Tobacco Control Report: What can be learnt?
Monday, 15 November 2004, 11:18 am
Press Release: Diabetes New Zealand
Tobacco Control: What can be learnt and applied to nutrition policy?
A report commissioned by Diabetes New Zealand
November 2004
EXECUTIVE SUMMARY
This report presents a brief assessment of tobacco control policy approaches and assesses their potential application to nutrition policy. It is based on a targeted literature review of sources, which prominently deal with the issues being considered.
The report begins by examining the justification for public health interventions. This is undertaken to ascertain whether both tobacco control and food consumption regulation can be said to have the same basis for intervention. From a public health perspective, the health impacts of tobacco use and the consumption of unhealthy food both provide a clear case for intervention.
Within the context of economic theory, intervention is justified when there are external costs or information failure about health risks or the effects of addiction. The presence of these justifications surrounding tobacco use has enabled the introduction of prescriptive and coercive interventions even in the most liberal and deregulated economies. When the matter of food consumption is considered, similar justifications are found. Although the external costs associated with tobacco use and second-hand smoke exposure do not have an equivalent in food consumption, there are financial externalities in respect of the wider community having to contribute to the costs of health treatments arising from the consumption of unhealthy foods.
With several rationales for intervention being shared between the consumption of tobacco and unhealthy foods, a range of mechanisms used for tobacco control could be adopted to influence food consumption. These are considered, as are evaluations of their effectiveness, to identify what may be regarded as best practice. For tobacco control, pricing mechanisms through taxation have been found to be particularly effective although there has been ongoing and unresolved debate over the level at which tobacco taxes should be set. Other mechanisms that have been used include the provision of information, the restriction of access by youth to tobacco products, tobacco industry restrictions on advertising and promotion, smoking bans and restrictions, tobacco product content notification and cessation therapies. Whilst the majority of these, to a greater or lesser extent, have been evaluated as being successful, the primary message that arises from the literature is that their success has been enhanced by the fact that they have been part of a comprehensive programme of tobacco control.
The implications of tobacco control policies for food consumption are considered beginning with an analysis of the differences between tobacco control and healthy food regulation. These differences are significant: food production and the food industry are far more complex than the tobacco industry; the epidemiological link between diet and health is not as well understood as the link between smoking and ill health; tobacco is associated in the public’s mind as being a public health issue whereas obesity is often seen as a matter of private responsibility; and there are differing relationships between public health officials and the tobacco and food industries.
These differences influence the type of interventions that can be implemented currently, making it more difficult to adopt prescriptive or coercive actions due to lack of information, the complexity of food issues, lack of public support and the need for industry involvement. Nevertheless, initial regulatory actions have been taken (largely internationally) which somewhat mirror tobacco control measures. These include ‘junk food’ taxes, improved labelling, restricting misleading health claims on products, public health media campaigns, school-based interventions and restricting advertising aimed at children. These are initial steps - they only touch on the potential action that can be taken.
The greatest lessons to be learnt from tobacco control policy are that to be effective, interventions need to be part of a comprehensive programme including all aspects that would reduce consumption, implemented in a staged approach as public and political support builds. As such, tobacco control had significant and ongoing financial support from successive governments despite initial public reticence. The driver of this support was research that clearly presented the health impacts from tobacco use. The key is to promote relevant research and to find the optimal mix of interventions which reflects and fits into a country’s social, economic, political, cultural and legal realities. As a step towards identifying this optimal mix, the report concludes by identifying the epidemiological components that need to be addressed in dealing with the obesity epidemic. General areas of future action are broadly outlined.
*small portion
http://www.scoop.co.nz/mason/stories/GE0411/S00059.htm
Tobacco Control Policy provides a model
Monday, 15 November 2004, 11:16 am
Press Release: Diabetes New Zealand
Tobacco Control Policy provides a model for Unhealthy Food Regulation
A combination of Government regulation and public education for the control of obesity is required, similar to the successful tobacco control policy says a new report released today by Diabetes New Zealand, to coincide with World Diabetes Day.
“Tobacco control in New Zealand is a success story with smoking rates falling considerably since the 1970s, and the amount of tobacco consumed per adult continuing to fall each year. The same approach is required for the control of obesity if we are to stem the soaring rate of obesity and its impact on health,” says Murray Dear, President of Diabetes New Zealand.
*small portion
http://www.scoop.co.nz/mason/stories/GE0411/S00060.htm
Blitz seeks to uncover lung disease sufferers Hundreds of thousands may be undiagnosed, experts say
Susan RuttanThe Edmonton JournalNovember 14, 2004
EDMONTON -- The term COPD may ring few bells with people, but that doesn't mean thousands of us aren't going to fall into its insidious clutches.
An estimated 750,000 Canadians are living with chronic obstructive pulmonary disease, and experts think hundreds of thousands of others may be undiagnosed.
Finding those undiagnosed people is the focus of a provincewide information blitz that will hit 13 Alberta municipalities on Wednesday, which is World COPD Day.
