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Smokefree

Re-energizing tobacco control with evidence-based findings

The accumulated evidence over the past half century on the causal relationship between smoking and harm to health provides us with a robust scientific foundation to inform policy design and action.

http://blogs.worldbank.org/health/re-energizing-tobacco-control-evidence-based-findings

Tobacco use is a leading cause of death worldwide, killing close to 6 million people each year. This enormous loss of life and its social and economic impacts undermine development across countries.

While progress has been made in global tobacco control since 2005, when the World Health Organization’s Framework Convention on Tobacco Control (WHO’s FCTC) came into force, renewed effort is needed across low-and middle-income countries, led by national governments, to halt this human-made health scourge once and for all.

In an era, where many question the power of scientific evidence to influence human behavior: whether at the level of individual lifestyle choices, or of public policy, I believe that faith and reason remain the essential guideposts for charting human progress.

The rational case for tobacco control is that it aligns individual self-interest, in terms of preserving health and avoiding suffering, with governments’ economic interests in reducing expenditures, increasing revenue, and maximizing social welfare. Indeed, individual self-preservation, domestic revenue generation, and improvement of overall social well-being is a powerful combination of motivators!

To make this combination work, policy formulation should be informed by a clear understanding of the biological and behavioral mechanisms that lead to the onset of tobacco-related diseases and their adverse health and economic effects. By using country-specific data, we can target policy makers, government officials, and health services personnel, particularly those working at the community level, to raise awareness of the dangers of tobacco for patients, families, and the general population.

The message has to be stark and unapologetic: both active smoking and exposure to secondhand smoke cause disease and kill prematurely. Indeed, accumulated evidence shows that nicotine (a chemical in tobacco): 1) Is a highly addictive stimulant that at high levels produces acute toxicity; 2) activates multiple biological pathways through which smoking increases risk for disease; 3) adversely affects maternal and fetal health during pregnancy, contributing to adverse outcomes such as preterm delivery and stillbirth, as well as congenital malformations (e.g., orofacial clefts); and 4) during fetal development and adolescence has lasting adverse consequences for brain development. It also shows that tar, the resinous, partially combusted particulate matter produced by the burning of tobacco, is toxic. It damages the smoker’s lungs over time. Carbon monoxide, a colorless, odorless gas produced from the incomplete burning of tobacco, accumulates indoors, and reduces the oxygen-carrying capacity of the blood.

We have to hammer home that cigarette smoking is causally linked to diseases of nearly all organs of the body. The evidence is sufficient to conclude that the risk of developing lung cancer from cigarette smoking has actually increased since the 1950s, due to changes in the design and composition of cigarettes. We have to explain that there is evidence for a causal relationship between smoking and several types of cancer, including liver and colorectal cancers, and prostate cancer. Smoking is the dominant cause of chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis; and smoking increases the risk of tuberculosis. We have to show that research continues to identify diseases caused by smoking, including such common diseases as diabetes. Scientists now know that the risk of developing diabetes is 30–40 percent higher for active smokers than nonsmokers.

Crucially, we need to link health arguments with the economic case for tobacco control. That case is powerful, as confirmed by recent studies demonstrating huge smoking-attributable economic costs in the United States and other countries. We can prove that the health benefits of tobacco taxes and other regulatory and control measures far exceed any required increase in taxes and prices, while disproportionately benefiting low-income households, as shown in a recent study in Chile and by results of the 2012 “sin tax reform” in the Philippines. Modeling work, as recently done in countries such as Armenia, Colombia, Lesotho, Moldova, Nigeria, and Ukraine, can inform policy making by reliably quantifying the likely impact of tobacco tax increases on prices, consumption, and domestic revenue mobilization. And related work in Ukraine, shows the estimated positive long-term health and cost-avoided impact of tobacco taxation and other control measures.

As we move into the third decade of the 21st Century, the achievement of smoke-free societies should be a critical marker of sustainable development. Globally, Finland, is paving the way. It has become the first country to set the goal of making itself tobacco-free by 2040. But to realize that vision, saving our children and their children from tobacco addiction, disease, and early death, we have to move from declaration of good intentions to committed, measurable, and sustained action over the medium term that is informed by quantifiable public health and economic evidence.

Don’t head to Finland if you fancy sitting out on a veranda with a beer and a smoke.

https://www.joe.co.uk/fitness-health/one-major-european-country-looks-set-to-be-completely-cigarette-free/108228

The European country looks set to be the first in the world to become completely cigarette-free. The country originally proposed a goal of being smoke-free by 2040 but new legislation today says the goal can be achieved by 2030.

According to the Nordic version of Business Insider, the government looks set to achieve the health goal by coming down hard on smokers and retailers.

Housing associations can now enforce a smoking ban on balconies and yards belonging to the housing complex. Capsule cigarettes that activate a taste such as menthol or blackcurrant when squeezed are getting banned outright.

Retailers are charged fees for selling nicotine products and the hike in costs means selling smokes is verging on non-profitable.

