Informe 2011 OMS-WHO: Sobre la Epidemia Mundial del Tabaquismo

8/2/2019 Informe 2011 OMS-WHO: Sobre la Epidemia Mundial del Tabaquismo

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INFORME OMS SOBRE LA EPIDEMIA MUNDIAL DE TABAQUISMO, 2011

Advertencia sobre los peligros del tabaco

Resumen

WHO/NMH/TFI/11.3

sin humo y con vida


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Organizacin Mundial de la Salud, 2011

Se reservan todos los derechos. Las publicaciones de laOrganizacin Mundial de la Salud estn disponibles en el sitio webde la OMS (www.who.int) o pueden comprarse a Ediciones de laOMS, Organizacin Mundial de la Salud, 20 Avenue Appia, 1211Ginebra 27, Suiza (tel.: +41 22 791 3264; ax: +41 22 791 4857;correo electrnico: [email protected]). Las solicitudes deautorizacin para reproducir o traducir las publicaciones de la OMS- ya sea para la venta o para la distribucin sin fnes comerciales

- deben dirigirse a Ediciones de la OMS a travs del sitio web dela OMS (http://www.who.int/about/licensing/copyright_orm/en/index.html).

Las denominaciones empleadas en esta publicacin y la ormaen que aparecen presentados los datos que contiene noimplican, por parte de la Organizacin Mundial de la Salud,

juicio alguno sobre la condicin jurdica de pases, territorios,ciudades o zonas, o de sus autoridades, ni respecto del trazadode sus ronteras o lmites. Las lneas discontinuas en los mapasrepresentan de manera aproximada ronteras respecto de lascuales puede que no haya pleno acuerdo.La mencin de determinadas sociedades mercantiles o denombres comerciales de ciertos productos no implica que laOrganizacin Mundial de la Salud los apruebe o recomiendecon preerencia a otros anlogos. Salvo error u omisin, lasdenominaciones de productos patentados llevan letra inicial

mayscula.

La Organizacin Mundial de la Salud ha adoptado todas lasprecauciones razonables para verifcar la inormacin que fguraen la presente publicacin, no obstante lo cual, el materialpublicado se distribuye sin garanta de ningn tipo, ni explcitani implcita. El lector es responsable de la interpretacin y eluso que haga de ese material, y en ningn caso la OrganizacinMundial de la Salud podr ser considerada responsable de daoalguno causado por su utilizacin.

Printed in Switzerland

Monitor:vigilar el consumo de tabacoy las polticas de prevencin

Protect: proteger a la poblacin del

humo de tabaco

Offer: ofrecer ayuda para dejar el

tabaco

Warn: advertir de los peligros

del tabaco

Enforce: hacer cumplir las

prohibiciones sobrepublicidad, promocin y

patrocinio del tabaco

Raise: aumentar los impuestos

al tabaco


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1

INFORME OMS SOBRE LA EPIDEMIA MUNDIAL DE TABAQUISMO, 2011 - RESUMEN

pases con respecto a las seis medidas deMPOWER hasta 2010, y se recogen otrosdatos acerca de las advertencias al pblicosobre los peligros del tabaco. El inorme

de este ao examina detalladamente lasdos estrategias principales para enviaradvertencias sanitarias: el etiquetado de lospaquetes de tabaco y las campaas en losmedios de comunicacin. El inorme oreceuna panormica completa de las basescientfcas para advertir a las personas delos eectos nocivos del consumo de tabaco,adems de inormacin acerca del estado deesas medidas en los dierentes pases.

Para seguir mejorando el anlisis de los datos,

se han pereccionado las categoras en lasque se clasifcan los logros normativos, queen la medida de lo posible se han adaptadoa las nuevas directrices derivadas del CMCTde la OMS. Se han vuelto a analizar los datosdel inorme de 2009 para armonizarlos conesas nuevas categoras, lo cual posibilita unacomparacin ms directa de los datos deambos inormes. Este ao se ha vuelto a optarpor orecer una versin impresa resumida delinorme y por publicar en lnea los datos mspormenorizados sobre los pases (vase http://

www.who.int/tobacco).

El tabaco sigue siendo la primera causamundial de muertes prevenibles. Cada aomata a cerca de 6 millones de personasy causa prdidas econmicas de cientos

de miles de millones de dlares en todoen mundo. La mayora de esas muertescorresponden a los pases de ingresos bajosy medios, y se espera que esta disparidadsiga aumentando en los decenios venideros.Si se mantiene la tendencia actual, en 2030el tabaco matar a ms de 8 millones depersonas al ao, y el 80% de esas muertesprematuras se registrarn en los pases deingresos bajos y medios. Si no se adoptanmedidas urgentes, el tabaco podra matar a lolargo del siglo XXI a mil millones de personas,

o ms.

El Convenio Marco de la OrganizacinMundial de la Salud para el Control delTabaco (CMCT de la OMS) demuestra que hayuna voluntad poltica mundial de reorzar elcontrol del tabaco y salvar vidas humanas. ElConvenio es un tratado mundial jurdicamentevinculante que sienta las bases para quelos pases apliquen y gestionen programasde control del tabaco para hacer rente a laepidemia creciente de consumo de tabaco.

A echa de mayo de 2011 el CMCT de la

OMS tena 173 Partes que abarcaban al 87%de la poblacin mundial, lo cual hace de luno de los tratados que ms rpidamenteha suscitado adhesiones en la historia de las

Naciones Unidas.

Para ayudar a los pases a cumplir susobligaciones dimanantes del CMCT, laOMS estableci en 2008 el plan MPOWER,consistente en seis medidas de control deltabaco basadas en datos que demuestranque son efcaces para reducir el consumode tabaco y salvar vidas. Las medidas deMPOWER orecen asistencia prctica a lospases para que apliquen polticas efcacespara reducir la demanda de tabaco. Dichas

medidas se centran en la reduccin de lademanda, aunque la OMS tambin reconocela importancia de las medidas que contemplael CMCT de la OMS para reducir la oerta yest comprometida con su aplicacin.

Los xitos del CMCT de la OMS se describenpormenorizadamente en el Informe OMSsobre la epidemia mundial de tabaquismo,

2011, el tercero de una serie de inormesde la OMS sobre los logros de la polticamundial de control del tabaco. En l se

actualizan los datos sobre los logros de los

Informacin general

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

P

Ambienteslibres de

humo

O

Programaspara dejarel tabaco

W

Advertenciassanitarias

W W

Medios decomunicacin

E

Prohibicionesde la

publicidad

R

Impuestos

M

Vigilancia

Proporcindepases(nmeroabsolutodentrodelasbarras)

Proporcindepases(nmeroabsolutodentrodelasbarras)

No hay datos, los datosno son recientes o noson recientes nirepresentativos

Datos recientes yrepresentativos deadultos o de jvenes

Datos recientes yrepresentativos tanto deadultos como de jvenes

Datos recientes,representativos y peridicostanto de adultos como de

jvenes

No se notificaron oclasificaron los datos

No hay polticas

Polticas mnimas

Polticas moderadas

Polticas completas

91

51

16

31

5

83

30

59

2218

89

67

19

1

87

59

23

19

6

97

18

30

23

26

23

62

69

27

13

71

3

101

19

ESTADO DE ALGUNAS POLTICAS DE CONTROL DEL TABACO EN EL MUNDO, 2011


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El nmero de personas que viven enpases que aplican los impuestos mnimosrecomendados sobre el tabaco haaumentado en 115 millones, y 26 pases

y un territorio tienen impuestos querepresentan el mnimo recomendado del75% sobre el precio al por menor.

Pese a los progresos que estn realizandolos pases en la recaudacin de impuestossobre el tabaco, sigue habiendo porparte de los gobiernos una fnanciacininsufciente de las actividades de controldel tabaco. Los gobiernos recaudanaproximadamente US$ 133 000 millonesen impuestos sobre el consumo de tabaco,

pero solo gastan menos de US$ 1000millones en actividades de control deltabaco, dfcit que resulta especialmentellamativo en los pases de ingresos bajosy medios.

Se siguen haciendo progresos sustancialesen la aplicacin de las medidas de MPOWER.Aproximadamente 3800 millones de personas(el 55% de la poblacin mundial) se benefcian

de al menos una medida que ha alcanzado elmximo nivel de consecucin, y entre ellas seincluyen los 1100 millones que se benefciande una nueva poltica desde 2008.

En 23 pases con 1900 millones dehabitantes se han realizado en 2009o 2010 campaas en los medios decomunicacin contra el consumo detabaco, una medida MPOWER que seevala por vez primera en el presenteinorme.

Los mayores progresos, medidos entrminos de poblacin abarcada, se hanhecho en la esera de las advertenciassanitarias en los paquetes de tabaco; otrostres pases con una poblacin de 458millones han promulgado leyes al ms altonivel sobre el etiquetado de los paquetes.