Lung specialists are fanning out across the province to give evening lectures on COPD in hopes of prompting more people to get tested, said Eileen Gresl, the Edmonton-based co-ordinator of the year-old COPD and Asthma Network of Alberta, in an interview Saturday.
COPD is the umbrella name now given to emphysema, chronic bronchitis and related lung diseases.
Most people who get the disease, which is the fourth-leading cause of death in Canada, are either smokers or ex-smokers.
"We need people to know about COPD because awareness is low everywhere you go, particularly in Alberta," said Gresl.
An Ipsos-Reid poll from a year ago found that only three per cent of Albertans know what COPD is, the lowest percentage in the country.
Gresl said many people dismiss their lung problems as the effects of being out of shape or of getting older.
"The symptoms come on slowly and they're insidious -- more coughing, more frequent respiratory-track infections like the common cold that persists for longer than in people around you.
"And you just go, 'I'm having a bad year.' "
Some people have been using puffers to help them breathe for years, without ever getting properly diagnosed, she said.
A lung function test, which involves exhaling into a tube, can pinpoint COPD, she said. Once diagnosed, said Gresl, people can get all the therapies available.
People at risk of COPD are smokers or ex-smokers who have a persistent cough, frequent long colds or respiratory infections, or increasing shortness of breath.
The COPD and Asthma Network was formed last year, bringing together doctors, nurses and respiratory technicians who specialize in lung problems. The information night is its first big project.
sruttan@thejournal.canwest.com
FREE EVENING LECTURES
Information sessions in northern Alberta on Wednesday, Nov. 17:
- Edmonton North -- 7 p.m., Castle Downs YMCA, 11510 153rd Ave.
- Edmonton South -- 7 p.m., Coast Terrace Hotel South, 4440 Gateway Blvd.
- Wetaskiwin -- 6:30 p.m., Good Shepherd Wellness Centre
- Camrose -- 7 p.m., Camrose Seniors Centre
- Vermilion -- 7 p.m., Alberta Provincial Building
- Bonnyville -- 7 p.m., St. Louis Parish Hall
- Edson -- 7 p.m., Seniors Pioneer Cabin
- Grande Prairie -- 6:30 p.m., Grande Prairie Inn
- Fort McMurray -- 7 p.m., Northern Lights Regional Health Centre, Ron Wolff Auditorium
Hospitals can lead attack on obesity
By Dr. Manoj Jain
Special to The Commercial Appeal
November 15, 2004
As an intern, I would hold my breath as I passed the nurses' and the patients' lounges at the hospital. Half a dozen cigarettes would be lit, and a cloud would hang near the ceiling.
Today, hospitals, office buildings, planes and buses are smoke-free. This is an intentional culture change. Our society decided that smoking was to be discouraged if we wanted a healthier population.
Over the decades, the results have been remarkable. Among adults, rates of smoking declined from 42 percent in 1965 to 23 percent in 2000. Smoking among high school students has dropped from 36 percent in 1997 to 29 percent in 2001.
The decline has been due to increases in cigarette prices, smoking bans and restrictions, as well as school-based and national media-based smoking prevention/cessation campaigns.
The $93 billion question is: "Can the same culture change occur for obesity?" In addition to a huge expense, obesity results in nearly 400,000 deaths annually.
In America, one in three adults is obese (30 pounds over a healthy weight) and two in three adults are overweight (10-30 pounds over a healthy weight). The rates are especially high in the Mid-South. Only 30 percent of Tennesseans get the recommended five servings of fruits and vegetables per day.
While smoking is declining, obesity is increasing.
The effort to bring about a culture change concerning obesity has begun. Tommy Thompson, secretary of Health and Human Services said, "It is important to pressure the food industry, the fast-food industry, the soft drink society ... getting them to offer healthier foods and put more things on the menu dealing with fruits and vegetables."
Local and national media campaigns, such as Healthy Memphis, Tennessee on the Move and VERB (which encourages tweens to be physically active every day) offer information and support.
Yet, just yesterday, I realized we have a long ways to go. My patient in the hospital with a fresh bypass chest incision was sitting just inches away from a breakfast tray. Cholesterol and fat-laden bacon and eggs were on his plate.
I walked into the hospital cafeteria and 20 varieties of candy and 10 different ice creams were ready to seduce me at the checkout line.
To fight obesity, we need a culture change, and maybe hospitals are a place to start.
Dr. Manoj Jain is a practicing physician and chair of the Healthy Memphis Common Table Community Partners Council.
http://www.commercialappeal.com/mca/healthy_memphis/article/0,1426,MCA_19196_3328832,00.html
Analysis: Sebelius made 'shrewd' decision
Tobacco taxes may be best option for funding
Monday, November 15, 2004
Topeka — Gov. Kathleen Sebelius is facing criticism for proposing a cigarette tax increase, but other alternatives for financing her health care proposals appear even less attractive.
Sebelius says tobacco taxes are the logical source of revenue because tobacco use generates big medical costs. But her choice could prove shrewd politically largely because nonsmokers far outnumber smokers.
"If you want a bill to pass, the fewer people who hate it, the better," said House Taxation Committee Chairman John Edmonds, R-Great Bend. "She's taken the better strategy."