Finland is the first country in the world to enforce such stringent legislation on smokers. It has been committed to reducing smoking since 1978 when it first banned the advertising of nicotine products. Smoking at the workplace has been banned since 1995 and in bars and restaurants since 2007.

According to Finland’s National Institute for Health and Welfare, smoking statistics have consistently decreased over the past 20 years. Only 17% of the population consider themselves smokers.

Up in Smoke: Finland on the Way to Completely Eradicating Tobacco Use

Finland has stepped up its efforts to completely ban tobacco smoking within its borders. A new law calling for tobacco smoking to be ended entirely by 2030, has introduced several new regulations on smokers and tobacco retailers.

https://sputniknews.com/europe/201701191049745363-finland-smoking-tobacco-eradicate-law/

The most recent regulations allow housing associations to ban smoking on lawns and balconies that they own. Cigarettes with flavor capsules embedded into their filters have been banned entirely. The fees that municipalities can charge on retailers selling tobacco has been drastically increased, as much as €500 per point of sale.

Some stores in Finland’s second largest city of Espoo have seen increases in fees in excess of 1,800 percent, and even 2,600 percent. Many retailers have claimed that the fee increases have made it unprofitable for them to sell cigarettes, and they would cease retailing the product entirely if smokers did not also buy food items alongside tobacco.

The Finnish smoking ban is so strict that it even extends to “imitation products” that do not contain tobacco or nicotine. Lakupiippu is a popular Finnish candy, a stick of liquorice shaped to look like a smoking pipe. The National Supervisory Authority for Welfare and Health (Valvira) has banned the pipes from being used in retailer loyalty programs as they “promote smoking.” Valvira’s opinion on candy cigarettes is unknown.

Finland has long led the world in banning and regulating smoking. The country banned advertisement of nicotine products in 1978, smoking in the workplace in 1995, and smoking in bars and restaurants in 2007.

The number of Finns who are smokers has steadily declined over the last 20 years, likely due to the costs and difficulties of the habit. A study with the Finnish Cancer Registry claims that “practically all Finnish men… born before the 1930’s practiced smoking.” Reports show that 18.6 percent of Finnish adults were smokers in 2009. That dropped to 17 percent in 2014 and 16 percent in 2015.

Finland is neck-and-neck with fellow Nordic country Denmark, who announced in 2016 their intention to create “the first smoke-free generation” by 2030 with a $334 million program to end smoking and other cancer risks to Danes.

SMOKEFREE 2025 AOTEAROA/NEW ZEALAND

New Zealand’s Smokefree 2025 goal is rooted in long-standing concerns among Mäori (the indigenous peoples of New Zealand) communities and leaders about the high rate of smoking related harms among Mäori.

In 2006 a leading Mäori Party Member of Parliament (MP), Hone Harawira, introduced a private member’s bill to make it illegal to produce or sell tobacco in Aotearoa (the Mäori name for New Zealand).

The bill was not successful.

However, it contributed to a change in focus of the aims for Mäori in tobacco control, from “auahi kore” (smoke-free), to “tupeka kore” (tobacco-free), led by another Mäori advocate, Shane Bradbrook.

The immediate trigger for New Zealand’s goal was the 2010 Mäori Affairs Select Committee (MASC) inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Mäori. The inquiry drew on input from multiple stakeholders, including Mäori communities, wh nau (extended family), hapü (sub-tribe), and iwi (tribes), researchers and clinicians.

The first of the MASC’s 42 recommendations was endorsed by the government in March 2011 in setting a goal of “reducing smoking prevalence and tobacco availability to minimal levels, thereby making New Zealand essentially a smoke-free nation by 2025.” In doing so it became the first government in the world to set a specific ‘endgame’ goal for the use of smoked tobacco products. This goal goes well beyond the more incremental target of the World Health Organization (WHO): a 30-percent reduction in  smoking prevalence, from 22 percent in 2010 to 15 percent in 2025.

New Zealand’s Smokefree 2025 goal has had a highly positive impact. It has created a clarity of purpose and clear timeline that has galvanised the tobacco control sector, media and the public. It has stimulated local Smokefree coalitions, and facilitated the discussion of radical interventions such as mandated very low nicotine cigarettes or radical reductions in supply of tobacco.

The goal has overwhelming public support and has ensured that tobacco control remains strongly on the political and policy agenda.

Since the adoption of the goal, some key interventions have been introduced, including:

• Annual, above-inflation, tobacco excise tax increases since 2010
• Introduction of smoke-free prisons in 2011
• Removal of point-of-sale tobacco displays in shops in 2012, and
• Substantial reductions in duty-free allowances for tobacco in 2014.

In September 2016 the bill to introduce standardised packaging (also known as plain packaging) was passed by Parliament; implementation will occur in the next 18 months. The Ministry of Health is currently consulting on permitting the sale of nicotine containing e-cigarettes and e-liquids.

