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Discussion Paper. Progression of Tobacco Control HNP DISCUSSION PAPER Progression of Tobacco Control Policies: Lessons from the United States and Implications for Global Action About this series... This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank’s Human Development Network. The papers in this series aim to provide a vehicle for publishing preliminary and Thomas E. Novotny and Hadii M. Mamudu unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For free copies of papers in this series please contact the individual authors whose name appears on the paper. Enquiries about the series and submissions should be made directly to the Editor Homira Nassery ([email protected]) or HNP Advisory Service ([email protected], tel 202 473-2256, fax 202 522-3234). For more information, see also www.worldbank.org/ hnppublications. THE WORLD BANK 1818 H Street, NW Washington, DC USA 20433 Telephone: 202 473 1000 Facsimile: 202 477 6391 Internet: www.worldbank.org E-mail: [email protected] May 2008 PROGRESSION OF TOBACCO CONTROL POLICIES: Lessons from the United States and Implications for Global Action Thomas E. Novotny and Hadii M. Mamudu May 2008 Health, Nutrition and Population (HNP) Discussion Paper This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank's Human Development Network. The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For free copies of papers in this series please contact the individual author(s) whose name appears on the paper. Enquiries about the series and submissions should be made directly to the Editor, Homira Nassery ([email protected]). Submissions should have been previously reviewed and cleared by the sponsoring department, which will bear the cost of publication. No additional reviews will be undertaken after submission. The sponsoring department and author(s) bear full responsibility for the quality of the technical contents and presentation of material in the series. Since the material will be published as presented, authors should submit an electronic copy in a predefined format (available at www.worldbank.org/hnppublications on the Guide for Authors page). Drafts that do not meet minimum presentational standards may be returned to authors for more work before being accepted. For information regarding this and other World Bank publications, please contact the HNP Advisory Services at [email protected] (email), 202-473-2256 (telephone), or 202-522-3234 (fax). © 2008 The International Bank for Reconstruction and Development / The World Bank 1818 H Street, NW Washington, DC 20433 All rights reserved. ii Health, Nutrition and Population (HNP) Discussion Paper Progression of Tobacco Control Policies: Lessons from the United States and Implications for Global Action Thomas E. Novotny a Hadii M. Mamudu b a Director of International Programs, UCSF School of Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco, CA, United States b Post Doctoral Fellow, UCSF School of Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco, United States Paper prepared for The World Bank Consultation “Taxes for Tobacco Control: improving effectiveness at the country level”, October 2-3, 2007, Washington DC. Abstract: This paper examines the historical experience of tobacco control in the last five decades and shares important lessons of public health interventions to inform current and future tobacco control programs in other countries. The paper is divided into four parts. The first part gives an overview of the political economy, principal influences and interventions in tobacco control in the United States. It stresses the importance of information shocks and the role played by grassroots organizations. The current situation of tobacco control in the United States is further discussed in the second part, with emphasis on the economic case that led to litigation, as well as the response of the industry and the States. The third part focuses on the present efforts of multilaterals like the World Bank, technical UN agencies such as the World Health Organization, in the context of the new global governance structure: the Framework Convention on Tobacco Control (FCTC). The last section discusses lessons learned and provides recommendations for comprehensive tobacco control programs. The paper suggests five major policy drivers that constitute components of a comprehensive tobacco control program: – science to inform policy, information strategies to educate consumers, advocacy to stimulate interventions, legal actions to develop regulations, and international collaboration through the FCTC. The paper concludes that while government has the responsibility for funding and implementing these activities; these can be most effective when supported by civil society. Keywords: “tobacco”, “public policy”, “international agencies/history”, “international agencies/legislation” Disclaimer: The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the World Bank, its Executive Directors, or the countries they represent. Correspondence Details: Thomas E. Novotny, 530 Parnassus Avenue, Library Suite 366, University of California, San Francisco, CA. 94143 – 1390, United States. Phone: 415-476-3115. Fax: 415-514- 9345, Email: [email protected] iii Executive Summary The historical experience of tobacco control in the United States in the last five decades provides evidence of effective public health interventions. The tobacco industry has been working to embed tobacco use in the personal behavior of individuals as well as in national structures which extend across disparate government sectors. To face these challenges multi dimensional efforts by national governments as well as civil society are crucial. Public - Private partnerships and new funding sources would also help to achieve success in global tobacco control. Tracing the history of tobacco control in the United States takes us back to the 1950s and 1960s when knowledge of the harmful effects of tobacco use was minimal. In 1964 the US Department of Health, Education, and Welfare through the Office of the Surgeon General, officially established that Smoking was a medical problem and a public health challenge. This shaped tobacco control science, policy, and advocacy for four decades in which a major influence has been the role of science leading to policy change. This has resulted in the reduction of smoking prevalence by at least half since 1964. In 2000, the US Surgeon General’s Report proposed five approaches to reduce tobacco use and its disease impact - educational, clinical, regulatory, economic, and comprehensive. Though the qualitative assessment of their impact has been mixed, laws and policies to support these measures have been effective. The science of tobacco control strongly supports a multi-component comprehensive programme that integrates various programmatic and policy interventions to influence social and health systems. Regulatory approaches that entail increasing the price of tobacco products through taxation, implementing smoke free policies and regulations, and restricting the sale and distribution of tobacco products have supporting evidence of effectiveness. Globally, these interventions can be implemented with strong government support. However, in many countries regulatory approaches appear to have been underutilized compared to behavioral-educational approaches. Media campaigns in the US to educate the public on the health consequences of smoking have proved effective. Another influencing factor has been litigation against the tobacco industry, the legal settlements of which were used to fund comprehensive programs. Media advocacy also influenced the establishment of other policies such as clean indoor air policies, smoking cessation programs, and taxation to recover smoking related health costs. Social norms supporting tobacco use can be changed slowly with multi- dimensional interventions that depend not only on strong government support, but on strong grassroot efforts and partnerships. These efforts have been a key component of tobacco control successes in the United States and in other developed countries. In low and middle-income countries, tobacco control is increasingly important for economic development and poverty reduction. The World Bank’s research in the late 1990’s including The Economics of Tobacco Control: Towards an Optimal Policy Mix and Tobacco Control in Developing Countries provided the analytical basis for such
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