Sebelius needs $50 million a year for the "HealthyKansas" program she and Insurance Commissioner Sandy Praeger outlined last week.
They want the state to cover medical services for an additional 70,000 Kansans. They also propose having the state subsidize private insurance plans to make them affordable for both small businesses and their low-wage workers.
Their plan would increase the state's cigarette tax by 50 cents a pack, to $1.29. Also, the tax on other tobacco products would rise to 15 percent from 10 percent.
Tough time for taxes
Legislators in both parties said Sebelius would have a tough time selling any tax increase, given the mood of voters in this year's elections.
However, many voters also worried about rising insurance premiums and prescription drug costs, and Sebelius said nearly 300,000 Kansans remain uninsured.
"There's a sense that we absolutely need to do something," said Sen. Janis Lee, D-Kensington, a member of her chamber's tax committee. "There clearly is a public will to have a solution."
Of course, there are reasons to avoid raising tobacco taxes to pay for health care proposals.
The state raised its cigarette tax in 2002 to the current 79 cents from 24 cents to help prevent a budget shortfall. Some legislators believe adding an additional 50 cents a pack will push Kansas smokers to buy cigarettes outside the state.
‘Least amount of burden'
Smokers and tobacco companies question the fairness of having a relatively small group of people pay for broad public health initiatives. A recent national study indicated about one-fifth of Kansans smoke.
"The whole thing about a fair tax system is to place the least amount of burden on the most people," said David Howard, a spokesman for the R.J. Reynolds Tobacco Co. in Winston-Salem, N.C. "This proposal does just the opposite."
Sebelius is betting Kansans would respond to raising tobacco taxes as voters did recently in Colorado, Montana and Oklahoma, where they approved large increases in cigarette taxes. Montana's tax will rise $1, to $1.70 a pack.
And other tax sources present their own problems.
Liquor, wine, beer
For example, Sebelius and Praeger could have proposed raising taxes on liquor, wine and beer.
Sen. John Vratil, R-Leawood, said he was surprised they didn't, given that excessive drinking leads to health problems and that the state last increased alcohol excise taxes in 1983.
However, others questioned whether higher alcohol taxes could support an entire health care program. The state expects to raise less than $69 million for the current budget from its alcohol excise taxes.
Raising alcohol taxes probably would touch many more Kansans than higher tobacco taxes. In February, a federal Centers for Disease Control report suggested that three in five adult Americans are at least occasional drinkers.
"Raising liquor taxes doesn't raise a lot of money, and it makes a lot of people mad," said House Minority Leader Dennis McKinney, D-Greensburg. "A lot of people want to enjoy a cold beer after a hard day's work."
Schools have first call
As another example, Sebelius and Praeger could have proposed raising sales or income taxes to pay for their proposals.
But legislators also face a debate over funding public schools. They're waiting for the Kansas Supreme Court to rule on a lawsuit challenging the constitutionality of how Kansas distributes its education dollars. Many worry that the court's decision will require an infusion of additional money.
Edmonds said public schools will have first call on any new sales and income tax dollars. He also said fewer legislators probably support a sales or income tax increase than higher tobacco taxes because far more Kansans would have to pay.
As for the cigarette tax, Edmonds said, "Nobody has to smoke, so it's a tax that nobody has to pay."
http://www.ljworld.com/section/stateregional/story/187709
Tobacco funds not appropriate for medicine
From the editors Monday, November 15, 2004
Last week, researchers at the University of California, San Francisco School of Nursing released a report showing many top medical schools continue to profit from financial ties to the tobacco industry, 17 years after the American Medical Association urged the institutions to divest such holdings.
Researchers say Philip Morris USA persuaded some schools to hold on to tobacco stocks and others to be quiet about their divesting by reminding them of the money the company had given to the schools, The Chronicle of Higher Education reported.
At least five parent universities of the top 12 ranked medical schools - Cornell University, Duke University, the University of Pennsylvania, Washington University in St. Louis and Yale University - had not divested their holdings, according to the report.
USC was not included in the findings.
Tobacco is responsible for the deaths of 440,000 people each year in the United States alone - or about one in every five deaths - according to the Centers for Disease Control.
For decades, the tobacco industry denied their product was addictive and said there was no scientific evidence proving tobacco caused problems such as cancer and heart disease. Only recently did the industry admit it was wrong.
Now, Philip Morris's aim is to reduce "the harm associated with cigarette smoking," a spokeswoman told the Chronicle.
If Philip Morris and others continue to give to medical schools, it will be a savvy public relations move, a way to show Americans their health is a industry concern, but a way to keep hawking a dangerous product.
But tobacco kills. There is no safe cigarette, and research shows there likely never will be.
The tobacco industry's main concern is maintaining profit in an increasing hostile environment, and sees association with top medical schools as a way of gaining legitimacy.
After all, medical school research sets the tone for health policies in the United States. Therefore, these schools must recognize tobacco donations go against the very essence of their existence - to help people.
And these schools should shed themselves of the money tainted with the deaths of 440,000 people each year.