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Research for International Tobacco Control (RITC)
Tobacco as a Development Issue
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2
Why is Tobacco Unique as a Policy Issue?
Tobacco use sustained through addictive properties, low prices, social norms, vigorous marketing by powerful multinational corporations
Perceived by many to contribute to social and psychological well-being
Tobacco epidemic exacerbated by complex factors with cross border effects, including trade liberalization, foreign direct investment, global marketing; transnational advertising, promotion and sponsorship; international movement of contraband and counterfeit cigarettes.
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Global Tobacco Consumption
Approximately 1.3 billion people smoke cigarettes (1 in 5 of the world’s population; 1 in 3 of those over 15)
Global prevalence (2000) = 29% (47% men: 10% women)
One in two long-term smokers will die from a tobacco related disease - many before 65
Tobacco expected to be the leading global cause of death before age 65 by 2020
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Global Tobacco Consumption
Smoking (particularly amongst men) culturally accepted in many countries
GYTS shows many smokers in developing countries begin in their teens
Quitting rates low in low- and middle-income countries compared to developed countries
Advertising is ubiquitous and aggressive
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Advertising
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Advertising
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Advertising
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Advertising
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Stages of the Tobacco Epidemic
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Past and Future Annual Deaths due to Tobacco Use
0.3 0 0.31.3
0.2
1.52.12.1
4.2
3
7
10
01234567
89
10
1950 1975 2000 2025-2030
Developed
Developing
World
Source: Who (2002) The Tobacco Atlas, p.36.
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Tobacco and Developing Countries
70 % of tobacco grown in developing countries
70 % of tobacco consumed in developing countries
In 2000 half of 5 million tobacco-related deaths occurred in developing countries
By 2030 70 % of tobacco–related deaths will occur in developing countries
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Global Burden of Non Communicable Diseases (NCDs)
Tobacco use linked causally to cancers, cardiovascular disease, respiratory diseases, tuberculosis, and diabetes
Population aging and changes in risk factors have accelerated the epidemic of NCDs in many developing countries
Burden of NCDs is increasing, accounting for nearly half of the global burden of disease (all ages)
Many developing countries now face a “double burden”
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Tobacco and Development
More than a health issue: economic, agricultural, environmental, socio-cultural, trade and marketing
Tobacco linked to poverty (up to 10% of household expenditures in poorest families)
Women and youth at particularly high risk
Tobacco kills people in their productive middle years
High economic costs – estimated $2.2 B direct medical costs; $5.4 B lost productivity in Canada (1992 USD)
Tobacco and Poverty
“Each tobacco user represents one of more people – whether the smoker or his or her spouse or child – who is needlessly going hungry”
(Efroymson et al, Tobacco Control 2001
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Tobacco and Poverty
Tobacco linked to poverty as household income is spent on tobacco rather than food or basic need
India/Bangladesh/Egypt: 2% - 4.5% of household expenditures on tobacco products
Bulgaria 10.4% of total income on tobacco products
China 17% of household income on tobacco
Even small amounts represent very high opportunity costs
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Tobacco and Poverty
Evidence in some countries that tobacco use is growing fastest amongst the poorest groups:
Indonesia:1981 – lowest income groups spent 9% of
their total expenditure on tobacco1996 – lowest income groups spent 15%
of their total expenditure on tobacco
In Bangladesh- smoking twice as high in the lowest income group as in the highest
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Tobacco and Poverty
Smoking exacerbates poverty in other ways:Poor families are vulnerable to illness
particularly the loss of a breadwinner Paying for treatment further impoverishes
families
Study of 20,000 poor men and women in 23 countries found that sickness or injury in a family is by far the most frequent trigger into (worse) poverty
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Poverty and Policies Urban and rural Bangladesh per capita
spending on tobacco higher than on milk
Spending by average smoker on cigarettes would buy 3000 calories of rice
Often men control the income and have first access to food. Women and children are most likely to go hungry.
