Follow the Data Podcast Episode 7: How tobacco control protects billions of people – Part 1
For the last 10 years, Bloomberg Philanthropies has been a major supporter of tobacco control, protecting more than 3.5 billion people in low- and middle-income countries through strong policies. Knowing that we can and must do more, our founder Mike Bloomberg announced a new round of funding this year that raises our total giving to $1 billion dollars and expands our work for another 6 years.
But what does it take to protect everyone? And why did we take on this monumental task?
In part one of this two-part series, we go in depth on tobacco control and how Bloomberg Philanthropies is working with partners around the world to protect billions of people from the harmful effects of tobacco.
In this episode of Follow the Data, we’ll hear from two of our partners: Indu Ahluwalia from the US Centers for Disease Control and Prevention’s Tobacco Control Program and Ryan Kennedy from Johns Hopkins Bloomberg School of Public Health as they sit down with Jen Ellis from the Bloomberg Philanthropies’ Public Health team.
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Katherine Oliver: Stroke, blindness, gum infection, heart disease, and of course cancer. These are only some of the harmful health effects of tobacco use. And despite a half-century of scientific proof that smoking is dangerous to our bodies, and anti-tobacco policies protecting billions of people, we still have a long way to go in the fight against tobacco.
In this 2-part series, we go in depth on tobacco control and how Bloomberg Philanthropies is working with partners around the world to protect billions of people from the harmful effects of tobacco.
For the last 10 years, Bloomberg Philanthropies has been a major supporter of tobacco control, protecting more than 3.5 billion people in low and middle-income countries through strong policies. Knowing that we can and must do more, our founder Mike Bloomberg announced a new round of funding this year that raises our total giving to $1 billion dollars and expands our work for another 6 years.
But what does it take to protect everyone? And why did we take on this monumental task? To answer this last question, let’s go back a year to the 2015 Bloomberg Philanthropies Awards for Global Tobacco Control, where Mike Bloomberg shared a staggering data point.
Mike Bloomberg:“The World Health Organization was very helpful and they got us interested, Bloomberg School of Public Health in Baltimore has been interested in this and Dr. Kelly Henning, who runs the Bloomberg Philanthropies Public Health practice got me interested in it and they said look, there’s going to be a billion lives lost this century unless we do something and if that isn’t impetus to do something, I don’t know what is.”
Katherine Oliver: Even in New York City, in Mike’s first term as Mayor, he quickly became a national leader on public health. After New York City banned smoking in bars and restaurants in 2003 — cities, states and countries around the world saw the positive health and economic impact of smoke-free laws. Mike knew that if it could work in New York, it could work in other cities and countries.
Armed with the fact that a billion people are expected to die this century if nothing is done about tobacco, Mike launched the Bloomberg Initiative to Reduce Tobacco Use. Luckily, progress is possible and countries have been stepping forward to address this issue like never before.
Success of the Bloomberg Initiative (which you will hear in the episode referred to as the BI) is driven by a robust set of strategic partners.
Today, we’ll hear from two of our partners: Indu Ahluwalia from the US Center for Disease Control’s Tobacco Control Program and Ryan Kennedy from Johns Hopkins Bloomberg School of Public Health as they sit down with Jen Ellis from the Bloomberg Philanthropies’ Public Health team.
Jen Ellis: Thank you guys so much for being here today. Can we just start by having you introduce yourselves? Ryan, why don’t you go ahead?
Ryan Kennedy: Sure. I’m Ryan Kennedy, and I’m faculty at Johns Hopkins. I work at the Institute for Global Tobacco Control.
Indu Ahluwalia: Good morning. My name is Indu Ahluwalia, and I work at the US Centers for Disease Control in the tobacco control program.
Jen Ellis: Great. So, let’s start with you, Indu. Can you tell us a little bit about what CDC contributes to the Bloomberg Initiative to Reduce Tobacco Use?
