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Tobacco Control Research: Local Priority Setting and a Global Vision 4 Confronting the Epidemic: A Global Agenda for Tobacco Control Research 4 RITC Focused Research Priority Topics 4 Integrating Research into a Global Vision: What Have We Learned in Tobacco Control? 4 Example from South Africa 2
Confronting the Epidemic: A Global Agenda for Tobacco Control Research (http: //www. who. int/tobacco/resources/publicati ons/general/en/) 4 Published by RITC-WHO in 1999 4 Based on RITC-sponsored agenda-setting meetings in Africa, Latin America and the Caribbean, and Southeast Asia; review of previous agendas 3
Research Themes Country-Specific Research 4 Lack of standardized and comparable data; need for county and regional data on: 4 Prevalence and consumption 4 Knowledge of health risks 4 Attitudes and behaviours with respect to tobacco use especially in specific population sub-groups 4 Pricing and tax policies 4
Research Themes Policy Interventions 4 Economic policy research: 4 Elasticity of demand studies to determine optimal levels of taxation according to social class, age and geographic conditions 4 The determinants, process and impact of illegal trafficking and the influence of smuggling on tobacco use 4 Opportunities and barriers for harmonization of prices at the regional level 5
Research Themes Policy Interventions 4 Legislative research: 4 Effect of international trade agreements on the production, trade and marketing of tobacco products 4 Empirical and theoretical research to assist in drafting, implementing and evaluating policies (including those outlined in the FCTC) 6
Research Themes Programme Interventions 4 Opportunities/barriers to tobacco control 4 Optimal components (programs and policies) for a comprehensive tobacco control strategy 4 Development of effective messages to counter tobacco industry promotions 4 Behavioural research to test prevention and treatment programmes for specific age/ethnic/cultural groups 4 Strategies for high risk groups 7
Research Themes Treatment of Tobacco Dependence 4 Development of a range of approaches to increase cessation in specific populations 4 Evaluation of pharmaceutical interventions and delivery mechanisms, their costeffectiveness, and their impact in diverse socio-cultural subgroups. 8
Research Themes Tobacco Product Design and Regulation 4 The biology of tobacco addiction 4 Characterization of additives of tobacco products 4 Examination of alternative labelling for tobacco products 4 Examination of public expectations and behaviour with respect to existing and new tobacco products 4 A research base for regulation of tobacco products 9
Research Themes Tobacco Industry Analysis 4 Overview of ownership, corporate structure, and regulation of the tobacco industry at local and international level 4 Tobacco production as an international and regional trade issue in terms of foreign exchange, employment, imports and exports, trafficking 4 Tobacco industry relationships with government (including lobbying) 4 Tobacco industry involvement in illegal trade 10
Research Themes Tobacco Industry Analysis 4 Tobacco industry advertising, marketing and promotion activities (particularly with respect to women, children and other high risk groups) 4 The impact of changes in advertising on consumption and public perceptions 4 Industry representation of the health consequences of tobacco use and addiction (including their influence on the content and direction of research. ) 11
Research Themes Tobacco Farming 4 Relationship of tobacco production to destruction of the ecosystem 4 Attitudes and beliefs of tobacco farmers and the underlying historical/cultural context 4 Economic impact of tobacco control in countries that grow and manufacture tobacco or tobacco products for domestic or foreign markets 4 Opportunities for alternative crops and livelihoods; information on crop options employment for all family members 12
Research Themes Tobacco Farming 4 Cultivation and curing practices at the country and local level 4 Occupational hazards related to cultivating, curing and handling tobacco 4 Impact of tobacco cultivation on women and children 4 The feasibility of diversification in countries heavily dependent on tobacco farming and manufacturing and the mechanisms for supporting these countries in their diversification efforts 13
Research Themes The FCTC 4 Research to support specific provisions of the FCTC 4 Monitoring mechanisms to evaluate the implementation and effectiveness of the FCTC and related protocols 14
Cross-cutting Themes 4 High risk populations 4 Country readiness 4 Dissemination 4 Capacity Development 4 Mobilization of Human and Financial Resources 15
RITC Focused Research Priority Topics 4 Poverty and Tobacco 4 Tobacco Farming: Health, Livelihoods, Economics and the Environment 4 Health Systems Interventions 4 Globalization, Trade and Tobacco 4 Alternate Forms of Tobacco Use 16
What have we learned from tobacco? Lesson # 1 There is no “magic bullet”
Lesson #1 4 A comprehensive strategy is needed to change social norms and support individual behaviour change 4 This consists of: 4 Programming 4 Policy 4 Mass media 4 Research 4 Community development 4 Industry “denormalization” 18
What have we learned from tobacco? Lesson # 2 All sectors must work together
Coordination of All Sectors 4 Researchers 4 Policy-makers 4 Advocates 4 Practitioners 4 The media 4 Private sector 4 Public 20
Policy Sectors in Tobacco Control The Media Public Opinion PUBLIC PRIVATE Main Policy Sectors VOLUNTARY Source: Waverley Brigden, L. (1997) after Spicker, P. (1995) & Kingdon, J. W. (1995)
What have we learned from tobacco? Lesson # 3 Understand the politics
Politics 4 Multinational industries have enormous resources and the ability to influence policy-makers 4 They can argue on economic grounds as well as from a health standpoint (e. g. , loss of jobs) 4 Ability to provide jobs and manufacturing 4 A problem “solved” in the developed world may emerge in developing countries 4 They are always several steps ahead of us (e. g. , waterpipe, harm-reduction tobacco products) 4 Industries will often challenge “health” research 23
South Africa 4 A “policy window” 4 A “champion” in the Minister of Health 4 Strong advocacy 4 A sound research base 4 “Framing” as both a health and economic issue 24
Cigarette prices and consumption South Africa 25
Cigarette excise taxes and government revenue – South Africa 26
Trends in Cigarette Consumption and Smoking Prevalence Year 1993 2000 Cigarette consumption (millions of packs) 1, 802 1, 333 Per capita consumption (packs p. a. aged 15+) 72. 6 45. 7 Smoking prevalence percentage (15+) 32. 6 27. 1 Avg. consumption per smoker (packs p. a. ) 223 169 27
Changes in Smoking Prevalence by Gender and Age Group 1993 2000 Change Male 51. 4 43. 8 -7. 6 Female 12. 9 11. 7 -1. 2 Aged 16– 24 24. 0 18. 7 -5. 3 Aged 25– 34 38. 7 31. 9 -6. 8 Aged 35– 49 38. 5 35. 2 -3. 3 Aged 50+ 23. 4 22. 5 -0. 9 28
Lessons Learned: 6 Case Studies 4 Legislative successes won in the face of vigorous opposition from an industry striving to protect its profits and market 4 Key role played by NGOs and charismatic individuals with commitment and dedication 4 Coalitions brought new skills and perspectives 4 Effective advocacy has to be learned 4 Lack of an organizational home and minimal level of funding make it hard to operate effectively 29
Lessons Learned: 6 Case Studies (cont’d) 4 Strong political support and political champions are crucial to success 4 Significant transformations in social norms can occur 4 The media can have a powerful role in influencing popular opinion 4 Understand the political framework and legislative timetable of the country 4 Legislation must be coupled with attention to implementation and enforcement 30
Lessons Learned: 6 Case Studies (cont’d) 4 Sound research is needed for good policy decisions 4 Policies and strategies must be comprehensive 4 It may be necessary to bring together diverse interest groups (e. g. , Ministries of Health and Finance) 4 Even when the situation has seemed hopeless, progress has been made 4 Persistence is essential 31
Thank You Linda Waverley http: //www. idrc. ca/ritc 32
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