Aunque no se analizaron ormalmentelas campaas a nivel subnacional en losmedios de comunicacin, es probableque a nivel local haya habido un nmero

considerable de personas expuestas apublicidad contra el tabaco.

En 16 pases con una poblacin de385 millones se han promulgado leyesnacionales que prohben umar en todoslos lugares pblicos y de trabajo; otros100 millones de personas se encuentranprotegidas por leyes integrales de estetipo vigentes a nivel subnacional.

Un pas ms, con una poblacin de 76

millones, ha aplicado servicios integralespara ayudar a las personas a que dejen deconsumir tabaco.

En tres pases ms con una poblacin de80 millones de habitantes se ha prohibidocompletamente toda la publicidad,promocin y patrocinio del tabaco.

Datos ms destacados


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3


W

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Proporcindelapoblacinmundial

11%

P

Ambienteslibres de humo

14%

O


15%


28%


E

Prohibicionesde la

publicidad

6%8%

R

Impuestos

M

Vigilancia

46%

PROPORCIN DE LA POBLACIN MUNDIAL CUBIERTA POR ALGUNASPOLTICAS DE CONTROL DEL TABACO, 2010

Nota: Las polticas de control del tabaco representadas aqu corresponden a las que han alcanzado el mximo nivel de consecucin enel mbito nacional.

Proporcindelapoblacinmundial

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

E

Prohibicionesde la

publicidad

5%

R

Impuestos

6%

O


13%

1%

1% 2%


W

8%

7%


28%

20102008

P

Ambienteslibres de humo

6%

5%

AUMENTO DE LA PROPORCIN DE LA POBLACIN MUNDIAL

CUBIERTA POR ALGUNAS POLTICAS DE CONTROL DEL TABACODESDE 2008

Notas: Se representan en el grfco cambios del 1%, como mnimo.

En esta grfca no se muestran los datos sobre la vigilancia porque no son comparables entre 2008 y 2010. Los datos sobre losmedios de comunicacin se recopilaron por vez primera en 2010, por lo que no hay datos comparables de 2008. Las polticasde control del tabaco representadas aqu corresponden a las que han alcanzado el mximo nivel de consecucin en el mbitonacional.


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de los medios fnancieros y del compromisopoltico necesarios para apoyar programasefcaces y sostenibles.

Aunque muchos pases han hecho progresosconsiderables en materia de control deltabaco, es necesario seguir trabajando eneste mbito. Hay que ampliar los xitos yaalcanzados, de modo que toda la poblacinmundial se encuentre plenamente protegidarente a los eectos nocivos del consumo detabaco. La continuidad de esos progresosimpedir que millones de personas muerancada ao de enermedades preveniblesrelacionadas con el tabaco y ahorrar cientosde miles de millones de dlares en gastos

sanitarios y prdidas de productividad. Denosotros depende que as sea.

El CMCT de la OMS demuestra la persistenciadel compromiso mundial con medidasdecisivas para luchar contra la epidemiamundial de tabaquismo, que mata a

millones de personas y cuesta cientos demiles de millones de dlares al ao. Las 173Partes en el CMCT de la OMS, que abarcanaproximadamente el 87% de la poblacinmundial, han asumido un compromisojurdicamente vinculante de aplicar polt icasefcaces de control del tabaco. El CMCT dela OMS proporciona a los pases los mediosnecesarios para el control del tabaco, cuyaaplicacin y cumplimiento reducirn elconsumo y salvarn vidas humanas.

La situacin de las medidas de MPOWERque se presenta en este Informe OMSsobre la epidemia mundial de tabaquismo,

2011 muestra que todos los pases,

independientemente de su estructura polticae ingresos, pueden aplicar programas efcacesde control del tabaco destinados a reducir suconsumo. Los progresos que se han hecho

con respecto a la consecucin del mximonivel de las medidas de MPOWER son signodel xito cada vez mayor del CMCT de la OMSy demuestran ehacientemente que hay unavoluntad poltica de control del tabaco a nivelnacional y mundial que puede aprovecharsepara obtener mayores resultados.

Muchos pases han hecho progresossignifcativos en la lucha contra la epidemiade consumo de tabaco y pueden considerarsecomo modelos para la actuacin de otros

pases que todava no han adoptado esasmedidas. Los pases deben seguir ampliandoe intensifcando sus esuerzos por lograr uncontrol del tabaco, y velar por que dispongan

Conclusin

Seguimos avanzando: cerca de 3800 millones de personas se

benefcian de alguna medida efcaz de control del tabaco.


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Fotograas e ilustraciones

Pgina 2 Fotgrao: Curt Carnemark

Pgina 4 Fotgrao: Anvar Ilyasov

Diseo de Estdio InfnitoMaquetacin de designisgood.inoImpreso por el Servicio de Produccin de Documentos de la OMS, Ginebra (Suiza)

El Informe OMS sobre la epidemia

mundial de tabaquismo, 2011ha sido fnanciado con ayuda

de Bloomberg Philanthropies


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20 Avenue Appia

CH-1211 Ginebra 27

Suiza

www.who.int/tobacco/


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fresh and alive

WHO REPORT On THE glObal TObaCCO EPidEmiC, 2011

Wr out the ers of tocco


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Mot tobacco uer

are unaware

o the harm caued

b tobacco ue.


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Up to hal

o all tobacco uer

will die rom a

tobacco-related dieae.


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Monitor Monitor tobacco use and

prevention policies

Protect Protect people rom

tobacco smoke

Oer Oer help to quit tobacco use

Warn Warn about the

dangers o tobacco

Enorce Enorce bans on tobaccoadvertising, promotion and

sponsorship

Raie Raise taxes on tobacco


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WHO Report on the Global Tobacco

Epidemic, 2011: Warning about thedangers of tobacco is the third i a

series o WHO reports that tracs the

status o the tobacco epidemic ad the

impact o iteretios impemeted to

stop it.

Large graphic healthwarning label

on tobacco packaging

and hard-hittingma media campaign

reduce tobacco ue.


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WHO Library Cataloguing-in-Publication Data

WHO report on the global tobacco epidemic, 2011: warning aboutthe dangers o tobacco.

1.Smoking - prevention and control. 2.Tobacco smokepollution - prevention and control. 3.Tobacco controlcampaigns. 4.Health policy. I.World Health Organization.

ISBN 978 92 4 156426 7 (NLM classication: WM 290)

ISBN 978 92 4 068781 3 (pd)ISBN 978 92 4 068782 0 (epub)ISBN 978 92 4 068783 7 (mobi)

World Health Organization 2011

All rights reserved. Publications o the World Health Organizationare available on the WHO web s ite (www.who.int) or can bepurchased rom WHO Press, World Health Organization,20 Avenue Appia, 1211 Geneva 27, Switzerland(tel.: +41 22 791 3264; ax: +41 22 791 4857; e-mail:[email protected]). Requests or permission to reproduceor translate WHO publications whether or sale or ornoncommercial distribution should be addressed to WHO Pressthrough the WHO web site (http://www.who.int/about/licensing/copyright_orm/en/index.html).

The boundaries and names shown and the designations employedand the presentation o the material in this publication do notimply the expression o any opinion whatsoever on the part othe World Health Organization concerning the legal status o anycountry, territory, city or area or o its authorities, or concerningthe delimitation o its rontiers or boundaries. Dotted lines onmaps represent approximate border lines or which there may notyet be ull agreement.

The mention o specic companies or o certain manuacturersproducts does not imply that they are endorsed or recommendedby the World Health Organization in preerence to others o asimilar nature that are not mentioned. Errors and omissionsexcepted, the names o proprietary products are distinguished byinitial capital letters.

All reasonable precautions have been taken by the WorldHealth Organization to veriy the inormation contained in this

publication. However, the published material is being distributedwithout warranty o any kind, either expressed or implied. Theresponsibility or the interpretation and use o the material lieswith the reader. In no event shall the World Health Organizationbe liable or damages arising rom its use.

