Building the evidence base for global tobacco control.

Building the evidence base for global tobacco control Marlo Ann Corrao,1 G. Emmanuel Guindon,2 Vilma Cokkinides,3 & Namita Sharma4 The tobacco control movement needs a global information system permitting routine monitoring of the tobacco trade, tobacco farming, the tobacco industry, the prevalence of tobacco use, associated mortality, and national resources for combating tobacco. The Tobacco Control Country Profiles database, a data collection initiative led by the American Cancer Society in collaboration with WHO and the Centers for Disease Control and Prevention, represents the first step in the development of such a system. Baseline data on several indicators of tobacco use were obtained from 191 Member States of WHO, two Associate Members, Hong Kong Special Administrative Region of China (Hong Kong SAR), China (Province of Taiwan) and the West Bank and Gaza Strip. The methods used to compile the data are described in the present paper. Selected indicators from the database were analysed in order to demonstrate the potential utility and value of data derived from an information system devoted to tobacco control. The analyses covered gender-specific smoking prevalence by WHO Region, per capita cigarette consumption by Human Development Index (HDI) category, and average real annual percentage changes in cigarette prices between 1990 and 1999 for selected countries in each category. In 1998, men were almost four times more likely than women to be smokers. The prevalence of smoking among men was highest in the Western Pacific Region. The differential in gender-specific smoking prevalence was narrowest in the Region of the Americas and the European Region. It was wider in the South-East Asia Region and the Western Pacific Region. The lowest and highest per capita consumption of manufactured cigarettes occurred in the lowest and highest HDI categories respectively. In the medium HDI category, China’s growing cigarette consumption after 1975 had a major bearing on the rise in per capita consumption. Cigarette price trends suggest that there is considerable scope for increasing taxes on tobacco products, particularly in low or medium HDI countries. The implications of the findings for future tobacco control efforts are discussed, as are issues surrounding the quality of available data, priorities for future data collection and the need to maintain and improve the information system in order to support such efforts. Keywords: smoking, statistics; smoking, epidemiology; tobacco, statistics; prevalence; commerce; databases, factual, utilization; information. Voir page 889 le re´sume´ en franc¸ais. En la pa´gina 889 figura un resumen en espan˜ol. Introduction It has been estimated that some three million deaths are attributable to smoking annually and that the number could rise to tenmillion within 30 to 40 years (1). Effective action against tobacco requires coun- tries to understand the magnitude of the adverse effects of smoking on their populations. As country representatives negotiate WHO’s Framework Con- vention on Tobacco Control, the need for reliable and timely data on tobacco and its use is greater than ever before. The effects of tobacco use could be monitored through a global system routinely assem- bling information on the tobacco trade, tobacco farming, the tobacco industry, the prevalence of tobacco use, associated mortality, and national resources for combating tobacco. Anticipating the demand for a global information system to support new tobacco control efforts, WHO and the Centers for Disease Control and Prevention initiated the development of the National Tobacco Information Online System (known provisionally as NATIONS) in 1998. The baseline data for this system were collected for the Tobacco Control Country Profiles (TCCP) project, led by the American Cancer Society. The project has produced a monograph to be presented at the 11thWorld Conference on Tobacco or Health (Chicago, 6–11 August 2000). In order to demonstrate the potential utility of the data available from the TCCP project and later from NATIONS, we have analysed gender-specific smoking prevalence, per capita cigarette consumption, and changes in cigarette prices. The analyses illustrate the type of comparison that can easily be made between regions and countries by means of data from 1 Program Manager, Tobacco Control Country Profiles, American Cancer Society, 1599 Clifton Road NE, Atlanta, GA 30329–4251, USA. Correspondence should be addressed to this author. 2 Economist, Tobacco Free Initiative, World Health Organization, Geneva, Switzerland. 