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TOBACCO USE It is estimated that there are 1.1 billion tobacco smokers worldwide. 19 In 2013, high-income OECD countries accounted for around 200 million smokers, and non-OECD countries accounted for 900 million smokers. Tobacco use currently causes almost 6 million deaths per year. More than 5 million of those deaths are the result of direct tobacco use 77 , while over 600 000 deaths are the result of non-smokers being exposed to second-hand smoke (including 170 000 deaths among children). 78 Other types of tobacco use, such as chewing tobacco or snuff, cause additional cancer deaths. TRENDS The global prevalence of tobacco smoking among people age 15 years and older is estimated to have declined from 27% in 2000 to 21% in 2013. 79 Globally, smoking prevalence declined in both men and women. Declines were largest for men in the high-income OECD countries, and in low-, middle- and non-OECD high-income countries in the European Region and the Region of the Americas (all with declines of around 10%) (Figure 6.11). Figure 6.11 Prevalence of tobacco smoking among people age 15 years and older, by region and sex, 2000–2025 8,80 Prevalence (%) AFR AMR SEAR EUR EMR WPR High-income OECD 60 50 40 30 20 Females POSITIVE DEVELOPMENTS Global action: The WHO FCTC has stimulated many countries to implement tobacco control measures. The WHO FCTC Secretariat, civil society and WHO have been instrumental in advocating for and operationalizing of the FCTC into country tobacco control policies and programmes (Box 6.2). Reducing demand: In 2008, WHO identified six evidence based tobacco control measures that are the most effective in reducing tobacco use, to assist countries with implementing selected WHO FCTC obligations. Known as MPOWER, these measures that correspond to one or more of the demand reduction provisions of the WHO FCTC are: • Monitoring tobacco use and tobacco control policies; • Protect people from tobacco use; • Offer help to quit tobacco use; • Warn about the dangers of tobacco; • Enforce bans on tobacco advertising, promotion and sponsorship; • Raise taxes on tobacco. Today, more than half of the world’s countries, representing nearly 40% of the world’s population – 2.8 billion people – has implemented at least one of these tobacco control demand reduction measures at the highest level of achievement (Figure 6.12). 19 This progress more than doubles the number of countries and nearly triples the number of people covered since 2007. Prevalence (%) 10 0 60 50 40 30 20 10 2000 2005 2010 2015 2020 2025 Males Specific actions by countries: There has been steady progress in global tobacco-control efforts in recent years, both in terms of the number of countries protecting their people and the number of people worldwide protected by effective tobacco-control measures. By 2014, 49 countries had introduced comprehensive, smoke-free laws covering all public places and workplaces; 24 countries were offering adequate help to quit tobacco use; 42 countries had mandated large graphic warning labels on their cigarette packaging; 29 countries had a comprehensive ban on all tobacco advertising, promotion and sponsorship, and 33 countries had taxes representing 75% of the price of a packet of cigarettes. These achievements were realized in the face of interference and threats from the tobacco industry. Success depended on high level political leadership in government and civil society support to champion tobacco control efforts. 0 2000 2005 2010 2015 2020 2025 Box 6.2 WHO FCTC The WHO FCTC, ratified by 180 Parties – representing 90% of the global population – is the first public health treaty negotiated under the auspices of WHO and is designed to counter the tobacco epidemic. The WHO FCTC requires its Parties to implement policies designed to reduce both demand and supply of tobacco products thus addressing social determinants of health. These interventions include, among others, raising taxes on tobacco; banning smoking in public places; pictorial health warnings; bans on tobacco advertising; controlling illicit trade of tobacco products; identifying alternative crops to tobacco farming and preventing sales to and by minors, and collecting and sharing data on tobacco use and prevention efforts. In February 2015, Parties to the FCTC celebrated 10 years of its entry into force. The WHO FCTC offers a model for addressing the negative effects of globalization on health. 146 HEALTH IN 2015: FROM MDGs TO SDGs
CHALLENGES Increasing use in some regions: Even though tobacco smoking prevalence is declining worldwide and in many countries, it appears to be increasing in the African Region and the Eastern Mediterranean Region. 