The

Tobacco Epidemic

Dr Susan Mercado Team Leader, Tobacco Free Initiative Western Pacific Regional Office

The only legal consumer product that kills half of its users when used as directed by the manufacturer.

 Tobacco

currently kills more than 6 million/year but this will increase to over 8 million/year in a few decades If current smoking patterns continue, the death toll from tobacco use will be:
2000 2025 ~ 150 M 2025 2050 ~ 300M 2050 2100 > 500M
Cigarette s

TOTAL for 21st Century 1 billion (half the deaths in middle age)

6 Global Deaths per Year 5

(millions)

5.0 3.9 3.0 1.8 1.7 1.2 1.0

4 3 2 1 0

0.6

T b cco oa

Lo e wr R sp e In ct fe

A S ID

D rrh a ia e l D a ise se

T B

T ffic ra In rie ju s

M la a ria M a s e sle

Unless urgent action is taken, tobacco will soon kill twice as many people and will kill 1 billion people this century

7,000 chemicals, 70 known carcinogens

Second hand smoke kills.

We have a high tolerance for second hand smoke exposure: Of the 600 000 yearly deaths from second hand smoke exposure--167,000 or 28% are children

Image source: adapted by CTLT from U.S. Surgeon Generals Report. (2006). 8

When you inhale, chemicals in tobacco smoke cause damage immediately Even the smallest amount of tobacco smoke can also damage your DNA, which can lead to cancer Even brief exposure to SHS can cause cardiovascular disease and could trigger cardiac events, such as a heart attack Tobacco smoke can quickly damage blood vessels and make blood more likely to clot. Smoking makes it harder for diabetics to control their blood sugar Quitting any time gives your body a change to heal the damage caused by smoking

The following countries have classified SHS as a carcinogen: Germany Finland USA SHS is a group A carcinogen with arsenic, asbestos, benzene, radon and vinyl chloride

Tobacco use is a pediatric disease.

80-90% of smokers initiate use before the age of 18.

The tobacco industry targets children and youth.

IceIn Viet or cream Nam 2008: FOR KIDS ?cigarettes

Ice cream and cigarettes?
Point of sale advertising in Viet Nam

Point of sale advertising. Again cigarettes beside candies. Why not beside pesticides?

The tobacco industry has deliberately made smoking glamorous and the norm.

Deadly product packaged in candy colours

Deadly product packaged in fruity flavours or with misleading descriptors e.g. lite, mild

Impulse control

Before adulthood the prefrontal cortex is underdeveloped making adolescents vulnerable to addictions.

SMOKING CAUSED DISEASES

DISEASES AND ADVERSE HEALTH EFFECTS CAUSED BY SECOND HAND

SMOKE

:TUBERCULOSIS AND SMOKING A STRONG ASSOCIATION

Smoking substantially increases the risk of tuberculosis and . death from TB More than 20% of global TB incidence may be attributable to . smoking Smoking is a risk factor for TB, independent of alcohol use and . other socioeconomic risk factors Smoking increases the risk of TB disease by more than 2 .times
Source: WHO TB and Tobacco Control Monograph, 2007

Chemicals in tobacco smoke reach lungs quickly every time you inhale. Chemicals and toxicants in tobacco smoke damage DNA which can lead to cancer. Exposure to tobacco smoke quickly damages blood vessels throughout the body and makes blood more likely to clot. This damage can cause heart attacks, strokes, and even sudden death. Chemicals in tobacco smoke inflame the delicate lining of the lungs and can cause permanent damage that reduces the ability of the lungs to exchange air efficiently and leads to chronic obstructive pulmonary disease which includes emphysema and chronic bronchitis.

Source: US Surgeon-General Report 2010

Health Advisory on Electronic Nicotine Delivery Systems (ENDS)/E-Cigarettes DOH warns the public on the use of these products. There is insufficient evidence that ENDS are safe for human consumption.

Rechargeable battery Atomizer tip

Indicator light

Vaporizing chamber

Replaceable ingredients cartridge

Nicotine is addictive.
Tobacco use is a chronic disease and is a gateway for use of alcohol and recreational drugs among adolescents.

10 Filipinos
die by the hour from tobacco-related disease

Number of current smokers in the :Philippines

million 17.3 (28.3%)

)Male smokers: 14.6 million (47.7% )Female smokers: 2.7 million (8.9%

THE TOBACCO ATLAS, 2009

THE TOBACCO ATLAS, 2009

 Youth
Global Youth Tobacco Survey (GYTS)*

Adults
Global School Personnel Survey (GSPS)* Global Health Professions Students

Survey (GHPSS)* Global Adult Tobacco Survey (GATS)+ School based survey*
Household survey+

P a ce of S d tsw o a rev len tu en h re u tC a C rren ig rette S ok m ers

50 Total B oy 40 G irl

P reva ce of S d len tu entswho V R NE E S ok B t L ely In te S ok gNext m ed u ik itia m in Y r ea

