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Public Health Team Q&A: Recent wins in tobacco control globally and in the US

Morgan Zeiss, a rising senior at Georgetown University and summer intern for Bloomberg Philanthropies’ Public Health team, took a few minutes to interview staff and partners on the latest updates in tobacco control globally.

What role has Bloomberg Philanthropies played in tobacco control?

Bloomberg Philanthropies has funded a global initiative to reduce tobacco use since 2007, and progress on passing evidence-based policies at country-level is expected to save 30 million lives. Currently, the Bloomberg Initiative to Reduce Tobacco Use (BI) focuses on 10 priority countries (India, China, Brazil, Mexico, Viet Nam, Philippines, Indonesia, Pakistan, Bangladesh, and Ukraine) and it supports the implementation of the WHO MPOWER policies – a set of evidence based policies such as smoke-free public places and advertising bans. Other areas of work include, holding the tobacco industry accountable, using global communications efforts to keep tobacco control on the global public health agenda, and further deepening support for tobacco taxes.

Our global partners for the Bloomberg Initiative to Reduce Tobacco Use. February 2017

While a lot of progress is being made abroad, what is going on in the United States specifically among youth? Would you say tobacco use is increasing or decreasing for this demographic?

According to the government’s 2016 National Youth Tobacco Survey, tobacco use in the United States among youth fell from 25.3 percent to 20.2 percent between 2015 and 2016 – a 20 percent decline. During the same period, the use of e-cigarettes fell from 16 percent to 11.3 percent, showing that teenagers may not be switching from traditional tobacco products to e-cigarettes to the degree some had predicted. In addition, over 245 cities and counties across the United States have raised the tobacco sale age to 21 in order to make it more difficult for youth to purchase tobacco products. Despite these declines, nearly 4 million middle and high school children were currently using tobacco products in 2016, reinforcing the need for continued strong tobacco control policies and programs.

What’s one region in the world where you’ve seen a lot of progress lately in tobacco control?

The Eurasian region has taken major strides to reduce tobacco use. Georgia just passed its most comprehensive tobacco control law to date. The law bans smoking in many public places, bans tobacco advertising and sponsorship, calls for 65% pictorial health warnings, and plain packaging on tobacco products. Although several provisions are not yet up to the Framework Convention on Tobacco Control (FCTC) standards – a WHO treaty that governments have signed and made legal commitments to combating the tobacco epidemic – this is a big step forward for Georgia. Once enforced, this tobacco control law will cover 3.9 million people. Ukraine recently passed a comprehensive tobacco control law and legislation is currently pending to close loopholes that exist in the smoke-free and advertising ban sections of the law. In addition, Johns Hopkins University will be hosting a leadership program in Kiev, Ukraine with 75 participants from around the Eurasian region where they will be trained in tobacco control best practices. Lastly, in Russia, a new Global Adult Tobacco Survey (GATS) shows a steep drop in tobacco use, from 39.4 percent in 2009 to 30.9 percent in 2016. Marked decreases in the exposure to and impact of secondhand smoke are also noted in the survey. This follows Russia’s introduction of a comprehensive tobacco control law in March 2013.

Members of the Georgian Parliament after the passage of the most comprehensive tobacco control law in the country’s history. May, 2017

What about countries in Asia?

In June of this year India released new data showing that tobacco use among adults declined 17 percent since 2010. As a result, there are over 8 million fewer tobacco users today than there were just seven years ago despite the growth in the Indian population. India has worked hard over the past several years to increase the size of the graphic warning on tobacco products and to continue to educate the public about the harms of tobacco use through paid and earned media strategies. This year, a new survey showed that in the Philippines there has also been a significant decrease in tobacco use; from 29.7 percent in 2009 to 23.8 percent in 2015. The results confirm that the Philippines government’s action to prevent and reduce tobacco use, particularly their significant improvement in the tobacco tax structure and rate, are working. However, nearly one in four Filipinos continue to use this deadly product so our work is not over.

Indian Ministry of Health and Welfare releasing the results of their second Global Adult Tobacco Survey. June 2017

Aside from countries, cities around the world are stepping up to combat global issues such as climate change and road safety; is this also true for tobacco control?

This is absolutely true. In fact, cities play a crucial role in combating the global tobacco epidemic and have made significant strides. Beijing, Shenzhen, and Shanghai have put smoke-free policies in place to collectively protect close to 60 million people from second-hand smoke – a number larger than many countries. Hong Kong also recently passed a law that increases the size of warning labels on tobacco products to 85 percent. The law will also double the number of rotating warnings and create a “Quit Line” to help smokers overcome their tobacco addiction. In Indonesia, 90 cities have gone smoke-free, protecting 80 million people from second-hand smoke. In May 2017 as part of Michael Bloomberg’s role as WHO Global Ambassador for Noncommunicable Diseases, he launched the Partnership for Healthy Cities, a global network formed to reduce NCDs and injuries with proven policies to advance health and strengthen economies. Of the 37 cities that have joined so far, 9 will focus on putting in place tobacco control policies.

Launch of Partnership for Healthy Cities. May 2017

As a young person, I’m shocked that tobacco companies can legally market to children in some countries outside the United States. What are the newest tactics Big Tobacco is using to target youth?

The tobacco industry continues to be our biggest enemy and are visibly present in the marketplace and the government. In Latin America, flavored cigarettes are the industry’s newest weapon and have increased in use among youth and non-smokers, who are turning away from traditional, unflavored tobacco due to the “harsh taste.” The tobacco industry works to make these products more appealing to younger smokers by using flavors, such as Menthol or fruit, product placement, and promotions. These efforts have led to an increase in the sale of flavored tobacco in the region, even as global tobacco sales decrease. In Brazil, a ban on additives in tobacco products, which includes flavors, is currently being challenged by Big Tobacco in the Brazilian Supreme Court. This attempt to repeal this ban is the perfect example of the industry’s commitment to targeting youth because the majority of marketing for these products is centered around schools.

Flavored tobacco products, that appeal to kids, on prominent display in Latin America. June 2017