Printed in Italy


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WHO REPORT ON THEGLOBAL TOBACCO EPIDEMIC, 2011

Warig about the dagers o tobacco

Made possible by fundingfrom Bloomberg Philanthropies


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Content

7 PROGREss CONTINuEs NEARLy 3.8 BILLION PEOPLE ARE

NOW COvERED By AN EECTIvE TOBACCO CONTROLMEAsuREA letter rom WHO Assistant Director-General

8 suMMARy

12 WHO RAMEWORK CONvENTION ON TOBACCO CONTROL14 Article 11 Packaging and labelling o tobacco products

15 Guidelines or implementation o Article 11

16 Article 12 Education, communication, training and public awareness

17 Guidelines or implementation o Article 12

18 WARN ABOuT THE DANGERs O TOBACCO18 People have a right to accurate inormation about the harms o tobacco use

22 Health warning labels on tobacco packaging

28 Anti-tobacco mass media campaigns

38 IMPLEMENTATION O EECTIvE MEAsuREs CONTINuEsTO GAIN MOMENTuM

38 Monitor tobacco use and prevention policies

42 Protect rom tobacco smoke

46 Oer help to quit tobacco use

50 Warn about the dangers o tobacco

50 Health warning labels

54 Anti-tobacco mass media campaigns


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ABBREVIATIONS

AFR WHO Arica Regio

AMR WHO Regio o theAmericas

CDC Ceters or Disease Cotroad Preetio

COP Coerece o the Partiesto the WHO FCTC

EMR WHO EasterMediterraea Regio

EUR WHO Europea Regio

NRT icotie repacemettherap

SEAR WHO South-East AsiaRegio

STEPS WHO's STEPwise approachto Sureiace

US$ Uited States doar

WHO Word Heath Orgaizatio

WHO FCTC WHO FrameworCoetio o Tobacco

Cotro

WHO TFI WHO Tobacco Free

IitiatieWPR WHO Wester Pacifc

Regio

62 Enorce bans on tobacco advertising, promotion and sponsorship

66 Raise taxes on tobacco

70 National action is critical to achieve the vision o a tobacco-ree world

74 CONCLusION

76 REERENCEs

82 TECHNICAL NOTE I: Evaluation o existing policies and compliance

86 TECHNICAL NOTE II: Smoking prevalence in WHO Member States

88 TECHNICAL NOTE III: Tobacco taxes in WHO Member States

93 APPENDIX I: Regional summary o MPOWER measures107 APPENDIX II: Regulation o warning labels on cigarette packages and

national anti-tobacco mass media campaigns

145 APPENDIX III: Status o the WHO Framework Convention on Tobacco Control

150 ACKNOWLEDGEMENTs

E1 APPENDIX IV: Global tobacco control policy data

E250 APPENDIX V: Country proles

E364 APPENDIX VI: Graphs on tobacco taxes and prices

E388 APPENDIX VII: Age-standardized prevalence estimates or smoking, 2009

E420 APPENDIX VIII: Country-provided prevalence data

E462 APPENDIX IX: Global Youth Tobacco Survey data

E504 APPENDIX X: Maps on global tobacco control policy data

Appendices IV through X are available in electronic ormat on the CD accompanyingthis book and online at http://www.who.int/tobacco/


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Over the past two years, 1.1 billion people have

become covered by at least one MPOWER measure

newly applied at the highest level.

People have an inherent right to receive inormation

about the health dangers o tobacco use, andcountries have an obligation to provide it.

Dr Ala Alwan, Assistant Director-General, World Health Organization


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7WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2011

PROGREss CONTINUEs NEARLy 3.8 BILLION PEOPLE ARE

NOW COvERED By AN EffECTIvE TOBACCO CONTROL MEAsURE

detailed national-leel data collected on a

global bai or anti-tobacco ma media

campaign.

The data are impreie. More than

1 billion people now lie in contrie with

legilation that reire large graphic health

warning on eer cigarette pack old in

their contrie, and 1.9 billion people lie

in the 23 contrie that hae aired high-

alit national anti-tobacco ma media

campaign within the pat two ear. It

i clear that btantial progre i being

made againt thi deadl prodct. Low- and

middle-income contrie hae been in theoreront o deeloping anti-tobacco ma

media campaign, howing that contrie

can ccell implement thi interention

regardle o income claication.

Neerthele, the tobacco epidemic

contine to epand becae o ongoing

tobacco indtr marketing, poplation

growth in contrie where tobacco e i

increaing, and the etreme addictiene

o tobacco that make it diclt or peopleto top moking once the tart. Althogh

there ha been progre, onl 19 contrie

ollow bet-practice tandard b reiring

large graphic health warning on tobacco

prodct package none o which are

low-income contrie. All contrie, in

partnerhip with the united Nation, health

deelopment agencie and ciil ociet,

can and mt do more b meeting their

commitment nder the WHO ramework

Conention on Tobacco Control and it

correponding gideline.

The nmber o people now protected b

tobacco control meare i growing at a

remarkable pace. The progre made onappling meare that redce the demand

or tobacco i a ign o the increaing impact

o the WHO ramework Conention on

Tobacco Control, which contine to be one

o the mot rapidl embraced, mearabl

ccel treatie in united Nation hitor.

Thi report, the third periodic contr-leel

eamination o the global tobacco epidemic,

identie the contrie that hae applied

eectie tobacco control meare thatae lie. Thee contrie can be held p a

model o action or the man contrie that

need to do more to protect their people rom

the harm o tobacco e. Tobacco contine

to kill nearl 6 million people each ear,

inclding more than 600 000 non-moker

who die rom epore to tobacco moke. up

to hal o the world 1 billion moker will

eentall die o a tobacco-related dieae.

Howeer, we hae the power to change thee

circmtance.

Oer the pat two ear, 1.1 billion people

hae become coered b at leat one

MPOWER meare newl applied at the

highet leel. Thi i the relt o action

taken b 30 contrie oer hal o them

claied a low- or middle-income which

hae applied meare that, while reiring

relatiel little inetment, are proen to be

highl eectie at changing tobacco e

pattern and aing lie.

The oc o thi report i on warning people

abot the harm o tobacco e. People hae

an inherent right to receie thi inormation,

and contrie hae an obligation to proide

it. The two main tpe o warning are

eamined: health warning label on tobacco

package and national anti-tobacco ma

media campaign. Large and graphic

warning label and hard-hitting ma media

campaign hae proen eectie in redcingtobacco e and encoraging people to

it. Thi report preent or the rt time

Thi report appear at a crcial moment

in the ght againt the growing epidemic

o noncommnicable dieae (NCD)

primaril cancer, diabete, and

cardioaclar and chronic lng dieae

which accont or 63% o all death

worldwide and or which tobacco e i one

o the bigget contribting agent. Thee

dieae kill an atonding 36 million people

each ear, with 80% o death occrring in

low- and middle-income contrie that can

leat aord them. An etimated 9 million

death occr below the age o 60 ear. On

1920 september 2011, the united NationGeneral Aembl will hold it rt-eer

high-leel meeting to conider the threat

and impact o noncommnicable dieae

on global health and hman deelopment.

Head o state will dic dring thi

meeting in New york how to raie awarene

o and plot trategie againt thi clter

o related dieae that hare eeral rik

actor, mot notabl tobacco e.

Becae tobacco e and epore totobacco moke cae a large proportion o

global illne and death, tobacco control

mt be gien the high priorit it deere

o that we can epand on the ccee we

hae alread realied. Coneentl, tobacco

control meare are epected to be caled

p a a core component o the otcome or

the united Nation high-leel meeting on

NCD.

A Dr Margaret Chan, Director-General o

the World Health Organiation ha aid,

What get meared get done. Thi

report i a trong and important tep in or

ongoing mearement o what ha been

achieed in tobacco control and how mch

more contrie need to do. We can and mt

contine thi work million o people

lie are at take.

Dr Ala Alwan

Aitant Director-General

World Health Organiation


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8 WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2011

Tobacco e contine to be the leading

global cae o preentable death. Itkill nearl 6 million people and cae

hndred o billion o dollar o economic

damage worldwide each ear. Mot o thee

death occr in low- and middle-income

contrie, and thi diparit i epected

to widen rther oer the net eeral

decade. I crrent trend contine, b 2030

tobacco will kill more than 8 million people

worldwide each ear, with 80% o thee

prematre death among people liing inlow- and middle-income contrie. Oer the

core o the 21t centr, tobacco e cold

kill a billion people or more nle rgent

action i taken.

The World Health Organiation ramework

Conention on Tobacco Control (WHO

CTC) demontrate global political will to

trengthen tobacco control and ae lie.

The WHO CTC i a legall binding global

summar

treat that proide the ondation or

contrie to implement and manage tobaccocontrol programme to addre the growing

epidemic o tobacco e. A o Ma 2011,

the WHO CTC ha 173 Partie coering

87% o the world poplation, making it

one o the mot rapidl embraced treatie in

united Nation hitor.

To help contrie ll their WHO CTC

obligation, in 2008 WHO introdced the

MPOWER package o i eidence-baedtobacco control meare that are proen

to redce tobacco e and ae lie.

The MPOWER meare proide practical

aitance with contr-leel implementation

o eectie policie to redce the demand

or tobacco. The MPOWER meare oc

on demand redction, althogh WHO

alo recognie the importance o and i

committed to implementing the ppl-ide

meare contained in the WHO CTC.

The contined cce o the WHO CTC i

detailed in thi ear WHO Report on the

Global Tobacco Epidemic, 2011, the third in

the erie o WHO report on the tat o

global tobacco control polic achieement. All

data on the leel o contrie achieement

or the i MPOWER meare hae been

pdated throgh 2010, and additional data

hae been collected on warning the pblic

abot the danger o tobacco. Thi ear

report eamine in detail the two primar

trategie to proide health warning labelon tobacco prodct packaging and anti-

tobacco ma media campaign. The report

proide a comprehenie oeriew o the

eidence bae or warning people abot the

harm o tobacco e, a well a contr-

pecic inormation on the tat o thee

meare.

