The Rising Tide of the Global Tobacco Epidemic

The Rising Tide of the Global Tobacco Epidemic Sara Savage, MPH Program Manager UW Tobacco Studies Program

Acknowledgements • Ross Hammond, Campaign for Tobacco-Free Kids • Kiyon Chung MD MPH, Cardiologist • Abigail Halperin MD MPH, UW Tobacco Studies • WA State Dept of Health, Tobacco Prevention and Control Program

Overview • Globalization and Expansion of the Tobacco Industry • Impacts on morbidity & mortality • Tobacco & Poverty • The International Response

A Formidable Enemy In 2002, Philip Morris, BAT and Japan Tobacco operated in over 50 countries each and had combined tobacco sales of over $121 billion, a sum greater than the combined GDPs of these 27 countries: Albania, Bahrain, Belize, Bolivia, Botswana, Cambodia, Cameroon, Estonia, Georgia, Ghana, Honduras, Jamaica, Jordan, Macedonia, Malawi, Malta, Moldova, Mongolia, Namibia, Nepal, Paraguay, Senegal, Tajikistan, Togo, Uganda, Zambia and Zimbabwe

“Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists. ” -- WHO Zeltner Report, 2000

Global Expansion Fueled By: • Opening up of trade with China, former Soviet Union, E. Europe • Increasing profit opportunities of a free market economy • Enhanced global communications & marketing

“We are still in the foothills when it comes to exploring the full opportunities of many of our new markets. ” -- Geoffrey Bible, Philip Morris CEO, 1996

Global Expansion Through Marketing Thailand

Traffic Lights in Bucharest, Romania

“Give me an amerika” Czech slang for a good cigarette

Indirect Marketing • Sponsorship of sports & entertainment events • Public relations (donations to organizations, scholarships, etc)

The Coming Epidemic

National Geo, ACS: 2003, WHO: 2002

Global Deaths Currently: Ø 4. 9 million people die per year Ø 13, 400 people per day Ø 560 people every hour By 2030: Ø 10 million people a year will die from tobacco use Ø 70% of those deaths will occur in developing countries

Tobacco-related Disease • Cancers (lung, bladder, kidney, stomach, pancreas, mouth, esophogus) • Cardiovascular Disease (heart disease, stroke, heart attack) • Respiratory Diseases (pneumonia, emphysema)

Women & Tobacco • Cancer: Cervical & Breast (premenopausal women) • Low bone density osteoporosis & hip fractures • Secondhand smoke exposure • Maternal & child Pre-term delivery, preeclampsia, low birth weight, impaired lung function, ear infections, SIDS

Tobacco and TB Ø Smoking increases incidence, morbidity & mortality of clinical TB Ø Decreases immune response Ø Causes structural changes in respiratory tract Ø India study (2003) Ø Ever smokers 3 x more likely than never smokers to develop active TB Ø Smoking accounted for 50% of male TB deaths (Benowitz, Arch Int Med 2004; Gajallakshmi, Lancet 2003)

Tobacco and HIV Ø Smoking doubled the risk of developing PCP and TB in HIV+ patients Ø Daily smoking reduced effectiveness of HAART (antiretroviral therapy) by 40% Miguez-Burbano et al, Addiction Biology, 2003.

Deaths Due to Cardiovascular Disease vs. Infectious & Parasitic Diseases in Men age 30 -69, 1990 In thousands Yusuf Circulation 2001: 104: 2746 -2753

Tobacco & Poverty 2004 Report by WHO

The poor tend to smoke the most Ø Globally, 84% of smokers live in developing & transitional countries Ø High smoking rates strongly associated with less education Ø Study in Chennai India found 64% of illiterate smoke, while 21% of those with 12+ yrs of schooling smoke

Tobacco use impoverishes individuals & families Ø In poorest households, 10% of household expenditures go to cigarettes. Ø In Bangladesh, over 10. 5 million malnourished people could have an adequate diet if money spent on tobacco was instead spent on food.

Tobacco Farming Ø Expensive inputs, low wages Ø Child labor = lost education opportunities Ø Pesticide & nicotine poisoning

Tobacco Impoverishes Countries ØEnvironmental Damage ØIncreased Health Care Costs ØLost productivity due to illness and premature death ØForeign exchange losses

The International Response v. WHO Framework Convention on Tobacco Control v. Bloomberg Initiative v. Bill & Melinda Gates Foundation

Framework Convention on Tobacco Control (FCTC) Ø First international public health treaty Ø Countries support the treaty by ratifying Ø Objective: To protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke. . .

Key Provisions of the FCTC Enact comprehensive bans on tobacco advertising, promotion & sponsorship within 5 years of ratification

Place rotating health warnings on packs that cover 30% or more of the package and can include pictures or pictograms Thailand Jordan Brazil

Ban the use of misleading and deceptive terms such as "light" and "mild"

Protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places

Other Key Provisions Ø Encourage tobacco tax increases Ø Include cessation services in national health programs Ø Prohibit free distribution of tobacco Ø Prohibit sales to minors Ø Promote NGO participation Ø Establish & finance a national coordinating body

WHO FCTC Entered into force 2/27/05 Ø 168 Countries Have Signed Ø 143 Parties (countries who have ratified) Ø U. S. refuses to ratify Ø Convention of the Parties regulating body of the treaty

Framework Convention Alliance Diverse group of over 250 NGOS from more than 100 countries working to support FCTC ratification and implementation WWW. FCTC. ORG

In Conclusion The Dean of Harvard School of Public Health recently declared the control of tobacco advertising, sales, and addiction as the first of eight public health priorities that would significantly improve global health outcomes. Bloom BR. Public Health in Transition. Sci Am 2005; 293(3): 92 -99

To learn more… HSERV 590 B Tobacco and Public Health Spring Q: Wednesdays 2 -3 credits 1: 00 - 2: 50 pm UW Tobacco Interest Listserv tobaccointerest@u. washington. edu