3 Director, Risk Factor Surveillance, American Cancer Society, Atlanta, GA, USA. 4 Presidential Management Intern, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. Ref. No. 00–0648 Special Theme – Tobacco 884 # World Health Organization 2000 Bulletin of the World Health Organization, 2000, 78 (7) theTCCPproject, which represents the first step in the development of a global tobacco information system. In addition, we highlight issues surrounding the quality of available data, priorities for future data collection, and the need to maintain and improve the system in order to support tobacco control efforts. Methods For analyses of smoking prevalence we categorized 191 Member States of WHO, two Associate Members, Hong Kong SAR, China (Province of Taiwan) and the West Bank and Gaza Strip, thus allowing comparison with previous studies con- ducted by WHO. For analyses of manufactured cigarette consumption we categorized countries according to the Human Development Index (HDI) (2), whereby 174 countries are placed in high, medium or low categories based on life expectancy, educational attainment and income, giving a better measure of basic human capabilities or deprivation than income alone. This made it possible to examine how manufactured cigarette consumption varied with basic standards of living. Country-specific statistics on smoking preva- lence in the TCCP database were obtained through Medline literature searches, personal contacts with investigators and nongovernmental organizations en- gaged in tobacco control, and reports from health ministries,national statisticalofficesandWHOcountry representatives. The minimum inclusion criteria for a surveywere the following itemsof information: date of the survey or its publication; characteristics of respondents (age and sex distribution); a description of sampling and data collection methods; and the questions used in assessing smoking behaviour. When several studies from the same country met these criteria they were compared with respect to geographical coverage, dates, sample sizes, response rates andmethods.Wherever different sources yielded contradictory data on prevalence, historical data were reviewed and experts working in the country were consulted. The most recent and representative studies on adult smoking prevalence were included. Regional estimates of smoking prevalencewere derived on the assumption that all studies reported current daily and occasional smoking among persons aged 15 years and older and that they reflected the smoking statuses of the populations in 1998. The gender-specific prevalence estimates for each coun- try were weighted by the size of the male and female populations aged 15 years and above. The values were averaged so as to obtain WHO weighted regional prevalence estimates. Each of these was assumed to apply to an entire WHO region. The number of smokers in each region was estimated by multiplying the prevalence by the total population aged 15 years and above. Data on per capita cigarette consumption in the TCCP were derived from production, import and export data in several electronic databases and national statistical yearbooks available for public scrutiny. Statistics on cigarette imports, exports and production were obtained from the United Nations Statistical Division’s Commodity Trade Statistics, the Industrial Commodity Production Statistics databases, the Uni- tedStatesDepartmentofAgriculture, andtheFoodand Agricultural database.1 For countries where these data were unavailable, figures from national statistical agencies and private research firms were used. Cigarette consumption in each country was calculated as production plus imports minus exports, using a three-year moving average for the years 1975 and 1985. For high development countries, consumption was also calculated for 1995, a year in which trade and production data were not available formost countries in the medium and low development categories. In the medium development category, consumption was calculated for 1994, and in the low development category it was calculated for 1991. Average per capita consumption was estimated within each HDI category by combining the country-level consump- tion figures and dividing by the population aged 15 years and above. Adult per capita cigarette consumption in the medium development category is presented both including and excluding China and is calculated separately for China. Data on cigarette prices, reflecting prices in the autumns of 1990 and 1999 unless otherwise noted, are presented by HDI category in US$ on the basis of values in local currencies and exchange rates in force when surveys were conducted (price and exchange rate data were obtained from the Economist Intelli- gence Unit). For countries where prices were sampled in more than one city, averages of all the city prices were calculated. Average annual real percentage changes in price between 1990 and 1999 were calculated using the percentage difference in local currency prices while taking into account or discount- ing for inflation. These calculations were facilitated by creating an inflation index based on estimates