To contine the proce o improing data

anali, categorie o polic achieement


23/172


W

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Shareofworldpopulation

11%

P

Smoke-free

environments

14%

O

Cessation

programmes

15%

Warning

labels

28%

Mass

media

E

Advertising

bans

6%8%

R

Taxation

M

Monitoring

46%

sHARE O THE WORLD POPuLATION COvERED By sELECTEDTOBACCO CONTROL POLICIEs, 2010

Note: The tobacco control policies depicted here correspond to the highest level o achievement at the national level; or thedenitions o these highest categories reer to Technical Note I.

hae been rened and, where poible, made

conitent with new and eoling WHO CTC

gideline. Data rom the 2009 report hae

been reanaled to be conitent with thee

new categorie, allowing or more direct

comparion o the data acro both report.

Thi ear contine the practice o printing a

treamlined mmar erion o the report

and pblihing more detailed contr-pecicdata online (http://www.who.int/tobacco).

sbtantial progre contine to be made

in appling the MPOWER meare. Roghl

3.8 billion people (55% o the world

poplation) are coered b at leat one

meare at the highet leel o achieement,

inclding 1.1 billion people coered b a

new polic ince 2008. More than 1 billion

people (17% o the world poplation)

are coered b two or more meare at

the highet leel o achieement. Gain

were made in all area, with a total o

30 contrie enacting at leat one new

MPOWER meare at the highet leel ince

2008. Anti-tobacco ma media campaign,

an MPOWER meare aeed or the rt

time or thi report, occrred in 23 contrie

reaching 1.9 billion people dring 2009 and2010.

Together, health warning label and anti-

tobacco ma media campaign are the

mot widel embraced MPOWER meare,

baed on poplation coerage. The MPOWER

meare howing the larget progre

ince the 2009 report, baed on poplation

coerage, i proiion o health warning

label on tobacco packaging. More than

a billion people now hae pack warning

law at the highet leel o achieement in

thi polic area, a gain o three contrie

(with nearl hal a billion people) that hae

paed ch legilation within the pat

two ear. Notabl, the united state o

America will moe rom er weak warning

label reirement to among the world

tronget in 2012, when it new warninglabel reglation are chedled to be

implemented.

Thi ear report alo proide, or the

rt time eer, tematicall collected

inormation abot anti-tobacco ma media

campaign, a highl eectie method o

warning the pblic abot the danger o

tobacco. The data reeal the promiing

work being done in thi area more than

19 countries with more than a billion people

now have pack warning laws at the highest level

o achievement in this policy area.


24/172


it tobacco e, epoed to eectie

health warning throgh tobacco package

labelling and ma media campaign,

protected againt tobacco indtr

marketing tactic and coered b taation

policie deigned to decreae tobacco e

and nd tobacco control and other healthprogramme. Pereerance b all contrie

in epanding the reach o tobacco control

programme i needed to achiee the goal

o a tobacco-ree world, and i critical to

aing the lie o the billion people who

ma otherwie die rom tobacco-related

illne thi centr.

1.9 billion people (28% o the world

poplation) lie in the 23 contrie that ran

at leat one trong anti-tobacco ma media

campaign dring the reporting period. Onl

een o the 23 contrie that ran a trong

campaign are claied a high-income

the majorit reporting eemplar campaignare low- or middle-income contrie,

proiding eidence that all contrie,

regardle o income leel, can rn eectie

ma media campaign.

The WHO Report on the Global Tobacco

Epidemic, 2009 oced on the importance

o protecting the pblic rom the danger

o econd-hand tobacco moke throgh

comprehenie moke-ree law. sbtantial

gain hae been made in thi area ince

2008 16 additional contrie hae paed

national legilation that ban moking in

all pblic place and workplace, inclding

bar and retarant, with the relt that

oer 385 million people hae been newl

protected rom the health harm o tobaccomoke. An additional 100 million people

are protected b comprehenie moke-

ree law that hae been paed at the

bnational leel ince 2008.

A contrie contine to bild on the

progre achieed ince becoming Partie

to the WHO CTC, more people are being

protected rom the harm o econd-hand

tobacco moke, proided with help to

More than 1.9 billion people live in the 23 countries

that ran at least one strong anti-tobacco

mass media campaign during the reporting period.


25/172


Shareofworldpopulation

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

E

Advertisingbans

5%

R

Taxation

6%

O

Cessationprogrammes

13%

1%

1% 2%

Warninglabels

W

8%

7%

Massmedia

28%

20102008

P

Smoke-freeenvironments

6%

5%

INCREAsE IN THE sHARE O THE WORLD POPuLATION COvEREDBy sELECTED TOBACCO CONTROL POLICIEs sINCE 2008

Notes: Changes o less than 1% are not labelled on the graph.

Data on monitoring are not shown in this graph because they are not comparable between 2008 and 2010. Mass media datawere collected or the rst time in 2010, so no comparable data are shown or 2008. The tobacco control policies depicted herecorrespond to the highest level o achievement at the national level; or the denitions o these highest categories reer toTechnical Note I.

P

Smoke-freeenvironments

O

Cessationprogrammes

Warninglabels

W

Massmedia

E

Advertisingbans

R

Taxation

M

Monitoring

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Proportionofcountries(Numberofcoun

triesinsidebars)

Proportionofcountries(Numberofcoun

triesinsidebars)

No known data, or norecent data or datathat are not bothrecent andrepresentative

Recent andrepresentative datafor either adults oryouth

Recent andrepresentative datafor both adults andyouth

Recent, representa-tive and periodicdata for both adultsand youth

Data not reported/not categorized

No policy

Minimal policies

Moderate policies

Complete policies

91

51

16

31

5

83

30

59

2218

89

67

19

1

87

59

23

19

6

97

18

30

23

26

23

62

69

27

13

71

3

101

19

THE sTATE O sELECTED TOBACCO CONTROL POLICIEs IN THE WORLD, 2010

Reer to TechnicalNote I or denitionso categories

Reer to TechnicalNote I or denitionso categories


26/172


WHO frameworkConention on

Tobacco ControlWhen WHO wa etablihed in 1948, it

Member state incorporated the power

to negotiate treatie into it Contittion.

Thi power remained dormant ntil

1996, when the World Health Aembl

adopted a reoltion reeting the WHO

Director-General to initiate deelopmento a ramework conention or global

tobacco control in accordance with the

WHO Contittion. Thi nprecedented

reet wa made in repone to the rapid

globaliation o the tobacco epidemic

and the growing magnitde o the health

brden aociated with tobacco e, which

kill nearl 6 million people and cae

hndred o billion o dollar in economic

damage worldwide eer ear.

Toda, the WHO ramework Conention on

Tobacco Control (WHO CTC) (1) i one o

the mot rapidl embraced treatie in the

hitor o the united Nation, with 173 Partie

coering 87% o the world poplation.

It contain legall binding obligation or

it Partie, addree the need to redce

both demand or and ppl o tobacco,

and proide a comprehenie direction orimplementing tobacco control polic at all

leel o goernment. The treat goerning

bod i the Conerence o the Partie (COP),

an intergoernmental entit compoed o all

Partie with reponibilit or giding and

promoting eectie implementation o the

WHO CTC. A part o thi reponibilit,

the COP conider the report bmitted

periodicall b each Part, in accordance

with Article 21 o the treat, and the global

mmar prepared b the Conentionsecretariat to reiew the progre, ccee

and challenge o implementation.

To refect the compleitie o the tobacco

epidemic, a well a the challenge o

contering a er well-nded and powerl

mltinational indtr, WHO CTC negotiator

inclded broad, encompaing treat

proiion to addre demand redction and

ppl redction ie in Article 6 and 817:

Article 6. Price and ta meare to redce

the demand or tobacco.

Article 8. Protection rom epore to

tobacco moke.

Article 9. Reglation o the content o

tobacco prodct.

Article 10. Reglation o tobacco prodct

diclore.

Article 11. Packaging and labelling o

tobacco prodct.Article 12. Edcation, commnication,

training and pblic awarene.


27/172


Many countries can easily improve

policies by increasing the sizeo warning labels, strengthening

the wording o warnings

and making them more specic,

and including pictures rather

than text-only warnings.

Article 13. Tobacco adertiing, promotion

and ponorhip.

Article 14. Redction meare concerningtobacco dependence and ceation.

Article 15. Illicit trade in tobacco prodct.

Article 16. sale to and b minor.

Article 17. Proiion o pport or

economicall iable alternatie actiitie.

In addition to thee ppl and demand

meare, the WHO CTC proide gidance

and encoragement or collaboration in

implementation; in particlar, ection

addreing General obligation (Article 5),scientic and technical cooperation and

commnication o inormation (Article 20,

21 and 22) and International cooperation

and reorce (Article 25 and 26) help

Partie maimie bet practice, hare

eperience and aoid intererence rom the

tobacco indtr.

