CERC 5 th Annual Health Disparities Institute Rod Lew, M.P.H. Asian Pacific Partners for...
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Transcript of CERC 5 th Annual Health Disparities Institute Rod Lew, M.P.H. Asian Pacific Partners for...
Eliminating Tobacco Disparities through 4 Levels of Policy Change:
Examples from the Pacific Islander Communities
CERC 5th Annual Health Disparities InstituteRod Lew, M.P.H.
Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL)
October 19, 2012
Overview
Tobacco as a Social Justice IssueIntroduce 4-Prong Policy Change ModelExamples of Legislative Policy (state, federal
and local)Tobacco tax in GuamFDA regulation of tobacco (and menthol issue)Local CBPR project resulting in tobacco retail
licensingElements of Change
The APPEAL Network
APPEAL PrinciplesNational Network for diverse Asian American,
Native Hawaiian and Pacific Islander (AAPI)Includes focus on U.S. –associated Pacific
Islands (USAPIs)Addressing tobacco and other health issues as
social justice issuesCommunities have different readiness levels
requiring capacity building Move communities toward social norm change
Tobacco as a health disparities and social justice issue
Sacred Use of Tobacco
History of Tobacco’s Commercialization
Heavy Targeting by the Tobacco Industry
Disparities in Resources and Capacity
Tobacco as a Social Justice Issue
Tobacco Use among Native Hawaiians/Pacific Islanders
Nativ
e Haw
aiia
n
Amer
ican S
amoa
Chuukese
Palau
an0
20
40
60
80
MenWomen
Pre
vale
nce
Distribution of U.S. Population by Race/Ethnicity, 2010 and 2050
7.6%12.2%
11.8%
16.0%
30.2%
64.7%
46.3%
3.0%1.5% 0.8% 0.8%0.1% 0.2%
4.5%
White, Non-Hispanic
Hispanic
African-American, Non-HispanicAsian
Native Hawaiian andPacific IslanderAmericanIndian/ Alaska NativeTwo or More Races
NOTES: All racial groups non-Hispanic. Data do not include residents of Puerto Rico, Guam, the U.S. Virgin Islands, or the Northern Marina Islands. Totals may not add to 100%.SOURCE: Kaiser Family Foundation, based on http://www.census.gov/population/www/projections/downloadablefiles.html U.S. Census Bureau, 2008, Projected Population by Single Year of Age, Sex, Race, and Hispanic Origin for the United States: July 1, 2000 to July 1, 2050.
Total = 310.2 million
Total = 439.0 million
2010
2050
Per Capita Cigarette Consumption United States 1900 to 1999
Source: Tobacco Use - United States, 1900-1999. MMWR November 5, 1999; 986-993
Impact of Tobacco Control Policiesand Tobacco Tax
Youth are most sensitive to tobacco price change- every 10% price increase decreases youth smoking by 6.5% and adult smoking by 2% (CTFK)
Tobacco tax has impact on tobacco prevention and treatment (Chaloupka 1999) but needs to be paired with tobacco control spending (Rice 1999)
Scenario : tax increase by $1, tc spending increase by 20 cents= smoking prevalence decrease from 12.2% to 11.2% in 5 years. (Max 2011). This results in $2.3 billion less in health care expenditures, 2367 lives saved and 46,000 years of life gained.
4- Prong Policy Change Model
1. Need to work within our racial/ethnic communities where tobacco may not be a high priority
2. …within the mainstream tobacco control movement where racial/ethnic communities are not a high priority
3. …with legislators where neither tobacco nor racial/ethnic communities are a priority
4. …against the tobacco industry where racial/ethnic communities are one of the highest priorities
Legislative Policy Change
State or Territorial LevelFederal LevelLocal Level
Tobacco use in Guam• Indigenous Chamorro represent 37% of the
159,358 population• Second highest prevalence of tobacco use
of any U.S. state or territory• Many tobacco distributors and tobacco influence• Other factors including highsuicide rate among youth
Guam’s Legislative PolicyBill 150 to raise tobacco tax by $2.00 per
pack of cigarettesCollaborative process of key public health,
policymakers and broad-based coalitionLegislative policy focused on relationships
and building on years of previous successesKey components of capacity building and
leadership development
Posted: Tuesday, January 26th, 2010 4:49 AM HST
Guam lawmakers OK bill to triple tobacco tax By Associated Press HAGATNA, Guam (AP) — Smokers on Guam are waiting to see if they will be paying the second highest tobacco tax in the United States.
The Legislature of the U.S. territory on Friday approved a bill to increase the $1 tax on a pack of cigarettes to $3.
If signed into law by Gov. Felix Camacho, Guam would tie Connecticut for second place behind Rhode Island's tax of $3.46 a pack.
Lawmakers say the intent of the increase is to stem the tide of smoking-related illnesses on the island.
American Medical Center family physician Dr. Vincent Taijeron Akimoto says tobacco abuse has led to hospitals being filled with people suffering from heart and lung disease.
If Akimoto had his way, Guam's tobacco tax would increase by $10 a pack.
Guam passes tobacco tax
Federal Legislative Policy
Tobacco industry has been targeting racial/ethnic communities and have successfully adapted their strategies to changing markets and policies
June 22, 2009 President Obama signed the Family Smoking Prevention and Tobacco Control Act
Unintended consequences of Master Settlement Agreement and FDA Legislation
CAPAC advocacy to encourage FDA to ban mentholated cigarettes
Increase of little cigars and cigarillos
Local Legislative Policy:Study on Environmental Influences of Tobacco
CBPR study among Pacific Islander and Asian American communities in 3 cities (Long Beach, Richmond and Seattle)
Aim was to study the relationship between environmental characteristics (both pro- and anti-tobacco influences) and tobacco use among youth using GIS mapping and Photovoice
Describe Your Community Exercise
“Here you can see part of Richmond stores trying to make money by selling smokes and having ads to influence people to smoke. By selling smokes that slowly kill us while they make money we should reduce smoke shops and ads.”
Long Beach City Council passes Tobacco Licensing Ordinance
·Advocates
·Communities
·Coalitions
·Leaders
·Partnerships
·Resources
·Time
·Community Participation
·Community Competence
·Community Empowerment
Prioritization and Goal-
Setting
LeadershipDevelopment
Infrastructure
Development
Community Mobilization
and Organizing
Inputs GuidingPrinciples
StrategicPlanning
Community CapacityBuilding
Short Term and
Intermediate Outcomes
Long TermOutcomes
Programs
·Cessation·Prevention
4-Prong Policy Change Model
·Community Policy·Mainstream Institution Policy·Legislative Policy·Corporate Policy
ReducedTobacco Use
Health Parity and
Health Justice
Strategic Framework for Tobacco Control among Asian Americans, Native Hawaiians and Pacific Islanders
Community Readiness
Environment Assessment
and Data
Elements of Effective Policy Change
4-Prong policy change approachDifferent pathways to policy changeBuild capacity through advocacy trainings and
leadership developmentPolicy change builds upon years of work Building alliances between all racial/ethnic
communities
Implications for Other issues in the Pacific
23
www.appealforcommunities.org
www.tobaccopreventionnetworks.org
Thank you !!