provided by the Economist Intelligence Unit. Results Prevalence of smoking Data on smoking prevalence were available from countries with populations representing 55.4 % of the African Region, 96.3% of the Region of the Americas, 88.7% of the Eastern Mediterranean Region, 88.8% of the European Region, 96.9% of the South-East Asia Region and 99.3% of the Western Pacific Region (Table 1). Menwere almost four times as likely to smoke as women, yet 23% of females were smokers in the Regionof theAmericas and23.4%were smokers in the 1 The following product codes were used to identify data for analysis in each of the sources: code 1222, COMTRADE Standard International Trade Classification (Revision 2); code 3140-07, UNSD Production International Standard Industrial Classification of all Economic Activities (Revision 2); code 828, FAOSTAT. Building the evidence base for global tobacco control 885Bulletin of the World Health Organization, 2000, 78 (7) European Region. Smoking prevalence among men was highest in the Western Pacific Region and lowest in the EasternMediterranean Region. Among women, smoking prevalence was highest in the European Region and lowest in the Western Pacific Region. There were about 1.235 billion adult smokers in a total world population of 5.926 billion (US Central Intelligence Agency’s estimate of the world’s popula- tion in 1998). On the assumption that there will be no change in the global prevalence of smoking, it can be expected that the number of cigarette adult smokers will reach 1.278billion this year (2000) and1.671billion in 2020 because of changes in theworld population (3). Per capita consumption The percentages of populations in the calculations of per capita consumption varied by HDI category and by year (Table 2). Fig. 1 presents estimates of per capita cigarette consumption for over 15-year-olds in 1975, 1985 and 1995 by HDI category. The estimates for countries in the medium category are presented with and without China and separately for China. The highest per capita consump- tion of manufactured cigarettes occurred in the high developmentcategoryanddecreasedbetween1975and 1995. Countries in the medium development category experienced a progressive 46% increase in consump- tion between 1975 and 1994, reaching 1139 cigarettes per capita in 1994. China experienced an increase in per capita consumption at a greater rate than that of the mediumdevelopment category as awhole from1975 to 1994. In total, China experienced a128% increase inper capita consumption between 1975 and 1994. Without China’s contribution to the medium development category, its per capita consumption would have decreased slightly between 1985 and 1994. Per capita cigarette consumption in the lowdevelopmentcategory remained fairly constant from 1975 to 1991. Price of cigarettes Table 3 presents trends in cigarette prices in various countries. Substantial increases in real cigarette prices, adjusted for inflation, occurred in only France, South Africa, the UnitedKingdom, and the USA. No increase or a substantial decrease in cigarette prices occurred in more than half the countries listed. This was especially true of imported brands. Discussion Using the TCCP database to support tobacco control The analyses presented above demonstrate the utility of the data available in the database for supporting programme and policy planning for tobacco control. For instance, analyses of smoking prevalence and cigarette consumption can assist in identifying the countries with the greatest need for resources devoted to tobacco control efforts. Globally, some 30% of adults were estimated to be smokers in 1998. By 2020 the number of smokers will have increased by 35% if global smoking prevalence remains the same. Per capita cigarette consumption trends over 20 years, however, demonstrate the changing nature of the pandemic. If consumption trends continue as they have been since 1975, an increase in cigarette consumption will occur in economically developing countries and a gradual decrease will occur in economically developed countries. The countries with the greatest expansion in the cigarette market will be those with the smallest resources available for tackling the health problems associated with tobacco use. While these analyses used very broad economic categories, the TCCP database allows comparisons between countries, geographical regions or other groupings which might lend support to tobacco control initiatives. Analyses of average real percentage changes in cigarette prices help to identify policy areas in which national governments can improve their efforts in tobacco control. The cigarette price trends in our study suggest that there is scope for increasing taxes on tobacco products, most notably in countries belonging to the low and medium HDI categories, Table 1. Gender-specific smoking prevalence by WHO Region, 1998 Weighted prevalence