31 In the European Region, the Western Pacific Region and the South-East Asia Region, prevalence of tobacco smoking is still high and efforts must be intensified to reduce it. Other forms of tobacco use also need to be addressed. Industry interference and industry tactics: The tobacco industry is fiercely challenging the implementation of pictorial health warnings and plain packaging in multiple countries, arguing that the packaging regulations impinge upon trademark and intellectual property rights. International trade and investment agreements are being used by the tobacco industry to challenge tobacco control measures in countries. New products, including Electronic Nicotine Delivery Systems (ENDS), and the growth in the use of existing products in new settings, such as water pipes, are presenting new challenges to tobacco control policymakers and regulatory bodies. Illicit trade: Illicit trade is a significant challenge to the reduction of tobacco use: one in 10 tobacco products available worldwide has been illicitly traded. Contraband cigarettes not only reduce governments’ tax revenues, but are also more affordable to vulnerable populations such as youth and low-income groups. In some instances, illicit trade has been supported by tobacco companies as a way of getting a foothold in markets. Farmers and agriculture: Supply reduction cannot be forced upon farmers who depend on tobacco crops for their livelihoods. However, economically viable alternative crops should be explored: tobacco growing is harmful to health in itself, 82 and support needs to be available for farmers wishing to switch to alternative crops. Equity: An analysis of the association between smoking prevalence and wealth within countries, using survey data from 2002 to 2004 in 48 low- and middle-income countries, found that current smoking was generally more prevalent in the poorer wealth quintiles, with the exception of women in some middle-income countries. 83 STRATEGIC PRIORITIES Tobacco control is a critical measure to achieve SDG Target 3.4 on reducing premature mortality due to NCD, being one of the leading risk factors for NCD. In addition, one of the health targets is specifically about tobacco control: “Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate”. The MPOWER measures for tobacco control, in line with the WHO FCTC, are listed in the WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020, 3 including the most cost-effective interventions (“best buys”) for tobacco control. 84 Evidence shows that the most cost-effective reduction measures for reducing tobacco use are: • reducing the affordability of tobacco products by increasing tobacco excise taxes; • creating by law completely smoke-free environments in all indoor workplaces, indoor public places and public transport; • alerting people to the dangers of tobacco and tobacco smoke through effective health warnings and mass media campaigns; • banning all forms of tobacco advertising, promotion and sponsorship. The measures are far more likely to be effective where implemented as part of a comprehensive approach, as envisaged by the WHO FCTC. Full implementation of the WHO FCTC involves adopting other demand reduction measures such as helping tobacco users to quit and regulating tobacco products. These provisions should be implemented via national tobacco control legislation and countries should ensure effective law enforcement. Integrating the implementation of the WHO FCTC with national health and development strategies and plans is also fundamental. Because tobacco control is a multisectoral issue, it requires an increase in multisectoral discussions and actions, including, for example, setting up and financing a functional multisectoral coordination mechanism, a focus on the relation between tobacco control and international trade or alternative livelihoods for tobacco farmers. When implementing the WHO FCTC, the infrastructures and capacities dedicated for broader tobacco control efforts should be integrated with other communicable and NCD programmes, such as for tuberculosis or respiratory diseases. Figure 6.12 Number of MPOWER interventions implemented at the highest level, 2014 81 Number of measures 0 Number of measures 0 1 2 3 4 5 1 2 3 4 5 Data not available Data not available Not applicable Not applicable 0 1700 3400 850 Kilometres 0 1700 3400 850 Kilometres NONCOMMUNICABLE DISEASES 147
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from M I L L E N N I U M DEVELOPMEN
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WHO Library Cataloguing-in-Publicat
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CONTENTS vii Abbreviations 1 1 From
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7 153 Mental health and substance u
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IHR IPCC ITN LLIN MCV MDG MDR TB mh
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SUMMARY This report aims to describ
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sourced development finance. 11 The
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Despite their overall success, the
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The 13 targets that underpin the br
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Box 1.1 Life expectancy improvement
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40 Advanced research on European he
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SUMMARY The SDGs position health as
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Figure 2.2 Trends in fertility by r
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Ageing Populations around the world
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The recent influx of refugees into
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and implementing policies and progr
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that dialogue is to demonstrate an
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One of the challenges we face as we
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Most recently, the right to health
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2100 Figure 2.15 Global average sur