Vietnam – annual household expenditure on tobacco 1.7 times expenditure on education
Advertising and low taxes encourage purchase of tobacco
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Cigarette prices and consumptionSouth Africa
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Cigarette excise taxes and government revenue – South Africa
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WHO Commission on Macroeconomics and Health (CMH)
CMH emphasized the interconnectedness of health and sustainable development
Where national disease burden is high, national wealth and productivity are likely to be low
Two way relationship between economic development and health:Poverty increases vulnerability to diseasePeople who are sick cannot work – affecting their
income
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WHO Commission on Macroeconomics and Health (CMH)
CMH emphasized tobacco as a link between poverty and illness
CMH highlights tobacco consumption as one of the serious deleterious consequences of globalization
Significant changes can be achieved through modest investments in tax increases; ad bans; strong health warnings on cigarette packages; and use of primary health care services for advice and assistance to smokers
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Millennium Development Goals (MDGS)
Overlap between the MDGs and CMH:Both seek to reduce the impact of health-
related problems as an element of economic development
Both focus on alleviation of poverty as a key determinant of future economic development
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Tobacco Cultivation
Given the growth in world population, the tobacco industry will not decline rapidly enough to cause workers to lose their jobs
Trans-national companies are increasingly replacing less efficient local operations. Manufacture of foreign cigarettes is highly mechanized
Most job losses result from increasing mechanization.
Farm families reap little profit from tobacco cultivation
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Tobacco Cultivation
Tobacco farmers in cycle of debt to repay farm input loans
Farm income vulnerable in case of bad crop year or low tobacco prices
Harm to farm families and the environment through heavy use of pesticides.
Labour intensive crop often involving women and children
Curing process harmful to health and involves extensive deforestation
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Tobacco Manufacturing and Marketing
Those working in tobacco factories or selling tobacco on the streets earn starvation wages.
Beedi workers in India among the most exploited in India
Young children often involved in the production of beedis
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The Framework Convention on Tobacco Control (FCTC)
A Global Treaty for a Global Problem
First global treaty to focus on a health issue
Negotiated under the auspices of the WHO
Came into force in Feb. 2005 following ratification by 40 countries
Includes demand and supply reduction strategies
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The FCTC:includes a variety of policy measures:
Advertising, promotion and sponsorship
Price and tax measures
Passive smoking and smoke-free environments
Packaging and labelling
Product regulation
Tobacco sales to and by young people
Treatment of tobacco dependence
Education, communication and public awareness
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Research for International Tobacco Control (RITC)
IDRC a pioneer in responding to this issue via RITC in1995 (with Health Canada & Sida)
Limited support from CIDA and Rockefeller Foundation
IDRC has recently renewed and expanded its funding to RITC
Continued funding from Health Canada; a new partnership with DFID
Focus on research, dissemination, capacity building and networking
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New Directions for RITC
Continued focus on research, capacity building, dissemination and networking
“Responsive” funding will respond to local needs and emerging topics globally
“Focused” funding will focus on Tobacco and Development issues
Allocated funding for fellowships to promote new researchers
Focus on priority countries and regions
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RITC Focused ResearchPriority Topics
Poverty and Tobacco
Tobacco Farming: Health, Livelihoods, Economics and the Environment
Health Systems Interventions
Globalization, Trade and Tobacco
Alternate Forms of Tobacco Use
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Research for Action on the FCTC
Public health issues cannot be contained within national borders; require greater collaboration and coordination
FCTC responds to:The tobacco epidemic in developing countries;Globalization;Trade liberalization
Highlights the need for: Multi-sectoral action and Trans-national cooperation
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Research for Action on the FCTC
This meeting focuses on transcending national borders, working toward greater collaboration, and building networks.
Purpose of the meeting:To capture lessons learned from the research;To discuss the policy implications of the
research;To strengthen research capacity through
interaction with peers and through specific workshops;
To provide an opportunity to network and for the development of networks
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Moving Forward
While tobacco use contributes to the entrenchment of individuals and nations in poverty, economic growth in the world’s poorest nations is likely to fuel, if unchecked, an increase in tobacco use.
Tobacco use is not a personal choice, freely made. Tobacco control should be a part of initiatives designed to improve health and reduce poverty.
Lack of statistical information results in poor evidence for the individual and national health and economic impacts of tobacco use.
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Moving Forward
Tobacco industry greatly overstates its contribution to national economies and understates the costs tobacco imposes.
Price and tax measures in coordination with measures to reduce smuggling will increase government revenues (and reduce poverty) and decrease tobacco use.
Action to reduce exposure to ETS will beneficial for health and the environment
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Moving Forward
4. Tobacco industry greatly overstates its contribution to national economies and understates the costs tobacco imposes.
5. Price and tax measures in coordination with measures to reduce smuggling will increase government revenues (and reduce poverty) and decrease tobacco use.
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Moving Forward
Controls on labelling and packaging, limits on advertising and sales to minors, education and public information will increase awareness of the dangers of smoking.
Support for alternative crops and the environment will limit the negative effects of tobacco cultivation and may alleviate poverty.
38
Thank You
Linda Waverley
http://www.idrc.ca/ritc