There are however growing concerns about whether the Smokefree 2025 goal will be achieved. The goal is often interpreted as reaching a smoking prevalence of less than 5 percent.

Smoking prevalence in 2014-15 in the New Zealand Health Survey was 17 percent. Modelling studies suggest the government’s midpoint target of 10 percent by 2018, and the 5-percent target, are unlikely to be met on current trends. Furthermore, current smoking prevalence of 38 percent for Mäori and 25 percent for Pacific peoples are unacceptably high. Studies suggest that the 5- percent figure for Mäori will not be achieved until beyond 2060.

One of the key MASC recommendations was for the government to establish a tobacco control strategy and action plan with a strong emphasis on Mäorifocused outcomes.

No such plan has been developed. It is unclear how the government intends to achieve the Smokefree 2025 goal, and what measures will be taken to reduce the unacceptably high level of smoking among Mäori and Pacific peoples.

Furthermore, although the government has implemented some positive measures since 2011, many more, including several key recommendations in the MASC Inquiry report, remain unaddressed.

For example, the government Smokefree 2025 goal included the aim of reducing tobacco availability to minimal levels by 2025, and also a commitment to investigate options for measures to reduce tobacco supply. However, the ministry of health in a report to the MASC described these measures as ‘low priority’, and there is no
evidence of any investigation or implementation of supply-side measures, other than the restriction on duty-free sales introduced in 2014.

Adoption of the Smokefree 2025 goal put New Zealand at the forefront of tobacco control internationally. However, the goal will not be reached without bold and determined political leadership.

Interventions cannot be cherrypicked according to what is politically pragmatic.

Achievement of the goal will require the government to develop a strategy and introduce a comprehensive range of effective interventions, developed in partnership with Mäori and Pacific communities and leaders, building on the energy, commitment and innovation to achieve Smokefree 2025 that is being shown by local coalitions across New Zealand.

With such a robust, evidencebased and comprehensive approach, the Smokefree 2025 goal can and should be achieved.

Professor Richard Edwards , Co-Head of Department, Department of Public Health, University of Otago, Wellington,

Shayne Nahu, Health Promotion and Campaigns Manager, Cancer Society of New Zealand,

Boyd Broughton, Programme Manager, Action on Smoking and Health,

Zoe Hawke, General Manager Tobacco Control Advocacy, Häpai

Te Hauora Mäori Public Health,

Louisa Ryan, Pacific Health Manager, Heart Foundation.

NZ won’t make smokefree by 2025 target – study

http://www.newshub.co.nz/nznews/nz-wont-make-smokefree-by-2025-target–study-2016080420

A new study shows New Zealand is way off its target to become smokefree by 2025.

The Government has committed to a goal of reducing smoking to 5 percent of the population or less within the next nine years.

But researchers at the University of Otago, in a series of articles published in the New Zealand Medical Journal, say current efforts aren’t enough.

“We want to achieve pretty much nil smoking,” says Prof Richard Edwards.

“Or certainly less than 5 percent, in all groups of the population, and our evidence is that for Māori we’re not going to do that until 2060, rather than 2025.”

For smoker Rachel Beaumont, her story is a familiar one.

“I got addicted at a young age. Plus like both my parents smoke, my whole family smokes,” she says.

“I know it’s not good for me but it’s hard to give up, aye?”

Smoking is the single biggest preventable risk factor for premature death and morbidity in New Zealand – it’s worst among Māori and Pacific people.

Efforts are being made to lower rates – taxes on cigarettes are going up, there are health warnings on packs, and the Government’s looking to bring in plain packaging. Even smoking in public spaces is under threat as councils investigate new bylaws.

But are all these measures working?

While overall rates are slowly declining, now around 15 percent, more than a third of Māori (35.5 percent) and almost a quarter of Pacific people in New Zealand smoke (22.4 percent).

The rates among women are even higher.

“Being brought up like people around us smoked, so I guess we do it too,” says one woman smoker.

She’s trying to cut down because at 27, it’s already affecting her health.

“I’m down from a pack a day to about four cigarettes a day.”

Māori and Pacific people are at a much higher risk of hospitalisation or death from respiratory disease.

Ministry of Health figures show Māori are 3.5 times more likely to be hospitalised for chronic obstructive pulmonary disease than non-Māori, and Māori children are one-and-a-half times more likely to have asthma than non-Māori children.

The Ministry of Health says while smoking rates have halved overall in the past 30 years, it has “priority populations where we need to do better – that includes our Māori and Pacific people, where there’s a high burden of harm caused by tobacco.”

Researchers says more could be done to raise awareness and reduce supply.

“Tobacco is available in every dairy, every supermarket, every gas station,” says Prof Edwards.

“We’re not trying to reduce the supply of tobacco and we’re not doing enough on the mass-media campaigning side.”

But for some, like Ms Beaumont, it will take more than money and health warnings to quit.

“If I got sick, if I got cancer or something, then yep, I’ll give up.”