The tet o the WHO CTC, and the cce

in implementing eectie national and

global tobacco control policie ince it

entr into orce, demontrate tronginternational commitment to ending the

tobacco epidemic. The treat etablihe

tandard that nderpin and drie tobacco

control throghot the world and reinorce

the role and trength o international

law a a tool to preent dieae and

diabilit. The power o thi treat lie not

onl in it obligation, which are binding

or all Partie, bt alo in the ormal

demontration o the need, recognied

globall, to protect preent and tregeneration rom the deatating health,

ocial, enironmental and economic

coneence o tobacco conmption and

epore to tobacco moke (1).

In Article 7 (Non-price meare to redce

the demand or tobacco), the WHO CTC

mandate: Each Part hall adopt and

implement eectie legilatie, eectie,

adminitratie or other meare necear

to implement it obligation prant to

Article 8 to 13 The Conerence o thePartie hall propoe appropriate gideline

or the implementation o the proiion o

thee Article (1).

The COP nanimol adopted gideline

or Article 11 in Noember 2008 and

nanimol adopted Article 12 gideline

in Noember 2010. Thee gideline

etablih high tandard o accontabilit

or treat compliance and inclde clear

tatement o prpoe, objectie andgiding principle.


28/172


Article 11 Packaging and labellingo tobacco productThe WHO CTC i an eidence-baed

treat: nowhere i thi more clear than inArticle 11, which et ot trong, clear

and legall obligator tandard or health

warning label on tobacco packaging. Thee

tandard are deried rom trong data

that health warning encorage tobacco

er to it and help keep ong people

rom tarting. Article 11 orm the bai

or international action to commnicate

the health rik o tobacco, and reire

all Partie to implement compliantwarning label on all tobacco prodct

old or otherwie ditribted within their

jridiction within three ear ater entr

into orce o the treat or that Part.

Article 11 o the WHO CTC reire

that health warning label on tobacco

packaging (2):

be approed b the competent national

athorit; hold coer 50% or more o the

principal pack dipla area, bt hold

be no le than 30%;

be large, clear, iible and legible;

not e mileading term like light

and mild;

be rotated periodicall to remain reh

and noel to conmer;

dipla inormation on releant

contitent and emiion o tobaccoprodct a dened b national athoritie;

appear in the principal langage() o

the contr.

The trength o the langage and o the

obligation et orth in Article 11 hae led

to mearable global progre in proiding

people with eectie warning abot the

danger o tobacco, althogh there i till

work to be done in mot contrie andin all region. Man contrie can eail

improe policie b increaing the ie o

warning label, trengthening the wording

o warning and making them more pecic,

and inclding pictre rather than tet-onl

warning.

In order to promote international cooperation, the COP reeted

that WHO Tobacco ree Initiatie (TI) etablih and maintain

a central databae o pictorial health warning and meage.

TI, in collaboration with the WHO CTC Conention secretariat,

ha etablihed ch a databae to acilitate haring o pictorial

health warning and meage among contrie and Partie.*Thi tpe o aitance and pport are part o WHO larger

tobacco control programme drien b the WHO CTC. To proide

technical aitance to help Member state ll ome o their

commitment to the treat, WHO ha propoed the MPOWER

package o meare. MPOWER pport the implementation o

i eectie tobacco control meare proen to redce tobacco

e. Each meare refect one or more proiion o the WHO

CTC, and the package o i meare i an important entr

point or caling p eort to redce the demand or tobacco.

MPOWER i an integral part o the WHO Action Plan or the

Preention and Control o Noncommnicable Dieae (3),

which wa endored at the 61t World Health Aembl in 2008and refect the commitment o WHO Member state to the

implementation o the WHO CTC.

* The health warning databae i reel acceible to the pblic

at: http://www.who.int/tobacco/healthwarningdatabae/en/

inde.html

WHO fCTC health warning databae


29/172


Guideline or implementation o Article 11

The prpoe o the Article 11 gideline i to ait Partie in

meeting their WHO CTC obligation and to gget mean b

which Partie can increae the eectiene o their packaging

and labelling meare. The btance o the Article 11 gideline

i eparated into een ection (2).

Developing eective packaging andlabelling requirementsThe Article 11 gideline articlate recommendation on deign

element o eectie warning label and dipla o inormation on

contitent and emiion, and encorage the ollowing meare

to increae the eectiene o packaging and labelling (2).

Warning label hold coer a mch o the principal dipla

area a poible.

I ed, pictre hold be in ll color. Warning hold appear on the ront and back o pack, a

well a at the top o principal dipla area, to maimie their

iibilit and in ch a wa that the opening o the package

doe not permanentl damage or conceal the warning.

Partie hold conider printing warning on cigarette lter

and/or on other related material (e.g. package o cigarette

tbe, lter and paper) a well a other intrment (e.g.

thoe ed or water pipe moking).

Warning hold addre dierent ie related to tobacco

e, in addition to harml health eect and the impact

o econd-hand tobacco moke epore (e.g. Adice onceation, the addictie natre o tobacco, adere economic

and ocial otcome ch a the annal cot o prchaing

tobacco prodct, the impact o tobacco e on other,

adere enironmental otcome, and tobacco indtr

practice).

Warning ma be deigned to target bgrop (e.g. oth).

Warning hold not contain antitatie or alitatie

tatement abot tobacco contitent and emiion (e.g.

tar, nicotine and carbon monoide gre) that might impl

that one brand i le harml than another. Where poible, warning hold ndergo pre-market

teting to ae their eectiene with the intended target

poplation.

Partie hold look to pack warning ed elewhere

or bet-practice eample on how to implement thi

interention.

Where it line erice are aailable, it line nmber

can be inclded on warning label to improe linkage to

ceation erice.

Partie hold conider legilation to mandate plain, generic

packaging and prohibit or retrict the e o logo, color,brand image or promotional inormation.

Process or developing eective packagingand labelling requirements

Warning label hold appear on all tobacco packaging, and

thoe label hold be eectie in accratel coneing the

health rik o moking. Thi ection o the gideline addree

conideration that each Part mt take into accont to

accomplih thi.

Developing eective packaging andlabelling restrictions

Tobacco packaging hold not be mileading. The gideline

pecicall recommend that gre or emiion ield not be

inclded on tobacco package, and that Partie conider plain,

generic packaging that retrict the e o logo, brand image

and promotional inormation b limiting packaging onl to brandname and prodct name diplaed in a tandard color and

ont tle.

Legal measures

To ait Partie in generating and implementing enorceable

meare that ati WHO CTC reirement, the gideline

inclde a nmber o pecic recommendation on drating

legilation to enre that eectie warning label are inclded on

all tobacco prodct.

Enorcement

Appropriate inratrctre and bdget are critical to enorcement.

Partie hold enre that all takeholder are aware o new

labelling meare and e inpector or agent to condct

pot check at import, eport and retail acilitie. Reaction to

noncompliance mt be rapid and, i poible, the pblic hold

be empowered to report noncompliance and le complaint.

Monitoring and evaluating packaging andlabelling measures

Monitoring and ealating the eect o tobacco control

meare are critical to ae their impact, identi where

improement are needed, and add to the bod o bet-practice

eidence. The gideline note that monitoring and ealation are

ongoing procee.

International cooperation

The gideline note that international cooperation i needed to

maimie the eectiene o packing and labelling proiion.

The WHO CTC proide or and promote cooperation,

inormation and epertie echange, and pport between andamong Partie in eeral area.


30/172


Article 12 Education, communication,training and public awareneundertanding that een the mot eectie

warning label are not cient, Article12 o the WHO CTC contain obligation

or Partie to promote and trengthen

pblic awarene o tobacco control ie

throgh other mean. Article 12 reire

Partie to proide the pblic with widel

acceible and comprehenie inormationon the addictiene o tobacco and the

rik and harm o tobacco conmption

and epore to tobacco moke, a well

a the adere health, economic and

Education, communication and training are most

eective when incorporated into a comprehensive

tobacco control programme.

enironmental coneence o tobacco

prodction. Partie are alo reired togie the pblic acce to a wide range o

inormation on the tobacco indtr.


31/172


The objectie o the Article 12 gideline are to identi

ke meare needed to ccell edcate, commnicate

with and train people on the health, ocial, economic andenironmental coneence o tobacco prodction and

conmption and o epore to tobacco moke, and to gide

Partie in etablihing a tainable inratrctre needed to

pport thee meare. A with other WHO CTC gideline,

thee draw on the bet aailable eidence, bet practice and

eperience. The gideline alo articlate a et o giding

principle or implementation. The btance o the Article 12

gideline all into i ection (4):

Providing an inrastructure to raise publicawarenessThe gideline emphaie that eectiel raiing pblic

awarene reire olid, tainable inratrctre that hold

inclde a tobacco control ocal point within the national

goernment to catale, coordinate and acilitate delier

o tobacco-related edcation, commnication and training

programme, and to monitor and ealate thee programme.

