Cancer Control Opportunities in Low- and Middle-Income Countries (2007) / Chapter Skim
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5 Preventing Cancers (and Other Diseases) by Reducing Tobacco Use
5 Preventing Cancers (and Other Diseases) by Reducing Tobacco Use
Pages 138-169
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From page 138... ...
Worldwide, tobacco use kills nearly 5 million people annually -- about one third from cancer and two thirds from other diseases -- accounting for 1 in every 5 male deaths, and 1 in 20 female deaths, over age 30. On current smoking patterns, annual tobacco deaths will rise to 10 million by 2030, about 3 million of which will be from cancer.
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From page 139... ...
Total Smokers Percentage of World Bank Region Males Females Overall Millions All Smokers East Asia and Pacific 63 5 34 429 38 Europe and Central Asia 56 17 35 122 11 Latin America and the Caribbean 40 24 32 98 9 Middle East and North Africa 36 5 21 37 3 South Asia 32 6 20 178 15 Sub-Saharan Africa 29 8 18 56 6 Low and middle income 49 8 29 920 82 High income 37 21 29 202 18 SOURCE: Reprinted, with permission, from Jha et al.
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From page 140... ...
About 60 percent of male and 40 percent of female tobacco deaths occurred in middle age (ages 35 to 69)
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From page 141... ...
from lung cancer. In contrast, in low-income countries, the leading causes of death among the 1.3 million male tobacco deaths were cardiovascular disease (400,000)
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From page 142... ...
Copyright 2000 by fig 5-1 the BMJ Publishing Group Ltd. quitting smoking at age 40 avoided 80 to 85 percent of the excess risk of lung cancer (Crispo et al., 2004)
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From page 143... ...
deaths 220 200 190 obaccoT 100 70 0 1950 2000 2025 2050 Year FIGURE 5-2 Tobacco deaths in the next 50 years under current smoking patterns. SOURCE: Reprinted, with permission, from Jha and Chaloupka, 2000a.
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From page 144... ...
Where constitutions do not allow this, restrictions on all advertising, promotion, and sponsorship must be adopted. · Packaging and labeling of tobacco products The treaty obligates parties to adopt and implement large, clear, visible, legible, and rotating health warnings and messages on tobacco products and their outside packaging, occupying at least 30 percent of the principal display areas.
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From page 145... ...
· Illicit trade in tobacco products Parties must adopt and implement effective measures to eliminate illicit trade, illicit manufacturing, and counterfeiting of tobacco products. INTERVENTIONS TO PREVENT SMOKING Hundreds of millions of premature tobacco deaths could be avoided if effective interventions were applied widely in LMCs.
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From page 146... ...
from the United States, United Kingdom, Canada, and other high-income countries have generally produced estimates that range from 0.25 up to an upper limit of 0.50, indicating that a 10 percent increase in cigarette prices could reduce overall cigarette smoking by 2.5 percent to 5 percent (Chaloupka et al., 2000; Gallus et al., 2006; U.S.
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From page 147... ...
The current recommendation of the FCTC, to increase tobacco taxes, is still well supported, but the magnitude of the impact and the specifics of effects appear likely to vary from place to place, possibly very considerably. Restrictions on Smoking Over the past three decades, as the quantity and quality of information about the health consequences of exposure to passive smoking has increased, many governments, especially in high-income countries, have restricted smoking in a variety of public places and private worksites.
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From page 148... ...
These publications resulted in the first widespread press coverage of the scientific links between smoking and lung cancer. The reports were followed, in many high-income countries, by policies requiring health warning labels on tobacco products, which were later extended to tobacco advertising.
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From page 149... ...
is still allowed, and advertising is permissible in any imported print media. Cigarette packets bear a single fixed health warning.
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From page 150... ...
. In addition, mass media antismoking campaigns, in many cases funded by earmarked tobacco taxes, have generated reductions in cigarette smoking and other tobacco usage (Kenkel and Chen, 2000; Saffer, 2000)
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From page 151... ...