Indu Ahluwalia: Absolutely. Jen, as you know, data are an essential tool to any public health effort, and surveillance is the backbone of public health, as it provides evidence for any kind of action. So, one of the things we do as a technical partner to the initiative is that we help countries to systematically assess their tobacco use landscape and to figure out what actions they need to take through the Global Tobacco Surveillance Program, GTSS, as you know. We are involved in helping countries to both look at the landscapes among the youth as well as adults systematically in an ongoing basis and helping countries interpret the findings, and to really develop evidence on what is going on within a country. To date we have about 185 countries doing youth surveys and 34 countries are active with the adult surveys. So, we have lots of data that countries can use and meaningfully for public health.
Katherine Oliver: These surveys are population-based surveys that measure prevalence of tobacco use in countries around the world.
Jen Ellis: Ryan, can you tell us a little bit about how Hopkins contributes to the Bloomberg Initiative?
Ryan Kennedy: Our Institute for Global Tobacco Control is involved in three complementary pillars of activities for the BI. First thing is that we are interested in knowledge and knowledge collection generation and knowledge synthesis. So, we’re really motivated by understanding the data.
Second, we’re interested in monitoring and conducting surveillance in the world of tobacco control. And thirdly, we’re really interested in training and capacity so that we can, at the university, we can help support the next generation of tobacco control advocates and researchers around the world.
In each of these areas we focus on information and developing the skills that will directly inform the passage of M-POWER, so that’s the sort of guiding principles from the World Health Organization.
Katherine Oliver: So, this is important. M-POWER is a set of guidelines that the World Health Organization promotes to reduce tobacco use. The acronym, M-POWER, stands for:
- M: Monitor tobacco use and prevention policies
- P: Protect people from tobacco smoke
- O: Offer help to quit tobacco use
- W: Warn about the dangers of tobacco
- E: Enforce bans on tobacco advertising, promotion and sponsorship
- And R: Raise taxes on tobacco
Ryan Kennedy: I’ll give you a couple of examples.
One of the things we’re doing right now in China is trying to understand what aspects or components of a health warning label might be the most effective in the context of China, a very sort of different population in terms of who was smoking than other parts of the world. And potentially different needs in terms of the content.
And China right now doesn’t have very effective health warning labels. They just have words. They don’t have pictures or pictorials that we know are important. So, we’re doing research in China to understand what components of the health warning label might be most effective.
Another example is that we’re evaluating the impact and some of the unintended consequences of some of the state level policies around smokeless tobacco bans in India. Very different tobacco use profile in that part of the world. Smokeless tobacco is a very common form of tobacco use, and states have these very innovative approaches to ban a product called gutka, which is a very common and popular form of smokeless tobacco.
What that policy decision meant on the ground is really interesting. So, we were able to do monitoring and surveillance to understand the impacts of that policy and how the tobacco industry responded.
Jen Ellis: So, Indu, you mentioned that there’s a lot of work that CDC does to understand tobacco prevalence in these countries, and you also talked a little bit about how you work with governments to make that data useful for them, public in some cases, interpreting those findings. What, Indu, do you see as the role of government in ensuring that tobacco control is informed by data?
Indu Ahluwalia: Jen, as you know, we work with the ministries of health in many – pretty much all of the countries where we’re doing tobacco surveillance. And what’s interesting to us is that over the time since this project started we have trained thousands of staff from all the countries that we worked with in terms of their capacity to conduct tobacco surveillance and to use the data in a meaningful way so that capacity stays, obviously.
And we’re extremely proud of that fact that we’re able to work with the governments directly. It also shows that these countries and ministries of health have decided that tobacco data are so critical to their national health agendas that many of them have set aside funds from their own budgets to partially or fully fund either the youth or adult surveys. And to us that’s also an indication of their commitment and long-term sustainability of this effort.
Jen Ellis: Ryan, any thoughts from your side on what you and what Hopkins sees are really the role of government in moving tobacco control forward, particularly using data?