estimate Estimated numbers of smokers Number % of total (%) (millions) of studies population represented by studies Region Male Female Total Male Female Total Africa 36.2 9.4 22.9 59.6391 15.1086 74.7477 15 55.4 The Americas 34.7 23.0 28.7 98.0754 67.8454 165.9209 30 96.3 Eastern 34.2 8.7 21.8 49.7699 11.9266 61.6965 17 88.7 Mediterranean Europe 43.5 23.4 33.0 144.3112 84.6990 229.0102 40 88.8 South-East Asia 48.2 8.2 28.6 242.6307 39.4710 282.1017 6 96.9 Western Pacific 62.3 5.8 34.4 387.2792 34.9310 422.2101 23 99.3 Total 47.9 12.4 30.2 981.7055 253.9816 1235.687 131 92.3 Sources: American Cancer Society and World Health Organization, TCCP database. Note: Several small countries for which population figures were not available did not contribute their population weight to the analysis. Special Theme – Tobacco 886 Bulletin of the World Health Organization, 2000, 78 (7) where cigarette prices have failed to keep up with increases in the general price level of goods and services. Cigarettes were more affordable in 1999 than at the beginning of the decade. Increasing the price of tobacco products is arguably one of the most effectivemeans of curbing their consumption (4). On average, a price increase of 10% can be expected to reduce the demand for cigarettes by about 4% in high-income countries and by about 8% in low- income and middle-income countries (5). The young (6, 7) and the poor (8, 9) tend to be more responsive to price changes than other groups of people. Analyses using data from the TCCP database, and later from NATIONS, can provide evidence in support of the World Bank’s tobacco tax and price increase strategy and related policies. Using the TCCP database for needs assessment In addition to providing an evidence base for tobacco control, the database identified disparities between countries in regard to the amount and quality of data available for analysis. This indicated priority areas for future data collection and tobacco control surveil- lance efforts. For instance, smoking prevalence statistics were not found for 33% of the countries, provinces and territories. The prevalence of smoking in the African Region has probably been influenced by the lack of data because only half the Regional population contributed to the estimate, whereas the data for the other regions cover more than 85% of their populations. Compared to previously reported statistics the representativeness of Africa’s regional smoking prevalence data has improved. In 1997, for example, WHO’s Tobacco or Health Programme analysed regional smoking prevalence in the early 1990s (10). The new estimate covers 22% more of the African Region’s population. The validity of estimates in developing regions can be expected to improve with increased access to country-specific data and increased capacity and resources for monitoring risk factors. Standardized survey meth- ods would also increase the utility of regional estimates. In all regions there were variations between countries in the survey methods employed, and regional estimates were affected by the compar- ability of country-specific data. The TCCP database made it possible to see ways in which consumption estimates could improve through standard reporting of country-level data to an information system. The accuracy of most per capita consumption estimates is limited by the information not included in each country’s official trade and production statistics. In countries where the preferred cigarettes are not of the manufactured kind the TCCP data underestimate consumption. Country-level data related to the consumption of roll- your-own, bidi and kretek cigarettes would usefully supplement information on manufactured cigarettes from databases of the United Nations and the United States Department of Agriculture. This is particularly relevant to the Eastern Mediterranean Region and Central and Southern Asia, where tobacco consump- tion is likely to be underestimated if traditional forms of use are excluded from the calculations. Routine data collection is less likely to provide the means of overcoming certain additional obstacles to estimating consumption, indicated below with a view to aiding the interpretation of TCCP data. The calculations we used did not account for factors that increase or decrease the true volume of trade and production, such as smuggling and tax exemption. The consumption formula does not account for cigarette stocks held in reserve by cigarette wholesalers and retailers. This factor only becomes apparent if a very large net change in stock volume occurs from one year to the next. The per capita consumption calculation includes only persons aged 15 years and older in its denominator and thus does not account for younger smokers. The importance of this factor is greatest in certain developing countries where the largest proportion of the population consists of people under 15 years of