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Tobacco and Society: How We Can Make a Difference in Public Policy Richard D. Hurt, M.D. Professor, College of Medicine Director, Nicotine Dependence Center Mayo Clinic http://ndc.mayo.edu © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED Star Wars Theme © 1977 Composed by John Williams 3173599-2 “In 1492, Columbus sailed the ocean blue… and thus began the globalization of tobacco--- sad but true.” Glynn T, et al, CA Cancer© 2013J Clin MAYO FOUNDATION 60:50, 2010FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS Early Cigarettes • 1883 - Allen & Ginter contest for mechanical cigarette roller • James Bonsack won contest. Roller produced 120,000 cigarettes/day • James Buchanan “Buck” Duke obtained rights and in 1884 Bonsack machines went on line in Durham, NC • 1889 American Tobacco Company formed © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED Handroller- 2500 cigarettes/day Bonsack Machine- 120,000 cigarettes/day © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED Hauni Cigarette Machine- 20,000 cigarettes/MINUTE © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED James Buchanan Duke 1856-1925 © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED American Tobacco Company • 1898 – Acquired R. J. Reynolds plug tobacco company • 1899 – Controlled 93% of cigarettes, 80% of snuff, 62% of plug tobacco, and 59% of pipe tobacco in USA • 1903 – Deal with Imperial Tobacco Company of Britain created British American Tobacco • 1906 – Duke successfully lobbied Congress to NOT include tobacco in the Food and Drug Act © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED American Tobacco Company • 1907 - Antitrust suit filed • 1909 - 3rd largest industrial enterprise in USA • 1911 - US Supreme Court dissolved Duke Trust - ATC, RJR, L&M and P. Lorrilard • 1913 – “Year of the Camel” - RJR © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED WHO Framework Convention on Tobacco Control The world’s first public health treaty aimed to protect present and future generations from the harms of tobacco use and exposure to tobacco smoke. Now ratified or acceded by more than 170 countries Conference of Parties (COP4) meeting in Uruguay © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED FCTC Measures to reduce demand • Price & tax (Art. 6, Art. 7) • Protection from exposure to tobacco smoke (Art. 8) • Regulation of contents and disclosures of products (Art. 9, Art. 10) • Packaging and labeling (Art. 11) • Education, communication (Art. 12) • Advertising, promotion & sponsorship (Art. 13) • Tobacco dependence and cessation (Art. 14) © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED Endgame in New Zealand by 2025 Drs. Richard Edwards and Hayden McRobbie © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED A non-endgame approach Vision The vision for this tobacco control plan is for New Zealand to be a country where smokefree lifestyles are the norm. Goals The goals of this tobacco control plan are: to significantly reduce levels of tobacco consumption and smoking prevalence to reduce inequalities in health outcomes to reduce the prevalence of smoking among Māori to at least the same level as among non-Māori to reduce New Zealanders’ exposure to second-hand smoke. Clearing the Smoke: A five-year plan for tobacco control in New Zealand (2004–2009). Wellington: Ministry of Health, 2004. © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED Facets of the endgame Zero (or very close to) smoking prevalence Zero or close to zero uptake of tobacco Nil or close to zero supply of tobacco – e.g. prohibition, no commercial supply Full denormalisation of tobacco use i.e. smoking seen as an undesirable and aberrant behaviour, unacceptable for children Zero or close to zero tobacco related mortality and morbidity Time-limited © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED The moral and ethical case for action 1. Tobacco is a uniquely hazardous product: Major cause of ill health, premature death and health inequalities Tobacco smoking is highly addictive most smokers want to quit and regret starting but only about 2% per year quit successfully spontaneously max quit success around 20% at 1 year with support Secondhand smoke (SHS) is a significant acute and chronic health risk for non-smokers (inc children) Tobacco products are legal only due to historical accident © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED The moral and ethical case for action 2. Smoking starts mainly among children and young adults: Hardly anyone starts smoking as a mature adult Children do not (cannot) make informed decisions about smoking 3. Protecting children from known hazards is generally viewed as a moral imperative and is a societal responsibility. © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED Analogy with alcohol “Sixteen-year-olds are in no position to assess the dangers of binge-drinking. Fifteen, 14 and 13-year-olds even less so. If the industry cannot find a way to keep alcohol out of the hands of children, society must.” Dominion Post editorial (response to death of James Webster, aged 16); 13th May 2010 © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED NZ Recommendations - DO NOW Further tax increases Ban retail displays- In place in Canada.To be implemented in large stores in UK in 2012 & all retailers 2015 Tobacco sellers > 18 years Compulsory reporting of additives by brand Prohibit covert sponsorship Action to enforce illegal sales laws © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED NZ recommendations - DO NOW[cont] Ban vending machines NRT available at all tobacco retailers Pharmacists -> Quit Card providers Ban or restrict duty free imports © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED NZ Recommendations - Future Plain packaging- Australia implemented 2013 Tobacco industry funds all treatment support including pharmacotherapy Regulate nicotine and additives Explore alternative (safer) nicotine delivery systems Control retailer numbers, density, and proximity © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED Summing up We need: to switch to endgame thinking a clear vision of the endgame and a defined time period to achieve it a comprehensive endgame strategy, including overarching measures to achieve the desired rapid reductions in smoking prevalence health professionals’ support © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED Endgame in Singapore • Deny access to tobacco for citizens born in or after the year 2000 • Gradual phase out → less disruption • Aligns with tobacco industry assertion “We do not want children to smoke” • Affixing to easily identifiable year facilitates identity checking • 70% of Singaporeans support the proposal Khoo D. et al Tobacco Control 19:355, 2010 © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED Clinton Global Initiative . Created in 2005 by President Bill Clinton “to help turn good intentions into real actions and results.” . Convenes over 1,000 global leaders to devise and implement innovative solutions to some of the world’s most pressing problems . CGI members make commitments to improve the lives of people across the globe 26 Global Smoke-free Worksite Challenge . Winter meetings of CGI participants helps implement commitments and also generate new ideas . Ask all CGI members to develop and implement smoke-free worksites . Leaders of the new commitment: Mayo Clinic, ACS, J&J, DHSS, Campaign for Tobacco-free Kids 27 28 29 Howard K. Koh MD, MPH Assistant Secretary for Health US DHHS 30 http://www.clintonglobalinitiative.org/ourmeetings/2011/meeting_annual_multimedia_player.asp?id=53 31 Advocacy at Different Levels • Institution • School • Community • State • National • International © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED Being an Effective Advocate • Call or write decision-maker • Contribute to political or nonprofit advocacy organization • Cultivate relationship with decision makers • Letter to editor • Volunteer or run for board positions • Testify before legislative body © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED WHY DOES A “CIVILIZED” SOCIETY TOLERATE A PRODUCT THAT KILLS >5 MILLION PEOPLE EVERY YEAR? WE DO NOT HAVE TO AND WE SHOULD NOT! © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED December 2007 December 2010 September 2009 We owe it to our grandchildren BUT WE OWE IT TO THEIR CHILDREN AND GRANDCHILDREN, TOO! December 2012 20th Century-100 Million Deaths 21st Century-1 Billion Deaths © 2013 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH. ALL RIGHTS RESERVED .
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