Tobacco Control and Lung Cancer in Africa (ID 6923)
15:10 - 15:30 | Author(s): L. Ayo-Yusuf
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Abstract not provided
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ED03.04 - Trumping Big Tobacco (ID 6439)
15:30 - 15:45 | Author(s): B. King
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Abstract for IASLC – Vienna conference ‘Trumping Big Tobacco’ Dr. Bronwyn King, CEO Tobacco Free Portfolios I never would have imagined my work as a doctor would take me to corporate boardrooms across the globe, from Melbourne to London, Paris, New York and more. But then I never would have imagined I would be invested in the tobacco industry either. In my early time as a doctor, I did a placement on the lung cancer ward of the Peter MacCallum Cancer Centre in Melbourne. Despite being able to offer the very best medicine available, the majority of my patients died, many of them in their 50’s and 60’s, some as young as 40. It was shocking to bear witness to the true impact of tobacco. Whilst the treatment and care of patients is paramount, we must deal with the source of the problem – tobacco and the companies that manufacturer it. Once I discovered that through my compulsory pension fund, I was invested in and actually owned a part of a several tobacco companies, I couldn’t just do nothing – I had to take action. In my quest to disentangle the Australian pension sector from tobacco I’ve become well informed about tobacco and the extent of the ‘tobacco epidemic’, as it is referred to by the World Health Organisation. The numbers astound me. Six million deaths per year are attributed to tobacco and we are on track for one billion tobacco related deaths this century. Many, including investors (both individual mums and dads as well as big financial institutions), aren’t actually aware of the extent of their tobacco exposure. Tobacco stocks are generally picked up in standard products. Often, tobacco companies have not been selected specifically for investment, but they are wrapped up within default investment products, so they still find a way into your portfolio. I founded Tobacco Free Portfolios to collaboratively engage with leaders of the finance sector to encourage tobacco free investment. Finance executives have been alarmed also, at the scale of the tobacco problem and have deeply considered the role they can play in addressing this pressing global issue. One by one, they have acted and are now proud to lead organisations that are tobacco free. There are now 35 tobacco free pension funds in Australia – just over 40% of all funds. Many more will soon follow. Each tobacco free announcement is met with resounding public support. Tobacco Free Portfolios recently took a global step and we were delighted to work with the global insurance giant AXA who announced a tobacco free decision in May 2016, divesting $1.8B Euro of tobacco assets. More organisations are soon to follow suit. That is the way of the future. Affiliations with the tobacco industry are no longer wanted. There are very few individuals or organisations that actively seek to be a part of the tobacco industry. The associations are often so deep and longstanding that it can seem overwhelming – but they must be addressed and they must be undone. Momentum for tobacco-free investment continues to grow steadily and I can confidently say that the conversation in Australian has largely moved from ‘should we go tobacco-free?’ to ‘how can we go tobacco-free?’ This is a pleasing development and a terrific case study, however, there is still much to do to accelerate action across the globe. The good news is that conversations I have in Vienna, Paris, Singapore, London and New York are received with exactly the same concern as the conversations I have in Melbourne, Sydney and Canberra. The devastating impact of tobacco is felt everywhere on Earth. Tobacco is everyone’s problem, not just the doctors that provide the care and treatment. We should all feel obliged to do something about it and all those with investments, including those through compulsory pension schemes have a role to play. It’s up to us to keep tobacco control on the agenda and in public dialogue. A tobacco free future that will allow our children and the generations to come to enjoy long and healthy lives should be our shared hope. If you are interested in supporting this work, please come along to the Tobacco Free Portfolios workshop on the morning of Wednesday 7[th] December. Further details available at www.tobaccofreeportfolios.org
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ED12 - Regional Tobacco Control Policies: Advances & Challenges (ID 281)
- Event: WCLC 2016
- Type: Education Session
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 1
- Moderators:Z. Zain, F. Mihaltan
- Coordinates: 12/07/2016, 11:00 - 12:30, Hall C7
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ED12.01 - Tobacco Control Policies in Eastern Europe (ID 6489)
11:00 - 11:15 | Author(s): G. Kovács
- Abstract
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According to the regional distribution of the World Health Organization (WHO), Europe extends from the Atlantic Ocean to Central Asia, encompassing states of the former Soviet Union. In political terms however, Eastern Europe refers to countries located on the eastern border of the European Union (EU). Consequently, in our presentation we focus on how smoking status has changed in some of the policy-wise emerging countries located here – namely the Czech Republic, Hungary, Poland and Romania – and how these data compare to Austria’s indicators. We present data on smoking prevalence and trends, restricting use, taxation and average cigarette prices, as well as the distribution of tobacco products in specific countries. Reference is made to restricting advertising and tobacco industry sponsorship activities. Smoking cessation support practice is another important aspect, while electronic cigarette (e-cigarette) regulation is a relatively new issue. Table 1 presents smoking prevalence and trends of specific countries.