age. Source: American Cancer Society and World Health Organization, TCCP database. Table 2. Population coverage by Human Development Index category in 1975, 1985 and 1995 Level of human development 1975 1985 1995 High 97.8% 97.3% 87.6% Medium 83.1% 85.9% 85.5%a Low 77.2% 81.6% 73.7%b a Population coverage in 1994. b Population coverage in 1991. Source: American Cancer Society and World Health Organization, TCCP database. Note: Coverage represents the percentage of the total population within each category that also reported consumption figures. Within each level of human development no population figures were available for certain countries, and these were not taken into account in the above calculations. Building the evidence base for global tobacco control 887Bulletin of the World Health Organization, 2000, 78 (7) Both the wide range of analyses possible using TCCP data and the limitations of these data indicate a need for standardized data collection techniques at the country level and greater access to data by researchers working outside each country. In the future, NA- TIONS can be expected to increase access to data.The system will integrate information systems and data sources electronically to facilitate the tracking of country-specific information across a wide range of indicators, including smoking prevalence and tobacco consumption, laws and regulations, morbidity and mortality, industrial organizations, tobacco econom- ics, and programmatic interventions against tobacco use. NATIONS will report time-trend data for each indicator and will update them periodically. In this way, the evidence base for tracking the progress of tobacco control policies will be increased and the common electronic framework necessary for storing and updating data, making information easily acces- sible to researchers, tobacco control advocates, and policy-makers over the Internet will be provided. Conclusion The results of these analyses using data from the TCCP database demonstrate the potential applica- tions of an information system devoted to tobacco control. Because TCCP compiled data on a wide variety of indicators, from employment in tobacco manufacturing to pharmaceutical treatments for tobacco dependence, future analyses are not limited to the type of prevalence, tobacco consumption and price comparisons presented here. Nor are they restricted to groupings by WHO Region and HDI level. Unfortunately, neither TCCP nor NATIONS can directly meet the need for standardized survey and data collection methods at country level. This Table 3. Cigarette prices in selected countries by human development level: 1990–99 Marlboro (US$ per pack of 20 cigarettes) Local brand (US$ per pack of 20 cigarettes) Country 1990 1999 Average 1990 1999 Average real annual real annual % change % change High human development Canada 3.85 3.50 –0.18 3.40 2.67 –1.67 Czech Republic 1.78 1.29 –5.66 1.05 1.15 –2.88 Denmark 4.64 4.37 –0.69 4.55 4.30 –0.67 France 1.98 3.26 7.40 1.20 2.76 14.86 Germany 2.86 2.87 –0.19 2.75 2.79 –0.09 Japan 1.75 2.58 1.01 1.61 2.30 0.70 New Zealand 2.63 3.81 4.78 2.67 3.62 3.78 Poland 1.34 1.21 –5.90 0.26 0.99 10.55 Sweden 3.90 4.32 3.20 3.72 4.20 3.45 United Kingdom 3.40 6.27 7.46 3.40 6.27 7.46 United States of America 1.74 3.16 4.72 1.71 3.04 4.39 Medium human development China 1.49 1.83 0.55 0.96 1.73 5.97 Costa Rica 0.89 0.69 –4.74 0.70 0.64 –3.63 Egypt 1.47 1.16 –6.52 1.10 1.16 –4.99 Hungary 1.46 1.01 –6.03 0.52 0.89 1.43 Kenya 2.15 1.59 –3.09 0.65 0.80 2.13 Mexico 0.52 1.07 0.16 0.45 0.86 –0.70 Malaysia 0.96 1.11 1.74 0.89 0.76 –1.50 Morocco 2.21 2.84 –0.76 0.98 1.45 0.78 South Africa 1.07 1.37 4.45 0.68 1.37 13.48 Thailand 1.16 1.09 –0.97 0.50 0.73 4.67 Turkey 1.66 1.32 –6.06 0.92 0.99 –4.44 Venezuela 0.46 1.44 3.06 0.46 1.28 1.49 Low human development Bangladesh 1.41 1.37 –1.25 1.13 0.85 –3.50 Coˆte d’Ivoire 1.87 0.94 –4.72 1.54 0.78 –4.67 Nigeria 1.26 0.83 –4.13 0.44 0.83 8.83 Senegal 1.15 0.80 –1.07 0.77 0.32 –5.09 Zambia 0.89a 2.03 –12.09 0.74a 0.64 –14.93 a 1993. Source: Economist Intelligence Unit; calculations made by World Health Organization. Special Theme – Tobacco 888 Bulletin of the World Health Organization, 2000, 78 (7) requirement is best tackled through capacity-building at local level with leadership from WHO and others in accordance with defined principles (11). The establishment of a permanent electronic framework for data management and retrieval, however, may provide an incentive for improving and increasing tobacco control efforts by making the results of independent research available to the global tobacco control community. n Re´sume´ L’information au service de la lutte antitabac Le mouvement de lutte antitabac a besoin d’un syste`me d’information mondial sur la culture et le commerce du tabac, l’industrie du tabac, la consommation de tabac et la mortalite´ qui lui est associe´e, ainsi que sur les moyens