WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
REGIONAL COMMITTEE Fifty-second session Brunei Darussalam 10-14 September 2001 Provisional agenda item 15
WPR/RC52/9 26 July 2001 ORIGINAL: ENGLISH
PREVENTION AND CONTROL OF TOBACCO USE
Recognizing the worsening tobacco epidemic within the Western Pacific, in 1999 the Regional Committee adopted resolution WPR/RC50.R6 urging Member States to promote and fully support the development and adoption of the WHO Framework Convention on Tobacco Control (FCTC). In 2000, the Regional Committee noted the contribution of tobacco use to the increasing burden of noncommunicable diseases in the Region, and encouraged countries to develop comprehensive, multisectoral strategies to address lifestyle factors that contribute to noncommunicable diseases, such as tobacco use.1 Tobacco use is one of the greatest public health challenges within the Region, despite increasing advocacy and education about the need for tobacco control. Major challenges to effective control include the political, economic and sociocultural aspects of tobacco production, trade and consumption; the lack of capacity and/or political will in some countries to carry out effective tobacco control policies; the shortage of evidencebased smoking cessation interventions and programmes; the tobacco industry’s aggressive resistance to comprehensive tobacco control policies; and the need to increase participation by Member States from the Region in the FCTC process. Addressing the tobacco epidemic requires comprehensive and integrated strategies at national, regional and global levels. The FCTC will enable countries to halt the global spread of tobacco use. The extent of regional participation in the FCTC process will, in large part, determine the likelihood of success for tobacco control in the Western Pacific. This annual report is presented for the information of the Regional Committee and for discussion at its fifty-second session.
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Resolution WPR/RC51.R5.
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1. CURRENT SITUATION
Tobacco use is one of the greatest public health challenges in the Region. The Western Pacific produces and consumes a substantial proportion of the world‘s tobacco. Three of the top ten cigarette manufacturing companies in the world, producing roughly 30% of the global supply of cigarettes, are found in the Western Pacific. Altogether, almost one half of the total supply of raw tobacco in the world is produced in the Region. The extent of smoking within the Region is significant when compared to other World Health Organization regions. The Western Pacific has 422 million smokers (34.4% of the global total), of whom approximately 387 million are men, and 35 million are women. Most of these smokers are found in China, Japan, the Philippines, Republic of Korea and Viet Nam. Smoking prevalence among adult men in the Region is about 60%, the highest in the world. Per capita consumption of tobacco continues to increase at an alarming rate. The hazardous effects of tobacco use are not limited to smokers. Chewing tobacco is
prevalent among certain subpopulations, particularly in Pacific islands countries, Cambodia, the Lao People’s Democratic Republic and Viet Nam. In addition, the scientific evidence reveals that there are considerable risks to health among nonsmokers who are exposed to second-hand smoke. The large and growing numbers of tobacco users directly at risk for adverse health effects, plus the considerable numbers who are indirectly harmed by second-hand smoke, comprise a significant proportion of the Region’s population. Given the magnitude of current exposure to tobacco, it is not surprising that one in four tobacco-related deaths in the world occurs in the Western Pacific. Although the long lead times between initiation of tobacco use and development of chronic disease often mask the impact of tobacco on public health, it is a major contributor to noncommunicable diseases in many countries. Unless prevalence of tobacco use decreases, tobaccorelated cancer, lung and heart conditions, and stroke will add considerably to the already heavy burden of chronic illness within the Region. Addressing the tobacco epidemic requires comprehensive and integrated strategies at national, regional and global levels. The WHO Framework Convention on Tobacco Control (FCTC) is an international legal instrument that will enable countries to halt the global spread of tobacco use. During the Working Group meetings and the first two sessions of the Intergovernmental Negotiating
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Body in October 2000 and April-May 2001, the draft Chairman’s Text of the FCTC continued to evolve as countries proceeded with the negotiations on the draft. This process will continue with the third meeting of the Intergovernmental Negotiating Body in November 2001. The active participation of Member States in the development, negotiation and adoption of the FCTC is crucial to tobacco control within the Region. To date, 20 Member States of the Western Pacific Region have
participated in the FCTC process. Enhancing regional participation through the inclusion of all Member States in the FCTC process will, in large part, determine the likelihood of success for tobacco control in the Western Pacific. Tobacco control in the Western Pacific Region is described in greater detail in The Work of WHO in the Western Pacific Region: 1 July 2000-30 June 2001 (pp. 136–142).
2. ISSUES
1.