Table 1. Smoking prevalence (%) (+15 years old) It is striking that while the proportion of smokers has decreased in Hungary and Poland, an opposite tendency may be observed in Austria. Smoking prevalence stagnated in Romania and the Czech Republic. It is noteworthy that the proportion of women smokers is high in Austria (28.3%), in Hungary (25.8%) and in Poland (24.1%). Smoke-free laws were adopted in the beginning of this Century in North America and Western Europe, and soon resulted in decreasing the proportion of smokers. Although there were smoking and trade control laws earlier in the presented countries, effective legislation has only been promulgated a few years ago and in some countries it hasn’t even been published. Hungary applies total ban on smoking in enclosed public places (with the exception of psychiatric units) since 2011. In Poland, a partial ban is in place, smoking is allowed in certain restaurants. The Czech Republic exercises a slightly more liberal regulation regarding restaurants. A partial ban exists in Romania in restaurants and there may be designated smoking areas in enclosed places where smoking is prohibited. Smoking is allowed in restaurants in Austria. Smoking is otherwise banned in all other enclosed places in these countries as well. It is well known that raising the price of tobacco products is the best tobacco control measure, we therefore compared tax rates and prices of popular cigarette brands. Although EU member states must comply with EU tax regulation requirements, recently joined members are allowed several years to converge, therefore significant differences may be observed in this manner between discussed countries. Countries generally apply combined taxation policy on cigarettes in agreement with Article 6 of the WHO Framework Convention on Tobacco Control Guideline: apart from the value added tax (VAT), the excise duty consists of an ad valorem and a specific element In 2015, the average 20 piece pack price (in Euro) was 4.6 in Austria, 3 in the Czech Republic, 3.2 in Hungary, 3.2 in Poland and 2.8 in Romania. Regulating the distribution and limiting the access to certain tobacco products is an important tool in tobacco control, and even more so in the prevention of youth smoking. The sale of tobacco products to minors is generally prohibited under 18 years (in Austria, under 16 years), however there are noteworthy differences where vending machines are concerned, e.g. in Austria these are allowed to operate. Sale of cigarettes over the internet is legal in the Czech Republic. Directly accessible distribution of tobacco products is allowed in Poland and Romania. Hungary applies the highest degree on distribution restriction: tobacco may only be purchased in supervised tobacco stores, vending machines and internet sale are prohibited. Advertising and tobacco industry sponsorship activities are uniformly forbidden in these countries. Yet another important issue of tobacco control is the accessibility and financial support of smoking cessation programs. Austria focuses its efforts on youth smoking prevention, nevertheless cessation programs are also coordinated nationally. The Czech Republic lays great effort on disseminating brief intervention practice among physicians and nurses. Health insurance covers smoking cessation programs, however pharmacotherapies are excluded. The National Health Fund partially covers smoking cessation programs in Poland. Romania has established specialized quit centers whose activities are partially covered by health insurance. In Hungary, the Methodological Centre coordinates cessation activity in nearly one hundred pulmonary outpatient clinics around the country, offering individual and group cessation counseling. Counseling is covered by health insurance, excluding pharmacotherapy. In addition, telephone counseling and cessation support is also available free of charge. Regarding e-cigarettes, diverse regulatory schemes are detected across Europe. In Hungary, the distribution of nicotine containing e-cigarette cartridges fall under the drugs act, whereas the same regulation applies to the use as to regular cigarettes. The latter is observed also in Poland. Promotion and distribution of e-cigarettes is prohibited in Austria. In the Czech Republic however, both advertising and distribution is analogues to that of regular cigarettes. The Association of European Cancer Leagues (ECL) assesses European countries’ efforts in tobacco control every three years using the Tobacco Control Scale (TCS). The TCS quantifies the implementation of tobacco control policies based on six strategies described by the World Bank: price increases, public information campaigns, bans on advertising and promotion, smoke free work and other public places, health warnings and treatment to help smokers stop. It is informative to observe the 2013 ranking of the discussed countries: the Czech Republic had a continuously deteriorating position and ranked 31[st], while Austria earned the 34[th], Poland the 20[th] and Romania the 19[th] position among the 34 surveyed countries. Hungary has significantly improved its position between 2010 and 2013, and due to fierce government measures in recent years it ranked 11[th] as compared to the previous 27[th] spot. References: 1. World Health Organization Framework Convention on Tobacco Control Implementation Database. 2. Ng, M., et al.: Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-2012. JAMA. 2014;311(2):183-192. doi:10.1001/jama.2013.284692CZE HUN POL ROM AUT 1980 26,2 34,8 42,5 26,8 27,8 1996 26,6 31,1 33,7 30,6 29,6 2006 26,3 32,9 30,5 26,7 32,5 2012 24,4 28,5 27,6 27,5 32,3
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