Post on 06-Jul-2020
First International Hookah Conference Sponsored by NYU/Abu Dhabi Institute
October 21st, 2013
Cheryl G. Healton, DrPHDean/Director GIPH
HEALTH INEQUITIES: INCOME DISTRIBUTION
http://chartsbin.com/view/2438
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Frenk et al, “Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World”, The Lancet, Vol. 376, December 4, 2010, p. 1935
World maps resized by population (A), burden of disease (B), density of medical schools (C), and density of workforce
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GLOBAL PHYSICIAN DISTRIBUTION
http://sasi.group.shef.ac.uk/worldmapper/images/largepng/219.png
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Deaths by Age Group: Low Income Countries
70 and older15-690-14
Source: WHO factsheet: The Top 10 Causes of Death http://www.who.int/mediacentre/factsheets/fs310_2008.pdf
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Deaths by Age Group: Middle Income Countries
70 and older15-690-14
Source: WHO factsheet: The Top 10 Causes of Death http://www.who.int/mediacentre/factsheets/fs310_2008.pdf
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Deaths by Age Group: High Income Countries
70 and older15-690-14
Source: WHO factsheet: The Top 10 Causes of Death http://www.who.int/mediacentre/factsheets/fs310_2008.pdf
80% OF DEAT HS CAUSED BY NCDS O C C U R I N L O W A N D MIDDLE INCOME COUNTRIES
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World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. 2009.
World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. 2009.
World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. 2009.
World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. 2009.
World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. 2009.
World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. 2009.
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Tobacco Could Kill 1 Billion by 2100
By EDITH M. LEDERER. The Associated PressThursday, February 7, 2008; 11:52 PM
NEW YORK ‐‐ The World Health Organization warned in a new report Thursday that the "tobacco epidemic" is growing and could claim 1 billion lives by the end of the century unless governments dramatically step up efforts to curb smoking. World Health Organization Director‐General Dr. Margaret Chan, right, speaks about the mpower box as New York Mayor Michael Bloomberg listens during a press conference announcing WHO's Report on the Global Tobacco Epidemic 2008 Thursday, Feb. 7, 2008 in New York. Thempower box is a symbol of the package being offered by the WHO in its effort………..
TRADE AGREEMENTS: PITFALLS• The one existing health treaty, while helpful, does not clearly give health priority over trade.
• Trade agreements represent a form of preemption of national, state, and local public health policymaking.
• Companies have used aggressive claims about trade treaties to oppose and raise the cost of health regulations using Investment and intellectual property provisions.
• They do this despite their own lawyers telling them they don't have a case.
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TRADE AGREEMENTS: PITFALLS CONT’D• The current Trans-Pacific Partnership (TPP) and Trans-Atlantic negotiations provide an opportunity for them to "fix" these provisions.
• Companies have been active in working to influence negotiations and are better integrated into the process than health groups, by virtue of sitting on advisory committees to the United States Trade Representative (USTR).
• TPP and other trade deals are negotiated in secret and disputes are resolved in secret.
• The TPP (and other trade agreements) should have an explicit carve-out for products deleterious to human health.
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World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. 2009.
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FEMALE TOBACCO USE
World Lung Foundation, American Cancer Society. Tobacco Atlas 2013 (Detail).
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MALE TOBACCO USE
World Lung Foundation, American Cancer Society. Tobacco Atlas 2013 (Detail).
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MALE STUDENT TOBACCO USE
World Lung Foundation, American Cancer Society. Tobacco Atlas 2013 (Detail).
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FEMALE STUDENT TOBACCO USE
World Lung Foundation, American Cancer Society. Tobacco Atlas 2013 (Detail).
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TOBACCO USE IN GHANA
WHO Report on the Global Tobacco Epidemic, 2013
FDA Regulation of tobacco products
Trends in Per Capita Consumption of Various Tobacco Products – United States,
1880‐2006
Source: Tobacco Situation and Outlook Report, U.S. Department of Agriculture, U.S. CensusNote: Among persons > 18 years old.