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Figure 2.17 Proportion of health fa
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42 World development report 2014: r
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3 UNIVERSAL HEALTH COVERAGE
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UHC is coverage that provides peopl
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Figure 3.4 Per capita government he
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living in poverty, are pushed furth
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integration of all SDG health targe
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GOVERNANCE Governance in the health
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HEALTH FINANCING A country’s heal
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HEALTH WORKFORCE Health systems and
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MEDICAL PRODUCTS Access to quality
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HEALTH INFORMATION Health informati
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SERVICE DELIVERY In order to achiev
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RESEARCH FOR UHC Research evidence
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NOTES AND REFERENCES 1 World health
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89 Implementing the Commission on I
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173 Labrique A, Vasudevan L, Chang
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SUMMARY Deaths among pregnant women
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Figure 4.3 MDG and SDG targets rela
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have declined from 25% to 14% betwe
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Chapter 5). As noted above, there h
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Figure 4.8 Wealth-related inequalit
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young children. 61 Specific indicat
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CHALLENGES Access to skilled care a
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CHALLENGES Scaling up effective int
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CHALLENGES Leaving no country behin
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CHALLENGES Endemic countries: Polio
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Figure 4.22 Prevalence of stunting
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CHALLENGES Spurring action in count
Page 105 and 106: CHALLENGES Ending child marriage: D
Page 107 and 108: 43 Financing global health 2014: sh
Page 109: 5 INFECTIOUS DISEASES
Page 112 and 113: Infectious and parasitic diseases a
Page 114 and 115: Figure 5.4 Global number of deaths
Page 116 and 117: International TB funding increased
Page 118 and 119: Improving quality of care: The qual
Page 120 and 121: Table 5.1 Summary of specific targe
Page 122 and 123: HIV/AIDS More than 30 years since t
Page 124 and 125: TUBERCULOSIS TB is a treatable and
Page 126 and 127: MALARIA Almost half the world’s p
Page 128 and 129: NEGLECTED TROPICAL DISEASES NTDs 89
Page 130 and 131: HEPATITIS Viral hepatitis is caused
Page 132 and 133: WATERBORNE DISEASES Waterborne dise
Page 134 and 135: CHOLERA Cholera is an acute diarrho
Page 136 and 137: SEXUALLY TRANSMITTED INFECTIONS STI
Page 138 and 139: NOTES AND REFERENCES 1 Global Healt
Page 140 and 141: 84 Dye C, Maher D, Weil D, Espinal
Page 143 and 144: SUMMARY NCDs are included as a spec
Page 145 and 146: Figure 6.2 Probability of death fro
Page 147 and 148: as task sharing using community hea
Page 149 and 150: The stated aim of the strategy is p
Page 151 and 152: CHALLENGES Despite declines in mort
Page 153 and 154: CHALLENGES Lack of access to effect
Page 155: CHALLENGES Diabetes is an increasin
Page 159 and 160: CHALLENGES Air pollution remains a
Page 161 and 162: 40 From burden to “best buys”:
Page 163: 7 MENTAL HEALTH AND SUBSTANCE USE
Page 166 and 167: Mental disorders, including dementi
Page 168 and 169: the effectiveness of task sharing b
Page 170 and 171: • To provide comprehensive, integ
Page 172 and 173: DEPRESSION AND SUICIDE Mental disor
Page 174 and 175: DEMENTIA The world’s population i
Page 176 and 177: SUBSTANCE USE AND SUBSTANCE USE DIS
Page 178 and 179: NOTES AND REFERENCES 1 Global Healt
Page 181: 8 INJURIES AND VIOLENCE
Page 184 and 185: Injuries, whether sustained acciden
Page 186 and 187: due to limited data. However, the s
Page 188 and 189: aiming to stop the predicted increa
Page 190 and 191: ROAD TRAFFIC INJURIES Every year, a
Page 192 and 193: VIOLENCE AND HOMICIDE There were an
Page 194 and 195: WAR AND CONFLICT In 2012, an estima
Page 196 and 197: DISASTERS Disasters are often assoc
Page 198 and 199: NOTES AND REFERENCES 1 Global repor
Page 201 and 202: SUMMARY In September 2015, heads of
Page 203 and 204: A 10-page declaration precedes the
Page 205 and 206: THE PLACE OF HEALTH IN THE SDGs 1 H
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that health systems providing integ
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FOLLOW-UP AND REVIEW 9 Monitoring t
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NOTES AND REFERENCES 1 Transforming
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WHO South-East Asia Region: Banglad
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ISBN 978 92 4 156511 0
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