Fighting an Unpopular War: Addressing the Global Burden of Cancer and Tobacco Loyce Pace Bass, MPH Director of Regional Programs Global Health
Understanding the Challenges Making the Case for Cancer & Tobacco Control
Why Cancer?
Tobaccorelated Diseases
6 million
WHO, World Health Statistics 2007 3
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World Economic Forum Global Risks 2010
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Why Tobacco? • Single most preventable cause of death in the world • Tobacco kills 6 million people annually and is projected to kill 1 billion this century • 70% of tobacco related deaths are in low and middle income countries • Tobacco use accounts for about 30% of all cancer deaths • Exposure to second hand smoke increases the risk of both cancer and heart disease by about 25% 7
Tobacco in Africa • Big Tobacco’s “final frontier” – Growth opportunity for industry – “CSR” programs • Western status perceptions positively reinforce tobacco use • Limited data reporting low prevalence but on the rise 8
Four Stages of the Tobacco Pandemic
Countries in each stage
STAGE 1
STAGE 2
•SubSaharan Africa
•China •Japan •Southeast Asia •Latin America •North Africa
STAGE 3
•Eastern Europe •Southern Europe
STAGE 4
•Western Europe, UK •USA •Canada •Australia
Adapted from: Lopez AD, Collishaw NE, Piha T. A descriptive model of the cigarette epidemic in developed countries. Tobacco Control, 1994, 3:242-247.
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Identifying the Solutions International Tobacco Control Campaigns & Interventions
Framework Convention on Tobacco Control (FCTC): Highlights • World’s first public health treaty • 168 parties covering 86% of the global population • Basis for expanded evidencebased programs and campaigns 11
FCTC: Mandatory Provisions • a comprehensive ban on advertising, sponsorship, and promotion, with narrow exceptions for countries such as the U.S. that face constitutional conflicts • warning labels that cover at least 30% of the principal display areas • elimination of deceptive and misleading labels such as “light” and “low tar” • protection of populations from exposure to secondhand smoke in public places and places of work • specific measures to reduce tobacco smuggling 12
FCTC: Additional Recommendations The treaty also encourages parties to enact other tobacco control policies, such as: • increasing tobacco taxes • eliminating duty-free sales of tobacco products • considering litigation against the tobacco industry • prohibiting the sale of tobacco to minors • including tobacco cessation services in national health plans 13
Continent-based center for promotion of effective policies through advocacy, research, surveillance, training with the following goals: •Improve data collection •Promote domestic legislation •Raise public awareness •Improve treatment access •Address resource limitations
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Africa Tobacco Control Grant Projects •
Establishment of tobacco control legislation
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Enforcement of existing smoke-free policies
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Special private-sector engagement and youth mobilization for demonstration of proven tobacco control best practices
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Innovative interventions & technologies for tobacco control communication & advocacy
•
Economics, industry, & tax research (new)
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Africa Tobacco Control Consortium • Implement policy (FCTC) – Smoke-free places – Advertising – Labeling – Taxation • Advance policy (advocacy) • Protect policy (countermeasures) • Promote policy (research) 16
Mobilizing the Response Advocacy for Global Cancer & Tobacco Control
Again, why cancer?
Tobaccorelated Diseases
6 million
WHO, World Health Statistics 2007 18
Common Cancer & NCD Risk Factors
• Tobacco use • Alcohol abuse • Unhealthy diet • Physical activity
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More NCD projections… (WEF) •
•
• •
Though linked to the rise in obesity associated with developed nations, low- and middle-income countries account for 80% of all deaths from chronic diseases globally. These conditions are the leading cause of death worldwide with the exception of sub-Saharan Africa and, unfortunately, chronic disease mortalities will overtake those of infectious diseases in that region as well by 2030. Out of the 35 million people who died from chronic diseases in 2005, one-half were under 70 and one-half were women. Over the next decade, if not addressed effectively, chronic diseases will increase by 27% in Africa, 25% in the Middle East and 21% in Asia and Pacific, accounting for 75% of all deaths globally.
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Do the resources match the needs? Global Health Disbursements - 2005
3,000
US$ millions
2,500 Includes World Bank, US Government, Gates Foundation, Global Fund
2,000 1,500
$84M
1,000
$24M
500
O th
er I
H
nf ec t
io u
IV s /A ID s In ju ry M M at al er na aria l N CD He al s th (c an ce r) Po lio To ba cc TB o To ba (20 05 cc ) o (2 00 8)
0
Sridhar & Batniji, Lancet, 200821
Photograph of a Man Holding the American Cancer Society’s Tobacco Atlas, July 23, 2008
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Setting the Agenda: Global Response • Advocate for non-communicable disease to be global health priority. • Develop integrated global health goals, interventions, or campaigns. • Mobilize financial and human resources to address burden. 23
Setting the Agenda: Local Response • Build the evidence base for action. • Develop and monitor comprehensive national or state cancer/NCD plans. • Ratify and enforce the Framework Convention on Tobacco Control. 24
Multilateral Advocacy Opportunities • G8/G20 cancer panel (June 2010) • Review of Millennium Development Goals & NCDs (September 2010) • UNGASS on NCDs (TBD 2011)
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Bilateral Advocacy Opportunities U.S. Examples: • FCTC ratification • Global Health Initiative • Integration of cancer/NCDs in current women’s health, health systems, or other funding streams 28
Civil Society Mobilization • Industry initiatives – CCA Business Summit 2009 – World Economic Forum sessions • Media engagements – Summits in Africa and LatAm • Regional Collaborations 29
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REGIONAL MEDIA SUMMIT
Celebrity Survivor
WHO Cancer Officer
Leading Tobacco Control Advocate
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Additional Resources: Data • Cancer Atlas
– http://www.cancer.org/downl oads/AA/CancerAtlasFront.p df • Tobacco Atlas – http://www.cancer.org/docroot/A A/content/AA_2_5_9x_Tobacco _Atlas_3rd_Ed.asp 33
Additional Resources: Interventions • Cervical Cancer Prevention (PATH) – http://www.path.org/cervicalcancer.php • Breast Cancer Early Detection (BHGI) – http://portal.bhgi.org/Pages/Default.as px • Tobacco Control: Smokefree Air (GSP) – http://www.globalsmokefreepartnershi p.org/ 34
Additional Resources: Policy • Public Cancer Program Planning – http://www.uicc.org/templates/ui cc/pdf/nccp/nccp.pdf • Global Cancer & NCD Advocacy – http://www.who.int/ncdnet/en/ • Global Tobacco Control Advocacy – http://www.fctc.org/ 35
Thank you. E-mail: lpace@cancer.org Update: cancer.blogs.com