Beginning in 1982, fine-cut chewing tobacco was reclassified as snuff.Source: US Department of Agriculture
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TOBACCO ADVERTIS ING AND PROMOTIONAL EXPENDITURES* .1978 TO 2010
$0
$2
$4
$6
$8
$10
$12
$14
$16
1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008
Expe
nditu
res
in B
illon
s
*CPI Adjusted to 2003 $Source: Federal Trade Commission Cigarette Reports
$15.2 BILLION
CDC “TIPS” NATIONAL PUBLIC EDUCATION CAMPIGN: INCREASING AWARENESS OF TOBACCO‐RELATED DISEASE
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Youth Smoking Trend (U.S.) 1975-2011
1981 0.30.3
1983 0.30.3
1985 0.30.3
1987 0.30.3
1989 0.30.3
1991 0.30.3
1993 0.30.3
1995 0.30.3
1997 0.4 0.30.4 0.3
1999 0.3 0.30.3 0.2
2001 0.3 0.2
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
% C
urre
nt S
mok
ing
Source: Monitoring the Future Survey, United States, 1975-2011
0%
10%
20%
30%
40%
50%
60%
% Current Smok
ing
12th grade students Combined (8th, 10th, 12th graders)
Smoking Prevalence among US Adults (>18yrs) 1955-2008
And Centers for Disease ControlSchroeder SA, Warner KE. Don’t Forget Tobacco. N Engl J Med. 2010 Jul 15;363(3):201-4
Setting a Challenging Yet Realistic Smoking Prevalence Target for Healthy People 2020: Learning From the California Experience.
Mendez, D, Warner, KE. Am J Public Health. 2008;98:556–559.
14.7%
16.8%
2010 goal
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Impact Of Smoke-free Air & Tax Pol icy
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TOBACCO DISPARITIES: THE UNDERSTUDIED AND THE UNDERSERVED
FDA Regulat ion -Cri t ical Opportuni t ies For Tobacco
Research and Pol icy
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Where we must go? Forg ing a New Path
Shift to digital and social media
FDA regulation and Industry Future Plans Marketing NEW non-combustibles Tobacco Products with claims of modified risk and harm reduction messages, especially to youth and young adults
Global forces, macroeconomics and End Game Scenarios
Implications for research, intervention and policy: Regulatory Science as a new discipline
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Fami ly Smoking Prevent ion And Tobacco Contro l Act (2009)
Public Health StandardCalls for the review of the scientific evidence regarding:
1. Risks and benefits to the population as a whole, including both users and non-users of tobacco products;
2. Whether there is an increased or decreased likelihood that existing users of tobacco products will stop using such products; and
3. Whether there is an increased or decreased likelihood that those who do not currently use tobacco products, most notably youth, will start to use tobacco products
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M o d i f i e d R i s k To b a c c o P r o d u c t s ( M R T P s )
“… the Secretary shall… issue an order that a modified risk product may be commercially marketed only if the Secretary determines that the applicant has demonstrated that such product, as actually used by consumers, will
benefit the health of the population as a whole taking into account both users of tobacco products and persons who do not currently use tobacco products.”
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J u l y 2 0 11 : M o d e l i n g a M e n t h o l B a n U s i n g S i m S m o k e
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E - c i g a r e t t e Aw a r e n e s s , U s e , a n d H a r m P e r c e p t i o n s
40.2% of Americans over the age of 18 had heard of an e-cigarette
11.4% of smokers have ever tried an e-cigarette. Of these, about 1/3 (4.1%) had used an e-cigarette in the past 30 days
Over 70% of smokers who have heard of e-cigarettes believe that e-cigarettes are less harmful than regular cigarettes
Young smokers more likely to have tried e-cigarettes than older smokers
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Flavored Tobacco Product Use Among U.S.Young Adul ts
( A m J P r e v M e d , i n p r e s s )
Overall, 18.5% of young adult tobacco users report using flavored products
Dual use of menthol and flavored product use ranged from 1% (nicotine products) to 72% (chewing tobacco).
Younger adults (18-24 vs. 25-34) more likely to use flavored tobacco products
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Rigorous and Rapid Survei l lance: the Legacy Young Adul t Cohort
32% of ever users (18-34) reported product initiation after the age of 18
Of 23% of young adult current users, 30% report dual use of cigarettes and another tobacco product.
Among dual Users: cigars 23%, little cigars 26%, hookah 17%, dip snuff 12%, chewing tobacco 12%, e-cigs 9%, snus 7%, dissolvables 3%
Dual use - higher in younger adults, males, less than high school education, and those not able to meet their expenses.
Rath J, Villanti A, Abrams D, Vallone D. Patterns of Tobacco Use and Dual Use in U.S. Young Adults: The missing link between youth prevention and adult cessation. Journal of Environmental and Public Health. 2012.
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REAL TIME Geospat ia l Survei l lance: Point -of -sa le Tobacco (POST)
Kirchner et al., (2012) Proceedings of ACM Wireless Health.
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LITTLE CIGARS AND CIGARILLOS: M o r e P r e v a l e n t a n d L o w e r - P r i c e d i n n o n - w h i t e a r e a s i n W a s h i n g t o n D C .
C a n t r e l l , K i r c h n e r , P e a r s o n , K r e s l a k e , G a n z , V a l l o n e ( A m J P u b . H e a l t h , i n P r e s s )
Thank You