Ryan Kennedy: Yeah. I think the data can certainly inform policy development. It can help set priorities for which policies need to be implemented first. It can also – I mean, data from the – in terms of surveillance helps to understand how policy is working, and so that can help inform how a government is responsible for enforcement of the policy.
Jen Ellis: Great. So, Ryan, you mentioned some of the work you’ve done on pack writings in China and some of the state-level work in India. What are some other examples of how Hopkins has really helped contribute to the Bloomberg Initiative work and helped move the policy initiatives forward?
Ryan Kennedy: One of the policy areas that’s really a priority is understanding tobacco industry activity. The industry is, obviously, always marketing, always thinking ahead. This past summer an example of what we worked on is trying to understand the landscape, the marketing environment in 12 different countries around the world.
So, we worked over a very short time period, I think it was only seven weeks, and we visited these 12 countries.
And we conducted data collection to understand the nature and extent of tobacco marketing around schools, around where kids are most days of the year. Another multi-country project that we’re working on is trying to systematically understand how the tobacco industry is using their packaging to promote tobacco use.
So, that is a systematic way of collecting a whole range of tobacco, cigarette products in the 14 different Bloomberg Initiative priority countries. And with that we’re able to collect the packs and, first of all, see whether or not those different cigarette products are compliant with the health warning regulations that are required of them in their countries.
And also, our staff is able to look at each individual pack and begin to code the different marketing techniques and strategies, the brand appeals, the positioning and use of different words and terms, so that we can get an idea of how the industry is using that pack as a really innovative marketing product.
And we can, in a sense then, understand what trends that may be happening and also what is happening across brands and across countries.
The final example I wanted to talk about was the emerging issues. There’s a lot of interest in some of the products that are coming on board. We have undertaken a global policy scan at the institute, so we have looked at national level policies in every country in the world to try and understand how these products, like electronic cigarettes, are being regulated in all the different domains that are familiar to us in tobacco control like taxation, like advertising and promotion restrictions, like product regulation.
Obviously, there’s almost 200 countries in the world to be looking at, and it’s a lot of work to keep on top. But I think it’s important for us to know and monitor and understand, first of all what is being done and secondly, when we know that we’ll be able to begin to understand how these policies are affecting public health.
Jen Ellis: Can you talk a little bit more about that? Some of the findings you mentioned support some of the policy areas that we know are important. How do you ensure that the research findings you have are used to advocate for policy change?
Ryan Kennedy: Well, it’s a whole process, Jen. So, that we’re really fortunate in the BI that we have different partner groups that we can work with.
So, they’re able to tell us what the policy priorities are and where data would be helpful to either support the development of tobacco control policies or in some cases to maintain those policies if they’re under threat. Or to help where we’ve seen loopholes. The industry is always brilliant at finding some way to go beyond the spirit of legislation that we’ve passed.
And then by working closely with the people on the ground and our other partners we can make sure that that’s used to effectively advocate the most powerful policies we can have to save the most lives.
We’re really fortunate that we have access to people in the country to explain to us what the priorities are so that we can work with them to make sure that we’re helping the experts, the ministry of health or the in-country advocates, to give them the data that they need that will help them to accomplish what the people in the country know is needed and necessary to advance their tobacco control policies.
Jen Ellis: Let’s think back to when this all started and when we initially started working with our priority countries. What did we do for those governments that maybe weren’t aware that tobacco control needed to be a priority? How have we worked to use data to help governments understand that tobacco control really needs to be on their radar as a priority issue?
Indu Ahluwalia: I think one of the things that we think about is it’s a great thing when you’re talking to the ministry of health and there’s an a-ha moment where they actually say, “Oh, we have a tobacco problem. We have too many adults and youth using tobacco, and we hadn’t thought about that because we were so focused on other areas.”
We have tons of evidence on what tobacco does and in ways it’s related to other health outcomes. We not only need to address other issues that are on our plate, but tobacco is a huge issue in terms of what it’s doing to our population, our kids, our families, and it’s something that there’s no need for it.