100 Total Boy Girl 80

30

26.2 23.4 18.2 12.4 17.5 12

60

20

16.6 11.5 7.8

40

30.2 23.9 20.6

1999

10

20

14.3 12.8 12.2

15 12.9 11.6
2007

0 1999 2003 2007

0 2003

100 80 60 40 20 0

P ercen g of S d tsw ta e tu en ith O e or Mo P ren w o S o e n re a ts h m k

56.1 55.4 54.7
Total B oy G irl 1999 2003 2007

100 80 60 40 20 0

P en g o S d tsE p s to erc ta e f tu en x o ed S o e inP b P c mk u lic la es

58.8 58.2 57.8
Total Boy G irl 1999 2003 2007

56.3 55.1 52.9

55.3 54.1 52.5

59.4 58.6 58.2

67.2 64.8 62.8

25 20 15 10 5 0

P ercen g of S d tsw os ta e tu en h e B t F d S ok es rien s m e

11.9 8.5 5.7
1999

15.3 9.1 5.5

2003

16.9 11.9 7.4

2007

P ercen g of u t S o ersw o ta e C rren m k h W n to S pS o in N w at to m k g o

100

85.7
80

89.6 88 88.2

89.3 88.1 88

10

P ercen g o u t S ok w o ta e f C rren m ers h Alw y F L e H v gaC a a s eel ik a in ig rette F t T in inth Morn g irs h g e in
Total B oy G irl

85.2 84.6

60

5.4 5 4.7 3.2 3

40

20

T otal B oy G irl

0.8 0.8
2003 2007 0 1999

0 1999

0.7
2003

0.3
2007

Figure 4:

Pe rce nt

Second Hand Smoke Exposure Home;Philippines at Global Adult TobaccoSurvey (GATS), 2009

100 80 60 40 20 0
Sm ok ing Allow e d ins ide Expos ure Daily ins ide the Expos ure M onthly ins ide the Hom e Hom e the Hom e 48.8 39.6 54.4

F igure 6: Second Hand Smoke E xposure in Public Places: Philippines G lobal Adult Tobacco Survey (G ATS), 2009 Percent 100 80 60 40 20 0
Public Transport R estaurants Government Offices H ealth Care Facilities 55.3 33.6 25.5 7.6

Fu ig re

7 S o in : mk g C s a nS tu o e s tio ta s f 1 5 y a a do e b S x e rs n ld r y e ; P ilip in sG b l h p e lo a Au T b c o d lt o a c S rv y (G T u e AS ), 2 0 09

Au d lts

P r et ec n

10 0 8 0 6 0 4 0 2 0 0
Q it R t ( v r u ae E e D ily a ) Q it A t m t u te p ( a tY a ) P s er I t r s e in ne e t d Q it in ( u r n u t g C re t C aet ig r t e S o es mk r ) 2. 1 5 2. 09 2. 50 6. 06 6 . 05 4. 78 4 . 67 5. 39 6. 1 1

T ta o l

Mn e

Wm n o e

Cigarettes account for 97% of tobacco expenditures (FIES, 2003). Average household expenditure on tobacco

V a r ia b le M ean N A n n u a l h o u s e h o ld in c o m e ( in p e s o s ) 1 3 7 ,7 5 8 .4 0 4 2 ,0 9 4 P r o p o r t i o n o f h o u s e h o l d s w i t h t o b a c c o 0 e. x6 p e n d i t u r e s 4 2 , 0 9 4 9 H o u s e h o l d e x p e n d i t u r e s o n t o b a c c o p r1 o, 9d 3u 1c t. 9 0( i n p e s o s 2) 8 , 8 3 6 s H o u s e h o l d e x p e n d i t u r e s o n c i g a r e t t e s 1( ,i 8n 6 p5 e. s4 o0 s ) 2 8 ,8 3 6 H o u s e h o l d e x p e n d i t u r e s o n c i g a r s ( i n p 9e .s 5o s ) 2 8 ,8 3 6 H o u s e h o l d e x p e n d i t u r e s o n o t h e r t o b a c 5c 7o . 1p r o d u c t s ( i n 2 p8 e, s8 o3 s6)
; Source: Quimbo, S, et al, 6-Country Economics of Tobacco and Tobacco Taxation, PHL 2008 Basic: FIES, 2003

3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0%

2.8% 2.6% 2.2% 1.6% 0.8%

Quintile 1

Quintile 2

Quintile 3

Quintile 4

Quintile 5

Source: Tobacco and Poverty Study in the Philippines, May 2006; Basic Data: FIES, 2003

Food 2.6% 3.3% Clothing 13.1% Housing Health 6.3% 1.6% 1.3% 8.2% 61.1% Education Utilities Transport & Communication Tobacco Other expenses

2.6%

Source: Tobacco and Poverty Study in the Philippines, May 2006; Basic Data: FIES, 2003

$)* Summary of Economic Costs in US for Four Smoking-related Diseases )using SAMMEC methodology figures, 2003(
Smoking-related Diseases Health Care Costs Productivity Losses from Death Productivity Losses from Disease Total Costs

Lung Cancer CVD CAD COPD All 4 Diseases

9,188,871 507,315,052 236,888,476 104,561,119 857,953,518

189,709,987 2,930,533,343 1,312,836,695 569,530,925 5,002,610,950

3,407,151 38,910,556 88,922,515 54,043,648 185,283,871

202,306,009 3,476,758,951 1,638,647,686 728,135,692 6,045,848,339

.PhP 52=$1* .Source: Tobacco and Poverty Study in the Philippines,2006

Tobacco Control
Taxation Comprehensive

advertising bans Information dissemination - Smoke-free public places

Cardiovascular risk reduction

Population-based salt

lowering Health education on BP, cholesterol, overweight Individual risk reduction approach