Running eective education,communication and training programmesThe gideline proide denition o ke term releant to

awarene raiing a well a tactic or Partie to implement

eectie trategie. Thee denition emphaie that edcation,

commnication and training are mot eectie when incorporated

into a comprehenie tobacco control programme, and that the

reire a tainable approach to maintain eectiene.

Involving civil societyPartie are encoraged to actiel inole ciil ociet in planning,

deeloping, implementing, monitoring and ealating tobacco

control edcation, commnication and training programme.

Goernment hold alo identi and inole ke commnit

tobacco control leaderhip and conider proiding direct nancial or

other pport to tobacco control eort ndertaken b ciil ociet.

Ensuring wide access to inormation on thetobacco industry

The gideline otline the man trategie emploed b the

tobacco indtr to ndermine tobacco control, and reerence the

obligation nder WHO CTC Article 5.3 to enre that policie

are ree rom tobacco indtr infence. To be eectie, tobacco

control edcation, commnication and training reire accrate

and trthl inormation abot the tobacco indtr; in trn,

Partie are reired to make ch inormation reel and readil

acceible to the pblic.

Strengthening international cooperationThe gideline recognie the importance o haring inormation

and bet practice between and among contrie a well a the

importance o collaborating to raie global pblic awarene o

tobacco control.

Monitoring o implementation and revisiono the guidelines

The gideline emphaie the need or Partie to monitor,

ealate and reie their commnication, edcation and

training meare to acilitate comparion, obere trend and

proide clear goal or implementation. Ealation hold alo

inclde determination o need, ormlation o objectie and

identication o reorce reired beore initiating awarene

raiing programme.

Additionall, 10 annee are appended to the Article 12

gideline that proide practical idea or implementation.

Thee annee are a erie o lit, inclding checklit or an

action plan or implementation o edcation, commnication

and training actiitie within a comprehenie tobacco

control programme, and or reearch-baed trategie and

programme. Eight additional lit ollow thee checklit and

coer peciic pblic awarene, edcation and training topic

area.

Guideline or implementation o Article 12


32/172


People hae a right to accurate inormationabout the harm o tobacco ue

Conmer o tobacco prodct hae a

ndamental right to accrate inormationabot the rik o moking and other orm

o tobacco e (5). The WHO CTC recognie

that a baic reiite or redcing tobacco

e i that eer peron be inormed o the

health coneence, addictie natre, and

potential or diabilit and prematre death

poed b tobacco conmption and epore

to tobacco moke.

Edcation abot the danger o tobacco

e and econd-hand moke epore caninfence an indiidal deciion to tart or

contine ing tobacco. ultimatel, one o the

objectie o warning the pblic abot the

danger o tobacco i to change ocial norm

abot tobacco e. Thi will cae man

indiidal to chooe not to e tobacco,

and alo increae pport or other tobacco

control meare.

Many people are unaware o

the harms o tobacco use

Depite clear eidence abot the danger o

tobacco e, man tobacco er worldwide

nderetimate the ll etent o the rik to

themele and other (6). Althogh a large

nmber o people know in general term

that tobacco e i harml to their health,

man apect o tobacco e hae not been

Warn about the

danger o tobacco


33/172


adeatel eplained and a a relt are not

well ndertood b mot tobacco er.

Man tobacco er are naware o the

harml chemical in tobacco prodct

and tobacco moke, a well a the wide

pectrm o pecic illnee caed b

tobacco e (7), and reentl do not know

that moking alo cae cancer other than

lng cancer a well a heart dieae, troke,

and man other dieae (8). Man moker

alo incorrectl beliee that light or low-tar cigarette are le harml (911).

Thi lack o knowledge lead to a btantial

miperception o the rik inoled with

tobacco e. A a relt, moker tend to

grol nderetimate the health rik o

tobacco e to themele and o econd-

hand moke epore to other. smoker

oten do not accratel ae the likelihood

o diabilit and death rom long-termtobacco e, or the ll etent o harm caed

b econd-hand moke epore. Man non-

moker are alo not aware o the danger o

econd-hand moke (12).

The etreme addictie natre o tobacco

i alo not widel acknowledged. Man

people, inclding moker, incorrectl

Stroke

Smoking causes... Smoke contains...

Impotence Cancer innon-smokers

Carbonmonoxide

Cyanide

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

No warning Package warning

Proportionofsmokerswhoagree

KNOWLEDGE ABOuT THE HARMs O TOBACCO Is HIGHER INCOuNTRIEs WITH TOBACCO PACKAGE WARNINGs

Source: (6).

Proven policies to reduce tobacco use include

mandatory health warning labels on tobacco packaging

and hard-hitting mass media campaigns that show

the harms o tobacco use.


34/172


beliee that tobacco e i impl a bad

habit, not an addiction (13). The oten do

not ll comprehend the peed with which

people can become addicted to nicotine,or the degree o addiction, and grol

oeretimate the likelihood that the will be

able to it eail when deired and beore

health problem occr.

showing the trth abot the danger o

tobacco e reire eidence-baed health

warning. Thee warning hold appear

directl on tobacco prodct packaging, be

inclded within tobacco adertiing andon marketing material (where not et

banned), and be contained in anti-tobacco

adertiement in ario tpe o media.

Proen meare to redce tobacco e

inclde mandator health warning label on

tobacco packaging and hard-hitting ma

media campaign that how the harm o

tobacco e (14).

Both youth and adultsbenet rom adult-ocusedapproaches

Becae people are mot likel to begin

to e tobacco a adolecent (15), it i

epeciall important to inorm ong people

abot the harm o tobacco e beore the

tart. Health warning can be coneeding man dierent method, inclding

warning label on tobacco packaging

and anti-tobacco ma media campaign.

Althogh there i a prealent belie that

eectiel proiding oth with warning

reire approache dierent rom thoe

ed or adlt, broad edcational eort

that reach all age grop hae been hown

to be more eectie in infencing othbehaior than eort targeted pecicall

at them (16). Anti-tobacco programme

directed at children to keep them rom

tarting tobacco e are politicall poplar

and hae broad pblic appeal, bt do not

contribte btantiall to redcing oth

moking eperimentation or initiation when

condcted a part o health edcation

clae in chool (17, 18). ocing anti-

tobacco edcational initiatie on childrencold alo weaken a more comprehenie

poplation-wide approach that wold hae

a greater long-term impact (19).


35/172


People have a undamental right to inormation

about the harms o tobacco;

countries have a legal obligation to provide it.


36/172


Health warning labelsare eective

Eectie warning label on tobacco

packaging ere eeral prpoe, inclding

dirpting the marketing ale o the

package. Becae traditional aene or

marketing tobacco prodct hae become

increaingl retricted de to wider adoption

o ban on tobacco adertiing, promotionand ponorhip, the tobacco indtr

ha become increaingl more reliant on

cigarette packaging a a primar marketing

ehicle (16, 20, 21). Warning label redce

the marketing eect o tobacco prodct

packaging, making it more diclt or

tobacco companie to reinorce brand

awarene.

The maimm redction in the marketing

eect o tobacco packaging wold be

achieed throgh the e o generic (i.e.

plain or tandardied) packaging,

which e onl tandard tpe ont in a

ingle color on a plain backgrond to

proide the minimm inormation necear

to identi a prodct, withot the e

o logo, tlied ont, color, deign

or image, or an additional decriptielangage. Becae generic packaging

ma increae accrate perception o the

rik o tobacco e and decreae moking

rate (21), eort to prohibit the e o

logo, color, brand image and other

promotional inormation are gaining

traction. The plainer the package and the

ewer branding element inclded, the le

aorabl moker will perceie the pack

and the greater the impact pictorial health

warning ma hae (22). The Atralian

Parliament i debating the adoption o a

bill to reire generic tobacco packaging

in 2011, which wold make Atralia the

rt contr to mandate generic packaging

beginning in Jl 2012.

Warning label alo hit the ale opackaging awa rom marketing and

toward pblic health meaging.

Eectie warning label increae moker

awarene o health rik (6) and increae

the likelihood that the will think abot

ceation and redce tobacco conmption

(2325). Prominent health warning

label that ll compl with WHO CTC

Health warning label ontobacco packaging

Eective warning labels

increase smokers

awareness o health

risks, and increasethe likelihood that

smokers will think about

cessation and reduce

tobacco consumption.

Atralian goernment propoed deign or plain packaging o

tobacco prodct


37/172


Smokers intention to quit before

introduction of pack warnings

Smokers intention to quit after

implementation of pack warnings

20

87

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

Proportion

ofsmokersthatintendedtoquit

INTRODuCTION O GRAPHIC WARNING LABELs IN CANADAINCREAsEs sMOKERs INTENTION TO quIT

Source: (29).

reirement proide the mot direct

health meage to moker (6, 26, 27)

and potentiall reach moker eer

time the prchae or conme tobacco

prodct (28, 29). Warning are alo een

b non-moker, aecting their perception

o moking and deciion abot initiation,

and ltimatel helping to change the

image o tobacco and denormalie it

e (30) (the preio chapter gie detailo pecic gideline contained in the

WHO CTC or characteritic o eectie

warning label).

