Report on the Global Tobacco Epidemic, 2011, which is the third in a series of WHO reports on the status of global tobacco control policy implementation. It tracks the status of the tobacco epidemic and the impact of interventions implemented to stop it. “This report is a strong and important step in our ongoing measurement of what has been achieved in tobacco control and how much more countries need to do. We can and must continue this work – millions of people’s lives are at stake”, said Dr Ala Alwan, Assistant Director-General World Health Organization.
The report also marks the first global research on tobacco counter-advertising (which was handled by World Lung Foundation) which explores the use of mass media as a method to warn people about the dangers of tobacco use and exposure to secondhand smoke. The two main types of interventions examined in this report are health warning labels on tobacco packages and national anti-tobacco mass media campaigns.
Tobacco use continues to be the leading global cause of preventable deaths, killing nearly 6 million people and causing hundreds of billions of dollars of economic damage worldwide each year. Worldwide more than 600,000 non-smokers die from exposure to tobacco smoke each year. According to WHO estimates, if current trends continue, then by 2030 tobacco would kill more than 8 million people globally each year . 80% of these premature deaths are likely to occur in low- and middle-income countries. So tobacco control must be given the high priority by scaling up tobacco control measures.
Over the past two years, 1.1 billion people, living in 30 countries (half of them being low or middle income), have become covered by at least one MPOWER measure (M for ‘monitor’ tobacco use and prevention policies; P for ‘protect’ people from tobacco smoke; O for ‘offer’ help to quit tobacco use; W for ‘warn’ about the dangers of tobacco use; E for ‘enforce’ bans on tobacco advertising, promotion and sponsorship; and R: stands for ‘raised’ taxes on tobacco). These measures, while requiring relatively little investment, are proven to be highly effective in changing tobacco use patterns and saving lives.
Nevertheless, the tobacco epidemic continues to expand because of ongoing tobacco industry marketing and the extreme addictiveness of tobacco that makes it difficult for people to quit once they start. The WHO Framework Convention on Tobacco Control (FCTC) is an evidence-based global treaty, which has been ratified by 174 countries. Its Article 11 sets out strong, clear and legally obligatory standards for health warning labels on tobacco packaging. These standards are derived from data that effective warning labels increase smokers’ awareness of health risks, and increase the likelihood that smokers will think about cessation and reduce tobacco consumption.
Many studies have also documented the effectiveness of graphic materials that show physical and emotional harms tobacco use inflicts. Mandatory and large health graphic warning labels on tobacco packaging and hard-hitting mass media campaigns have proved effective in reducing tobacco use and encouraging people to quit.
Effective warning labels increase smokers’ awareness of health risks, and increase the likelihood that smokers will think about cessation and reduce tobacco consumption.
Canada became the first country to introduce large, graphic health warning labels on cigarette packages in 2001.
However, as of now, only 19 countries (1 billion people) follow best-practice standards by requiring large graphic health warnings on tobacco product packages, and none of these are low-income countries.
Only 6 (Bhutan, Democratic People’s Republic of Korea, India, Maldives, Nepal and Sri Lanka) out of the 11 South-East Asia Region countries, where smokeless tobacco products are extensively used, have some legislation requiring health warnings on smokeless tobacco packaging. However none of them meet the best-practice level for health warnings on smokeless tobacco products. India ranks third in prevalence of adult tobacco use with 35% of its adult population addicted to this lethal poison. Also, 25% of its adult population is addicted to chewing tobacco.
The main impediment is the tobacco industry’s bullying tactics against implementation of health warnings because they are effective in changing attitudes about smoking, and the industry is especially resistant to large, graphic pictorial warnings. Tobacco giant Phillip Morris has partially succeeded in getting strong pictorial health warnings diluted in Uruguay, and is trying to do the same in Australia. In India also, the strong tobacco lobby has been successful in the past to delay the periodical rotation of, and/or dilute health warnings on tobacco packs, as mandated in the FCTC.
Article12 of the WHO FCTC contains obligations for Parties to promote and strengthen public awareness of tobacco control issues through other means. People have a fundamental right to information about the harms of tobacco, and countries have a legal obligation to provide it.
Anti-tobacco advertising and mass media campaigns can be used effectively to increase awareness of the harms of tobacco use and of second-hand smoke exposure. Their hard hitting themes can also be used to explain the benefits of a tobacco-free society, and help convince people to quit.
Exposure to effective anti-tobacco mass media campaigns has similar effects on adults and youth, with adult smokers more likely to quit and youth less likely to become established smokers.
The report indicates that more than 70% of the world’s population saw no national tobacco counter-advertising in the last two years. Thus only about 28% of the world’s population is exposed to effective anti-tobacco mass media campaigns. India happens to be one of the 24 (out of which 16 are low or middle income) highest achieving countries on the Anti-Tobacco mass media campaigns front. In nearly 150 countries (including 110 low and middle-income countries), there is a paucity of any anti-tobacco public education using mass media.
Television advertising seems to be the most commonly employed type of media for anti-tobacco mass media campaigns. Within its National Tobacco Control Programme, the Government of India allocates approximately US$ 5 million annually to anti tobacco mass media campaigns. One of its most recent campaigns highlights the harmful effects of smokeless tobacco use. With support from the World Lung Foundation it has launched a website as an advocacy platform to highlight the dangers of smokeless tobacco products. An innovative mobile technology using text messaging has also been used to supplement television and radio advertising on the harms of smokeless tobacco use.
World Lung Foundation alone has supported the launch of 64 anti-tobacco print and broadcast mass media campaigns in 18 countries, viewed by 643 million people.
According to WHO’s data, more than twice as many middle-income countries (14) as high income countries (6) had implemented best practice campaigns.
A comprehensive total ban on all tobacco advertising, promotion and sponsorship could decrease tobacco consumption by about 7%, independent of other tobacco control measures. There are only 19 countries with 425 million people, representing 6% of the world’s population, who are fully protected against tobacco industry marketing tactics. An additional 101 countries ban national television, radio and print tobacco advertising, but not all other forms of direct and/or indirect advertising. However, this level of ban is still insufficient to protect people from tobacco advertising and marketing. 74 countries currently do not have any restrictions at all on tobacco advertising, promotion and sponsorship or have very minimal restrictions.
According to Sandra Mullin, Senior Vice President, Policy and Communications, World Lung Foundation, "We are turning the tobacco industry’s own tools against it, globalizing anti-tobacco advertising in order to make it easy to spread the message: tobacco causes illness and death. To shift behavior, counter-marketing needs to be run on a regular basis with a consistent message over the long term.”
Shobha Shukla - CNS
(The author is the Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She is also the Director of CNS Gender Initiative and CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: firstname.lastname@example.org, website: http://www.citizen-news.org/)
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