Jen Ellis: Ryan, any thoughts from your side about how we worked with some governments to help them really get on board with tobacco controls a priority issue?
Ryan Kennedy: Yeah. I think one of the strategies at IGTC is to really work closely with NGOs and civil society within the country who are aware of what is needed to get the data in the hands of the government.
Katherine Oliver: The IGTC is the Institute for Global Tobacco Control. The IGTC’s mission is to identify and support effective tobacco control interventions.
Ryan Kennedy: And so, we’ve been working really closely to make sure that the data collected is going to be useful and powerful and present it in a way that’s understandable, accessible and relevant. And then use the channels that are most likely to be effective at accomplishing change.
Jen Ellis: Indu, let’s talk about some of the examples of success that you’ve seen. What are the countries that have been particularly successful? What are the real exciting successes that you’ve seen?
Indu Ahluwalia: What’s interesting to us is most of the countries implementing tobacco surveillance activities recognize the need for data. And it’s been interesting to see how they’ve taken the data and to use evidence-based around it to develop successful policies, policies that have teeth to them and actually move the tobacco landscape forward to the tobacco prevention efforts.
Some of the examples around smoke-free are really what we’ve seen some successes around. Some countries that have, for example, used data successfully are India, for example. They use GATS, which is the adult tobacco survey data to do a total ban on gutkas, and very exciting effort. And historic effort in a country with taking the lead in trying to use data for information to develop a meaningful policy that’s going to impact every state in the union of India.
Other examples include Philippines, which have used tobacco data very successfully to finance their healthcare system, for example. I think Turkey is a very good example. They’ve done multiple waves of data collection and use that data to implement the demand reduction measures in the World Health Organization’s framework.
That has led them to have the highest level of compliance with the treaty. Smaller countries like Uganda have done a national law that is quite meaningful, and they have done a systematic way to educate their healthcare district-level staff in knowing about the law and having smoke-free policies around it.
So, there’s some really excellent examples of using data to inform policies at different levels. And I think we’re really excited to see that – how data are changing the landscape of how countries deal with the tobacco epidemic.
Jen Ellis: Ryan, do you want to mention any other successes that Hopkins has seen?
Ryan Kennedy: There’s a handful of really discrete examples that I can highlight.
Chile, for example, used one of our reports on tobacco marketing to children to advocate for stronger laws around tobacco advertising and promotion. We’ve done a lot of work in Russia, for example, to understand their marketing laws. They had a very interesting approach to restrict or ban sales in a retail outlet.
So, kiosks, for example, were no longer allowed to sell tobacco products, what happened? We were able to document how that law was affected, it was fully implemented and the compliance with their law was really high. There’s often sort of a disbelief in some of these jurisdictions that will actually work. And when we have the data in hand it helps to validate these laws are possible because implementation is always in question.
And to that end we were able to study tobacco control policy implementation in Bangladesh. Some countries are very large. They’ve got big populations, dispersed across huge areas. And a federal law to be rolled out can be really challenging. So, using data to understand what were their strategies? What were their techniques? What process did they follow? It helps not only to better understand the comprehensiveness of their implementation but to support other jurisdictions that are going to be grappling with the same challenges.
Jen Ellis: Thank you guys both so much for joining us. It’s been a pleasure to talk to you, and we’re so thrilled to continue working together on this important initiative.
Katherine Oliver: We hope you enjoyed part 1 of our two-part series on tobacco control. In our next episode, we take a look at how countries are implementing M-POWER policies like advertising bans, raisings taxes on tobacco products, and passing critical laws to protect the public.
If you’d like to learn more about the Bloomberg Initiative to Reduce Tobacco Use, visit Bloomberg.org.
Thank you for listening to our podcast – if you haven’t already, subscribe and send us your feedback at firstname.lastname@example.org.
As our founder Mike Bloomberg says, if you can’t measure you can’t manage it. Until next time, keep following the data.
Special thanks to producers and editors Ivy Li and Lindsay Firestone, and music composer Mark Piro.