Tobacco use has social and political implications that stretch well beyond the boundaries of the health sector. Government ownership or subsidy of tobacco industries is a significant barrier to securing political commitment for tobacco control. Socioeconomic practices and cultural beliefs surrounding the use of tobacco hinder successful implementation of interventions to reduce tobacco consumption. Addressing these issues on a country-specific basis, as well as among subregional groupings of countries, is crucial to the development and implementation of meaningful tobacco control policies. Tobacco control needs high-level political support if social and political barriers are to be overcome.
2.
National capacity and the political will to carry out effective tobacco control policies diverge widely in the Region. Identifying particular needs and available resources within Member States, and matching resources with needs, will help countries to support each other in achieving national and regional reductions in tobacco consumption.
3.
While smokers often realize the danger they face from continued tobacco use, the addictive properties of nicotine make quitting difficult. Many current and future smokers are unaware that tobacco use is addictive and only limited information is available in the Region on smokers’ intentions to quit. There is limited availability of evidence-based smoking cessation programmes in the Region. Pharmacological aids to cessation remain unavailable in several countries and areas and are often not affordable for the majority of the population. In addition,
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health care providers often have limited motivation and training in recognizing and treating nicotine addiction, although such treatment is known to be one of the most effective clinical strategies to enable smokers to quit. More training in treatment options for smoking cessation is needed for health care providers. 4. The tobacco companies continue to market their products in the Asia-Pacific region aggressively. The resources available to the industry for promoting and sustaining tobacco use far outweigh those available for tobacco control. While some progress has been made in developing national policy and legislation, the tobacco industry has often been able to use its formidable experience of resistance to tobacco control to pressure governments to ease restrictions on the sale and promotion of tobacco products and to limit other comprehensive tobacco control measures. In addition, some tobacco companies have begun to promote themselves as friends of public health. Several countries in the Region have asked the Regional Office for guidance on how to deal more effectively with pressure from the tobacco industry. 5. Participation in the FCTC process needs to be expanded to include all Member States in the Region, in line with the request of the Regional Committee in 1999 for Member States to give their full support to the FCTC.2 This support will be critical during the ongoing negotiations on the Chairman’s Text of the FCTC.
3. ACTIONS PROPOSED
The following actions by Member States are proposed for consideration by the Regional Committee. 1. Develop and implement strategies to enable Ministers and/or Secretaries of Health to take the lead in the preparation, negotiation and ratification of the FCTC. These strategies should include the initiation of an inter-ministerial process to address FCTC-related matters and the intersectoral aspects of controlling the tobacco epidemic; and the establishment of an
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Resolution WPR/RC50.R6.
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intersectoral coordinating body, including participation of relevant nongovernmental organizations (NGOs), to guide the development and implementation of national plans of action for tobacco control. 2. Establish partnerships with other countries in order to strengthen and harmonize tobacco control strategies that have regional and global dimensions, and to make full use of existing tobacco control resources within the Region. 3. 4. Provide adequate resources to support national tobacco control programmes. Strengthen capacity for tobacco cessation interventions. Medical and health associations should include the recognition of nicotine addiction and the application of evidence-based cessation interventions in the training curriculum of health providers. The inclusion of cessation services in primary health care should be considered. 5. Implement resolution WHA54.18 (Annex), which calls for transparency in the tobacco control process, and urges WHO and Member States to assure the integrity of health policy development and to be aware of affiliations between the tobacco industry and members of their delegations to the Health Assembly and other meetings, including those related to the FCTC. 6. Participate fully and actively in the FCTC process, including the third meeting of the Intergovernmental Negotiating Body scheduled for November 2001 and subsequent meetings.
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WPR/RC52/9 page 7 ANNEX
FIFTY-FOURTH WORLD HEALTH ASSEMBLY Agenda item 13.5 22
WHA54.18 May 2001
Transparency in tobacco control process The Fifty-fourth World Health Assembly, Noting with great concern the findings of the Committee of Experts on Tobacco Industry Documents, namely, that the tobacco industry has operated for years with the expressed intention of subverting the role of governments and of WHO in implementing public health policies to combat the 1 tobacco epidemic; Understanding that public confidence would be enhanced by transparency of affiliation between delegates to the Health Assembly and other meetings of WHO and the tobacco industry, 1. URGES WHO and its Member States to be alert to any efforts by the tobacco industry to continue this practice and to assure the integrity of health policy development in any WHO meetings and in national governments; 2. URGES Member States to be aware of affiliations between the tobacco industry and members of their delegations; 3. CALLS ON WHO to continue to inform Member States on activities of the tobacco industry that have negative impact on tobacco control efforts. Ninth plenary meeting, 22 May 2001 A54/VR/9
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Tobacco company strategies to undermine tobacco control activities at the World Health Organization. Geneva, July 2000. http://www.who.int/genevahearings/inquiry.html.
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