Althogh mot o the eidence crrentl

aailable ha eamined the impact o

health warning label on the packaging o

manactred cigarette, pictorial health

warning label are alo eectie in redcing

the appeal and increaing the perception o

rik o mokele tobacco prodct among

oth (31).

Pictorial warning labels areespecially powerul

Pictorial label are more eectie thantet-onl warning (6, 28, 3238), in part

becae the are noticed b more people,

proide more inormation, and eoke

emotional repone to the image (28, 39).

Pictorial warning are een more important

in contrie with low literac rate where

man people cannot ndertand written

meage. stronger health warning tend

to tain their eect longer than weaker

or more general warning (28). Becae

moker recall more readil the warning

the hae een recentl (40), it i important

to rotate warning label periodicall and to

introdce new one reglarl.

Warning label that inclde pictre

are mot likel to be noticed and rated

eectie b moker (27, 32), andincreaing the ie o warning label alo

increae their eectiene (28). The three

contrie that crrentl hae the larget

pictorial health warning reirement

or cigarette package (a an aerage o

the package ront and back) are urga

(80%), Mariti (65%) and Meico

(65%).


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The ie o the warning on the ront o

the package i mot critical or immediate

impact, a pack are generall diplaed

with the ront howing and moker aremot likel to take cigarette rom pack

while looking at the package ront (28). The

placement o warning label at the top o

the pack, rather than at the bottom, i alo

likel to increae their iibilit and make

it more diclt to conceal the warning in

retail dipla.

Ater Canada became the rt contr to

introdce large, graphic health warninglabel on cigarette package in 2001,

moker who had read, thoght abot and

diced the label were more likel to

hae it, made a it attempt, or redced

their moking (29). Abot three in 10

ormer moker reported that the label had

motiated them to it and more than a

arter aid that label helped them remainabtinent (41). In another Canadian td,

abot a th o moker reported redcing

their conmption a a relt o eeing the

pack warning label (42).

Atralia introdced graphic health warning

label in 2006 that caed more than hal

o moker to beliee that the had an

increaed rik o ding rom moking-related

illne, with 38% eeling motiated to it(40). Other contrie with pictorial warning

label, inclding Brail (26), singapore (43)

and Thailand (44), report imilar eect

on moking-related behaior. Graphic

warning alo perade moker to protect

the health o non-moker b moking le

inide their home and aoiding moking

near children (43, 45).

Health warning labels can beused to promote quit lines

smoker are more likel to redce tobacco

conmption and think abot itting a

a relt o eeing trong graphic warning

label (25). Proiding direct inormation

abot ceation erice on tobaccopackaging, in addition to health warning,

ma rther motiate moker to make

a it attempt. Promoting it line b

inclding telephone nmber directl on


39/172


tobacco packaging raie awarene o the

aailabilit o it line erice (46), and the

eperience o eeral contrie how that it

increae call b moker who are eekingaitance to it (46).

Youth respond towarning labels

yoth repond to graphic health warning

label imilarl to adlt (16). Graphic

warning label are more likel to preent

adolecent rom initiating moking (47)or, i the are alread moker, to think

abot ctting down or itting (48).

stdie o children and adolecent nd

that mentioning pecic dieae on health

warning label make them more belieable

than general warning and that pictorial

warning are eectie in making oth think

abot the health danger o moking andabot redcing conmption (4951).

Governments benet romwarning labels

Warning label on tobacco packaging can

be implemented at irtall no cot to

goernment (28, 32). In general, warning

label are oerwhelmingl pported bthe pblic, oten with leel o pport at

8590% or higher (5254), and een mot

moker pport labelling reirement.

Warning alo help gain pblic acceptance

o other tobacco control meare ch a

etablihing moke-ree enironment. It

i important or national tobacco control

programme to monitor compliance withwarning labelling reirement, a tobacco

companie in ome contrie do not ollow

reglation een when enacted with orce

o law (55).

Health warnings in manycountries can be made muchstronger

Man contrie, epeciall low- and middle-

income contrie, hae health warning

label that are ineectie, and ome do

not mandate an warning at all. In man

In general, warning labels are

overwhelmingly supported

by the public, oten with levels

o support at 8590% or higher,and even most smokers support

labelling requirements.


40/172


contrie, warning are weakl worded and

age, proide onl general inormation

withot mention o pecic health rik, ande mall-ied print with no pictre. In

ome contrie, warning are not printed in

a local langage.

some contrie mandate tronger warning

label or manactred cigarette than or

other tobacco prodct or or looe tobacco

(56), which lead man people to beliee

that thee prodct are le harml (57).

Thi i epeciall problematic in contriewhere there are high rate o e o local

tobacco prodct other than manactred

cigarette; thee locall marketed prodct

hae tpicall not been coered b warning

label reirement, and implementation onew labelling gideline or them ha been

inconitent.

Tobacco industry argumentsagainst eective warninglabels can be countered

The tobacco indtr reglarl ght

implementation o health warningbecae the are eectie in changing

attitde abot moking (58), and the

indtr i epeciall reitant to large,

graphic pictorial warning (59). To

preent or dela implementation o healthwarning, the tobacco indtr make

ario ale claim, ch a: people

alread know the rik o tobacco e;

there i no eidence that pictorial warning

work; large, graphic health warning

iolate tobacco compan trademark and

intellectal propert right; mandating

warning i too epenie; more time i

needed to implement warning; people

who b tobacco ot o packaging (ch aingle cigarette) will not ee the warning;

graphic warning demonie tobacco er;

Warning labels

on tobacco

packaging

can be

implementedat virtually

no cost to

government.


41/172


and goernment hold pa or their own

adertiing i the want to ie health

warning (60, 61). Thee ale claim haeoten been ed to attempt to block health

warning legilation, bt thee prio

argment can be contered with act

abot the eectiene and legalit o

warning label. In Atralia, ome tobacco

manactrer hae tarted inclding card

in cigarette pack that encorage moker

to complain to the goernment abot

the impending reirement or generic

packaging and other tobacco controlpolicie, inclding moking ban and

increaed tae (62).

WHO FCTC requirements andrecommended guidelines on

warning labels

Article 11 o the WHO CTC reire that

health warning label on tobacco packaging

conorm to pecied characteritic, inclding

that the be approed b the competent

national athorit; coer at leat 30% and

preerabl at leat 50% o principal pack

dipla area; be large, clear, iible and

legible and not e mileading term (e.g.

light or mild); be rotated either b ingmltiple warning that appear concrrentl or

b introdcing new warning ater a period o

time; dipla inormation on contitent and

emiion o tobacco prodct; and appear in

the principal langage() o the contr. Thegideline to Article 11 (2) inclde a nmber

o other recommendation or health warning

label (ee the preio chapter or ll detail

o WHO CTC warning label reirement

and recommendation).

Warning labels

that include

pictures are

most likely

to be noticedand rated

eective by

smokers.


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Media are important totobacco control eorts

The media, which encompa jornalitic

reporting and commentar, entertainment

programming and paid adertiing and

promotion, pla a ke role in haping

tobacco-related knowledge, opinion,

attitde and behaior, and can beetremel powerl in infencing both

indiidal and polic-maker regarding

tobacco e and tobacco control ie (16,

63, 64). A a relt, ma media adertiing

campaign hae become a ke component

o tobacco control programme (16, 65, 66).

In Noember 2010, the COP adopted

gideline or implementation o Article 12 o

Anti-tobacco ma media campaign

the WHO CTC (Edcation, commnication,

training and pblic awarene) to ait

Partie in meeting their treat obligation

(ee the preio chapter or more detail on

Article 12 gideline) (4).

Anti-tobacco mass media

campaigns can reducetobacco use

Anti-tobacco ma media campaign are

ed to increae awarene o the harm

o tobacco e and o econd-hand moke

epore, and in particlar the harml

eect on health (67). Anti-tobacco

adertiing can alo be ed to eplain

the benet o a tobacco-ree ociet,

or to reeal tobacco indtr tactic

that the pblic might nd objectionable.

sch campaign contribte to change

in attitde and belie o moker that

lead to change in their moking-related

behaior, pecicall b redcing tobacco

conmption and increaing motiation

to make ceation attempt, a well a

redcing epore to econd-hand mokeamong non-moker (16).

Anti-tobacco adertiing tain meaging

abot the danger o tobacco. Adertiing

campaign can be rn in all tpe o media

(teleiion, radio, print, billboard and

other otdoor dipla adertiing, and

online) (16), a well a on other item (e.g.

matchbook coer) that are likel to be een


43/172


b moker (68). Anti-tobacco ma media

campaign can be cot eectie compared

with other interention depite the epene

reired (69), and can hae a greater

impact becae the reach large poplation

ickl and ecientl (16).