existant au plan national pour la lutte contre le tabac. La base dedonne´es parpays (TobaccoControl CountryProfiles – TCCP) mise en place par l’American Cancer Society en collaboration avec l’OMS et les Centers for Disease Control and Prevention constitue une premie`re e´tape vers l’e´tablissement d’un tel syste`me. Des donne´es de base sur une se´rie d’indicateurs relatifs a` la consommation du tabac ont e´te´ recueillies aupre`s de 191 Etats Membres de l’OMS, de deux Etats Membres associe´s, de deux provinces de Chine et de trois territoires occupe´s. Le pre´sent article de´crit les me´thodes utilise´es pour synthe´tiser les informations. Il analyse e´galement les indicateurs employe´s pour les TCCP, de fac¸on a` mettre en e´vidence l’utilite´ et la valeur potentielles des donne´es fournies par un syste`me d’information spe´cifiquement voue´ a` la lutte antitabac. Cette analyse porte sur la pre´valence du tabagisme par sexe et par Re´gion OMS, sur la consommation de cigarettes au regard de l’indicateur du de´veloppement humain (HDI) et sur l’e´volution annuelle moyenne en valeur re´elle du prix des cigarettes entre 1990 et 1999. L’article met e´galement en avant certains proble`mes concernant la qualite´ des donne´es et la ne´cessite´ de maintenir et d’ame´liorer le syste`me d’information afin de faciliter les efforts de lutte contre le tabagisme. Globalement, les hommes e´taient pre`s de quatre fois plus nombreux que les femmes a` fumer en 1998. C’est dans la Re´gion du Pacifique occidental que le pourcentage d’hommes consommant du tabac e´tait le plus e´leve´. S’agissant de la proportion respective de fumeurs et de fumeuses, c’est dans les Ame´riques et en Europe que l’e´cart entre les hommes et les femmes e´tait le plus faible, et dans les Re´gions de l’Asie du Sud-Est et du Pacifique occidental qu’il e´tait le plus marque´. En ce qui concerne les cigarettes industrielles, la consommation la plus faible et la plus e´leve´e par habitant coı¨ncidaient avec l’indicateur le plus faible et, respectivement, le plus e´leve´ du de´veloppement humain. Dans la cate´gorie moyenne, l’augmentation globale de la consommation enregistre´e depuis 1975 en Chine corres- pondait a`uneaugmentation parhabitant.Quantauprixdes cigarettes, son augmentation e´tait infe´rieure a` la moyenne du renche´rissement des biens et services, ce qui fait que les cigarettes e´taient relativement plus abordables en 1999 qu’en 1990. Ces indications confirment qu’il existe une importantemarge potentielle d’augmentation des taxes sur les produits du tabac, notamment dans les pays ou` l’indicateur du de´veloppement humain est faible a` moyen. L’analyse met e´galement en lumie`re la contribu- tion potentielle de la base de donne´es TCCP au de´veloppement des programmes et politiques de lutte antitabac. Ainsi, les statistiques de la consommation des cigarettes permettent d’identifier les pays ou` le besoin de ressources dans ce domaine est le plus aigu. Les pays ou` le marche´ de la cigarette connaıˆt la plus forte expansion sont a` l’e´vidence ceux qui disposent des ressources les plus faibles pour faire face aux proble`mes associe´s au tabac. De meˆme, l’analyse de l’e´volution du prix des cigarettes et autres donne´es connexes permet de de´finir des domaines d’intervention dans lesquels les gouver- nements pourraient renforcer leur contribution a` la lutte antitabac, par exemple en augmentant le prix des cigarettes afin de faire baisser la consommation. Le projet TCCP a re´ve´le´ des disparite´s entre les pays en ce qui concerne le volume et la qualite´ des donne´es disponibles pour l’analyse et permis d’identifier un certain nombre de priorite´s pour les futures activite´s de collecte de donne´es et de surveillance. Ainsi, on n’a pas pu e´tablir la pre´valence de la consommation de tabac dans 33 % des pays,provinceset territoiresoccupe´s englobe´sdans l’e´tude. Dans la Re´gion africaine, cette indication a e´te´ biaise´e par le faitqueseule lamoitie´ de lapopulationa e´te´priseencompte dans les estimations. Les estimations relatives a` la consommation de cigarettes pourraient eˆtre ame´liore´es graˆce a`des syste`mesdecollectededonne´es standardise´sau plan national. Dans les pays ou` les cigarettes les plus consomme´es ne sont pas les cigarettes industrielles, les donne´es TCCP sous-estiment la consommation des populations concerne´es. Des statistiques sur la consomma- tion des cigarettes roule´es, des bidis et des cigarettes kretek permettraient de dresser un tableau plus complet que les donne´es limite´es aux cigarettes industrielles. Le large e´ventail d’analyses autorise´es par les donne´es TCCP et les limites de ces meˆmes informations confirment la ne´cessite´ de techniques de collecte des donne´es normalise´es au plan national et d’un meilleur acce`s aux donne´es par des chercheurs travaillant en dehors des pays concerne´s. Resumen Acopio de datos