Among its provisions (which have been strengthened since passage) are: · Prohibition of all advertising, promotion, and sponsorship · Requirement of fixed health warnings on cigarette packets · Ceiling levels of tar and nicotine · Smoking bans in many public places · Prohibition of tobacco sales to people under age 18, and possession of tobacco products and smoking by any person under 18 SOURCE: Hamzah (2005)
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From page 152... ...
The study predicted that a comprehensive set of tobacco advertising bans in high-income countries could reduce tobacco consumption by more than 6 percent, taking into account price and nonprice control interventions (Saffer and Chaloupka, 2000)
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From page 153... ...
. The evidence that interventions aimed at reducing the supply of tobacco products are effective in reducing cigarette smoking is much weaker than it is for demand-side interventions (Jha and Chaloupka, 1999, 2000b)
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From page 154... ...
price increases, (2)
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From page 155... ...
The greatest relative impact of a price increase on deaths averted is among younger age cohorts. The price increases used in the model are achievable, and may even be conservative.
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From page 156... ...
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From page 157... ...
Several years of intense, heavily funded opposition by the tobacco industry and public debate ensued. Public opinion eventually swung toward the health advocates, and in 1995 the Senate passed -- with 90 percent of the vote -- the "Law for the Protection of Public Health Against the Effects of Tobacco Use." Provisions included a ban on smoking and cigarette sales in health care centers, schools, and enclosed workplaces; a ban on tobacco sales to those under 18 years; a ban on smokeless tobacco; a ban on radio and television advertising and limits on other media; large health warnings on cigarette packages; and free smoking continued
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From page 158... ...
While NRTs and other nonprice interventions are less effective than price increases, they can still avert a substantial number of tobacco deaths (18 million and 35 million deaths, respectively)
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From page 159... ...
tobacco control interventions would occur after 2010, but a substantial number of deaths could be avoided even before then. No attempt has been made in this analysis to examine the impact of combining the various packages of interventions (e.g., price increases with NRT, or NRT and other nonprice interventions)
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From page 160... ...
Comprehensive Tobacco Control Programs In recent years, several governments, mostly in high-income countries, have adopted comprehensive programs to reduce tobacco use, often funded by earmarked tobacco tax revenues. These programs have similar goals for reducing tobacco use, including preventing initiation among youth and young adults, promoting cessation among all smokers, reducing exposure to passive tobacco smoke, and identifying and eliminating disparities among population subgroups (U.S.
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From page 161... ...
NOTE: Price increases assume a high price elasticity (1.2 for low- and middle-income countries and 0.8 for high-income countries)
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From page 162... ...
Middle-income countries averaged 0.51 percent of government revenue from tobacco taxes, while lower income countries averaged 0.42 percent. An increase in cigarette taxes of 10 percent globally would raise cigarette tax revenues by nearly 7 percent, with relatively larger increases in revenues in high-income countries, and smaller increases in revenues in LMCs (Sunley
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From page 163... ...
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From page 164... ...
However, earmarking tobacco taxes can be justified if governments use these funds to benefit those who pay for tobacco control policies and programs, and secure public support for new or higher tobacco taxes. Earmarked taxes also have a political function in that they help to concentrate political winners of tobacco control, and thus influence policy.
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From page 165... ...
· Complete adertising and promotion bans on tobacco products · Mandating that public spaces be smoke free · Large, explicit cigarette packet warnings in local languages (which also helps to reduce smuggling) · Support of counteradertising to publicize the health damage from tobacco and the benefits of stopping tobacco use
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From page 166... ...
1998. Earmarked tobacco taxes: Lessons learned.
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From page 167... ...
1998. Emerg ing tobacco hazards in China: Retrospective proportional mortality study of one million deaths.
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From page 168... ...
2002. Global and regional estimates of the effectiveness and cost-effectiveness of price increases and other tobacco control policies.
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From page 169... ...
1994. Cigarette smoking by socioeconomic group, sex, and age: Effects of price, income, and health publicity.
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