Adertiing can alo help to conteract

poitie image o tobacco e portraed btobacco indtr marketing and reere the

erroneo perception that tobacco e i a

low-rik habit (67). Changing ocial norm

abot tobacco e in thi wa alo increae

pport or other initiatie to redce

tobacco conmption (70).

A well-nded and intenie anti-tobacco

ma media campaign i mot eectie a

part o an ongoing, mlti-aceted tobacco

control programme, in part becae nergie

created b mltiple interention are capable

o prodcing greater redction in moking

than might be epected b merel adding

together epected impact o indiidal

interention (16, 71, 72). Howeer, een

in the abence o other tobacco control

interention, ma media campaign haebeen hown to be eectie on their own.

A i the cae with health warning label,

mot crrent eidence ha eamined the

impact o ma media campaign on

cigarette moking in high-income contrie.

Howeer, eidence rom low- and middle-

income contrie and or other tpe o

tobacco e i growing (7375).

Television is the mosteective advertising medium

Teleiion i generall conidered to be the

mot powerl commnication medim,

and teleiion adertiing i epeciall

eectie (16). Anti-tobacco teleiion

adertiing ha higher recall than do

adertiement in radio or print media(76, 77) becae teleiion acilitate

the e o graphic imager, which help

reinorce the aociation o tobacco

with dangero health coneence.

Thee image more accratel depict

the hman impact o tobacco e b

graphicall howing ering and illne,

and can clearl portra tobacco e a

ociall ndeirable and negatie. In

Anti-tobacco mass media campaigns can be

cost eective compared with other interventionsdespite the expense required,

and can have a greater impact because

they reach large populations quickly and eciently.


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contrie where nding or anti-tobaccoadertiing campaign i limited, e o

le-epenie radio adertiing ma be

an eectie pplementar or alternatie

commnication medim, epeciall in

place where radio broadcat reach a

larger poplation than doe teleiion

programming (78).

Epore to eectie anti-tobacco ma

media campaign ha imilar eect onadlt and oth, with adlt moker

more likel to it (79) and oth le

likel to become etablihed moker

(80). Adertiing campaign broadcat at

cient epore leel and at reent

interal redce adlt moking prealence

(81, 82) and decreae oth moking (83,

84); increae the nmber o mokereeking ceation erice rom telephone

it line (85) and increae adlt ceation

rate (86); relt in tead poitie change

in attitde, belie and intention to moke

among oth (87); and increae oth

abtinence rate (88). Een limited epore

to anti-tobacco teleiion adertiing can

increae intention among oth not to

moke and redce the likelihood o their

becoming moker in the tre (89).

Relt rom GATs how that anti-tobacco

adertiement on teleiion and radio

reach large egment o the poplation

(90). Dierence between contrie ma

be related to the reenc and dration o

eiting anti-tobacco media campaign, a

well a to dierence in teleiion and radioacce.

Social media is increasing inimportance

Althogh traditional media contine

to hae the widet poplation reach,

e o the Internet and other emerging

ocial media i epanding rapidl. Theenewer commnication method are

becoming increaingl more eectie in

reaching oth, who in ome cae are

being epoed to them to a ar greater

etent than the are to other media. New

media orm can be ed to dieminate

anti-moking meage that preent


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oth moking initiation a well a aitadlt with moking ceation (16,

91). Howeer, it i important that thee

emerging commnication method adhere

to etablihed eidence-baed moking

ceation gideline (e.g. conelling, it

line and pharmacotherap) (92).

Anti-tobacco mass mediacampaigns with hard-hittingthemes help convince peopleto quit

Campaign ing graphic image o

illne and howing people ering or

ding demontrate the harm caed b

tobacco e, and are epeciall eectie inconincing tobacco er to it (9395).

yong and middle-aged adlt hold

be the oc o adertiement wheneer

poible, whether the are ering rom

tobacco-related illne themele or

are eperiencing the negatie eect o

omeone who i ill (e.g. A parent). Thi

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Informational campaign Hard-hitting campaign

Proportion

ofrespondents

Said something

personally important to me

73%

82%

More convincing

than other ads

73%

81%

Made me want to try

to stop smoking(among smokers)

61%

80%

HARD-HITTING ANTI-TOBACCO CAMPAIGNs ARE MORE EECTIvE THANINORMATIONAL CAMPAIGNs IN sO PAuLO, BRAzIL

All dierences shown are signicant atp


46/172


help conteract widel held amption

that onl the elderl are aected b

tobacco-related illne.

Campaign deeloped primaril or adlt

can be eall eectie among oth (96,97), wherea adertiing oced on oth

doe not hae a imilar impact on adlt

(98). Adertiing that oce on the

health impact and other negatie apect

o moking appear to be the mot eectie

among oth (16, 99101), althogh

depict illne attribtable to moking or

that proide practical adice on remaining

tobacco-ree are conidered mot helpl

(106).

Anti-tobacco ma media campaign aregenerall belieed to be more eectie

when tailored to the cltral ale o

ario targeted racial and ethnic grop,

althogh thi i not necearil the cae

(107). At leat among oth, content and

other characteritic o adertiement

meage ocing on the harm o econd-

hand moke and on tobacco indtr

deception are alo promiing trategie

or preenting oth moking (102,

103). Adertiement that make a trong

emotional appeal are likel to increaerecall among oth (104). Among adlt,

adertiement eliciting trong negatie

emotion are rated mot eectie, wherea

hmoro adertiement were een a

ineectie (16, 105). Among adlt moker

who had recentl it, adertiement that

Exposure to eective anti-tobacco mass mediacampaigns has similar eects on adults and youth,with adult smokers more likely to quit and youth

less likely to become established smokers.


47/172


are more important than ethnicit or

nationalit in determining reaction to anti-

tobacco adertiing (108110). Moreoer,

tdie hae hown that adlt mokerand non-moker alike react imilarl to

graphic image that indce an emotional

repone (105), depite perceied cltral

or geographical dierence. ue o meage

teting i important to enre that the

approache choen will reonate with target

adience.

Anti-tobacco mass mediacampaigns can promotesmoking cessation services

Ma media adertiing campaign, which

are an eectie interention in themele,

can alo be a el method or inorming

tobacco er abot ceation erice

and directing them to it line (111).

Promoting it line directl throgh

adertiing encorage moker to eekaitance to it (85). Howeer, moking

ceation meage are mot eectie in

an enironment that aim to make moking

le ociall acceptable.

In New york Cit, or eample, which

implement it own comprehenie

mnicipal tobacco control programme,

telephone call or help to it moking

adrpled dring a period o heaanti-tobacco adertiing compared with

the ame period the ear beore when

there wa no campaign (112). stdie

alo how that becae people o lower

ocioeconomic tat appear le reponie

to anti-moking teleiion adertiement a

meared b the rate o it line call, more

need to be done to reach diadantaged

grop (113).

Anti-tobacco mass mediacampaigns can be expensive,but are cost ecient

Althogh adertiing campaign can

be a cot-ecient mean o reaching

large nmber o people, the can alo

be epenie, and teleiion adertiing

i all the mot cotl component ocomprehenie tobacco control programme

(16). Contrie can oten ccell

adapt adertiing ed elewhere to ae

the time and epene needed to deelop

original campaign material (114). Thi can

be mot eail done i there are no people

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Campaign prompted some teenagersI know to quit or try to quit

Campaign made smoking seemless cool and desirable

53%

Proportionagreeing,

amongadolescentsw

hosawt

headult-focusedcampaign

85%

ADuLT-OCusED CAMPAIGNs INLuENCE ADOLEsCENTsMOKERs AND NON-sMOKERs IN AusTRALIA

Source: (97).


48/172


depicted in the campaign material, bt

adaptation hold alo refect dierence

in geographical contet, racial and ethnic

identit, and langage. The priorit hold

be on ing or adapting eiting materialthat hae alread been ealated or

eectiene. When no eiting material

are appropriate, new one hold be

pre-teted prior to widepread e

wheneer eaible.

In addition to the cot o broadcat air

time and print media pace, there are

alo prodction cot. Anti-tobacco

adertiement hold hae the ameprodction alit and peraie power a

tobacco indtr adertiing and marketing

material. Althogh prodction cot and

air time or pace mt all be paid or,

the ma alo be proided ree or at dicont

throgh goernment bidie, nding rom

nongoernmental organiation and grant

o air time rom broadcater (16). Tobacco

control programme can alo maimie

the impact o their nancial reorce b,

or eample, pooling prchae with othergoernment agencie to obtain larger olme

dicont. Additionall, ome goernment

allocate tobacco tae or other goernment

reene to coer at leat ome o the cot

o media campaign.

In the 1960 in the united state,

beore tobacco adertiing wa banned

on tel

Informe 2011 OMS-WHO: Sobre la Epidemia Mundial del Tabaquismo

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Transcript of Informe 2011 OMS-WHO: Sobre la Epidemia Mundial del Tabaquismo