estadı´sticos para la lucha antitaba´quica mundial El movimiento contra el tabaco necesita un sistema mundial de informacio´n para vigilar regularmente el comercio, el cultivo y la industria de ese producto, ası´ como la prevalencia del ha´bito de fumar, la mortalidad Building the evidence base for global tobacco control 889Bulletin of the World Health Organization, 2000, 78 (7) asociada y los recursos nacionales para la lucha antitaba´quica. La base de datos sobre las caracterı´sticas de los paı´ses en relacio´n con la lucha antitaba´quica, una iniciativa de recopilacio´n de datos coordinada por la Asociacio´n Estadounidense de Lucha contra el Ca´ncer en colaboracio´n con la OMS y los Centros para el Control y la Prevencio´n de Enfermedades, representa el primer paso en el desarrollo de dicho sistema. Se obtuvieron datos comparativos sobre varios indicadores del consumo de tabaco de 191 Estados Miembros de la OMS, dos Estados Miembros Asociados, dos provincias de China y tres territorios ocupados. Los me´todos utilizados para compilar los datos se describen en el presente documento. A fin de demostrar la utilidad y el valor potenciales de los datos derivados de un sistema de informacio´n dedicado a la lucha antitaba´quica, se analizan los indicadores arriba mencionados. Los ana´lisis versan sobre la prevalencia de tabaquismo por sexos por regio´n de la OMS, el consumo de cigarrillos per ca´pita por categorı´a del ı´ndice de desarrollo humano (IDH) y los cambios porcentuales anuales reales promedio de los precios de los cigarrillos entre 1990 y 1999. Se destacan temas relacionados con la calidad de los datos y la necesidad de mantener y mejorar el sistema de informacio´n para respaldar la lucha antitaba´quica. A nivel mundial, los hombres tenı´an una probabilidad de fumar casi cuatro veces mayor que las mujeres en 1998, y la prevalencia ma´s alta de tabaquismo masculino se registro´ en la Regio´n del Pacı´fico Occidental. Las diferencias de prevalencia de tabaquismo por sexos eran menores en la Regio´n de las Ame´ricas y la Regio´n de Europa y mayores en la Regio´n de Asia Sudoriental y la Regio´n del Pacı´fico Occidental. Con respecto a los cigarrillos elaborados, el consumo per ca´pita ma´s bajo y el ma´s alto se registraron en las categorı´as ma´s baja y ma´s alta, respectivamente, del ı´ndice de desarrollo humano. En la categorı´a de IDH medio, el consumo creciente de cigarrillos en China despue´s de 1975 tuvo una influencia predominante en el aumento del consumo per ca´pita. Los precios de los cigarrillos no aumentaron tan ra´pidamente como el nivel general de los precios de los bienes y servicios, y en consecuencia los cigarrillos fueron ma´s asequibles en 1999 que en 1990. Estos resultados indican que hay un margen considerable para aumentar los impuestos que gravan los productos del tabaco, particularmente en los paı´ses de IDH bajo y medio. Los ana´lisis muestran el potencial que encierra la base de datos sobre las caracterı´sticas de los paı´ses para apoyar la planificacio´n de programas y polı´ticas. Por ejemplo, los ana´lisis del consumo de cigarrillos pueden contribuir a determinar en que´ paı´ses se necesitan muchos recursos para la lucha antitaba´quica. Los paı´ses con mayor expansio´n del mercado de los cigarrillos son evidentemente aquellos que tienen menos recursos disponibles para abordar los problemas asociados con el tabaco. El estudio de la variacio´n porcentual de los precios de los cigarrillos y los ana´lisis conexos pueden ayudar a identificar las esferas normativas en las que los gobiernos pueden mejorar sus esfuerzos de lucha antitaba´quica, por ejemplo aumentando el precio de los cigarrillos como medio para reducir el consumo. El proyecto revelo´ disparidades entre los paı´ses en cuanto a la cantidad y la calidad de los datos disponibles para efectuar ana´lisis y mostro´ esferas prioritarias para los fines futuros de la recopilacio´n de datos y los esfuerzos de vigilancia. No se encontraron estadı´sticas sobre la prevalencia del tabaquismo en un 33% de los paı´ses, provincias y territorios ocupados considerados. El ana´lisis de la prevalencia del tabaquismo en la Regio´n de A´frica estuvo muy determinado por la falta de datos, ya que las estimaciones se realizaron so´lo con la mitad de los habitantes de la Regio´n. Los ca´lculos sobre el consumo de cigarrillos podrı´an mejorar mediante una notificacio´n normalizada de los datos sobre los paı´ses. En los paı´ses donde los cigarrillos preferidos no son los elaborados, los datos que aporta esta base sobre consumo de cigarrillos por la poblacio´n dan lugar a subestimaciones. Si se reunieran datos sobre el consumo de cigarrillos confeccio- nados manualmente y de cigarrillos de bidi y de kretek, se podrı´a obtener un panorama ma´s completo que el que ofrecen los datos sobre consumo de cigarrillos elaborados. 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