Ncd meri paavola_110314 final

Tobacco Control

NCD seminar, THL 11.3.2014

Meri Paavola, Ministerial Adviser

Ministry of Social Affairs and Health

1 13/03/2014 Etunimi Suku

Deaths from tobacco use

Tobacco use is one of the biggest public health

threats

Worldwide, nearly 6 million deaths per year (8.8% of

all deaths)

Globally use of tobacco products is increasing,

but decreasing in high-income countries

Risk is big

Every second die

… loosing on average 14 years of life

Many of those killed are still in middle age

Stopping smoking works

3 13/03/2014 Etunimi Sukunimi

Smoking prevalence globally (source: WHO Report on the Global Tobacco Epidemic)

Smoking prevalence in Finland and

tobacco policy actions 1960–2013

19 %

13 %

0%

10%

20%

30%

40%

50%

60%

1960 1970 1980 1990 2000 2010

Men

Women

Tobacco Act

2010

Ban on

restaurant smoking

Restrictions on

smoking in

restaurants

Smokefree

workplaces Tobacco Act

1976

The North Karelia

project launched

Report of the Tobacco

Committee

Petitionary

motion

Health Behaviour and Health among the Finnish Adult Population 2013 (THL)

Percentage of 14-18-year olds who use

tobacco products daily 1977-2013


0

5

10

15

20

25

30

35

197

7

197

9

198

1

198

3

198

5

198

7

198

9

199

1

199

3

199

5

199

7

199

9

200

1

200

3

200

5

200

7

200

9

201

1

201

3

boys

girls

Daily use of tobacco products

among boys and girls

Tobacco products daily, boys Tobacco products daily, girls

Adolescent Health and Lifestyle Survey 2013

Daily smoking in Finland by educational group

1978-2011 (Age-adjusted; 25–64-year-old population)

Satu Helakorpi, Anna-Leena Holstila, Suvi Virtanen, Antti Uutela Health Behaviour and

Health among the Finnish Adult Population, Spring 2011. National Institute for Health

and Welfare (THL), Raportti 45/2012. Helsinki 2012.

0

10

20

30

40

50

% Men

Lowest Middle Highest

0

10

20

30

40

50

% Women

Daily smoking of adolescents by type of

school and gender in 2000-2011

13.3.2014 www.thl.fi/tupakka 9

25 22

17 19

39 40

17 14

10 11

40 39

0

5

10

15

20

25

30

35

40

45

Pojat Tytöt Pojat Tytöt Pojat Tytöt

Yläkoulu Lukio Ammatillinen koulutus

%

2000/2001 2002/2003 2004/2005 2006/2007 2008/2009 2010/2011

The proportion of daily smoking adolescent (%) in secondary schools, general upper secondary education and vocational upper

secondary education and training by gender 20002011. Grade level-adjusted proportions, the whole country (pooled years).

School Health Promotion Study, National Institute for Health and Welfare. Online material (only in Finnish):

www.thl.fi/kouluterveyskysely.

School Health Promotion Study was extended to vocational upper secondary education and traing in 2008.

Exposure to Environmental Tobacco

Smoke in Finland

%

0

10

20

30

40

50

60

83 86 89 91 93 95 96 97 98 99 2000 2004 2007 2010

At home

At work

Health Behaviour and Health among the Finnish Adult Population (THL)

13/03/2014

History of Finnish Tobacco Control

legislation

1976: Advertising ban, smoke-free schools, smoke-free public

transport and public premises; warning texts in packages; prohibition to sell tobacco to people under 16

1994: smoke-free workplaces except restaurants; indirect advertising also prohibited; age limit for tobacco purchases up to 18

2007: smoke-free restaurants (separately ventilated smoking room is

allowed with licence)

2010: – Aim: to end the use of tobacco products – 90% of hotel rooms smoke-free, smoke-free sporting arenas (even

when outdoors), smoke-free public events (also outdoors) – ban at the point of sale

Finnish Tobacco Act 2010

• The new aim is to end the consumption of

tobacco products.

• From “reducing” to “ending” the use of tobacco

products => ENDGAME!

• Tobacco is not an ordinary commodity and it

should not be treated as one

• The aim legitimize strong measures

• Among other things, it means we are not promoting

products based on “harm reduction”

• Tobacco Free Finland 2040

Tobacco-free Finland 2040

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040

Men

Women

Tobacco point of sale display ban

Finland 2012 Other countries

Iceland 2001

Thailand 2005

Canada 2005

Ireland 2009

Australia 2009

Norway 2010

New Zealand 2012

Kosovo 2013

UK 2012-2015

Tobacco-Free Finland 2040

Not possible to prohibit the sale of tobacco

The aim should be achieved by other means

Tobacco use should reduce by 10 % annually

A comprehensive and multisectoral strategy: 1+1>2

Domestic measures are not enough;

FCTC and EU tobacco directive are helpful

Tobacco control strategy

Legislation (+implementation!)

Taxation (price)

Prevention

Cessation

Media and public awareness

Communities

Evaluation, monitoring and surveillance

WHO’s Framework Convention on Tobacco

Control (FCTC)

Treaty was adopted 2003

Roadmap for successful global tobacco control

Demand reduction and supply reduction

guidelines, protocols

176 parties, 90 % of world’s population

Important tool worldwide

www.fctc.org

Demand reduction

Price and tax

Exposure to tobacco smoke

Regulation of the contents of tobacco products

Regulation of tobacco products disclosures

Packaging and labelling

Education, communication, training and public

awareness

Tobacco advertising, promotion and sponsorship

Tobacco dependence and cessation


Supply reduction

Illicit trade

Sales to and by minors

Provision of support for exonomically viable

alternative activities


21

Main elements of the new

Tobacco Products Directive (1)

Ingredients

• Ban of products with characterising flavours

• 4 year transitional period for flavoured products with market share > 3% (e.g. menthol)

• Certain additives (vitamines, caffeine, etc.) are prohibited

• Reporting obligations for all ingredients

22

Main elements of the new TPD (2)

Packaging and labelling

Combined (picture and text) warnings (65%) on both sides of the unit packet

Position at the top

Health warnings on the lateral sides

Some standardisation of packets

No promotional elements

Slim cigarettes not covered by TPD

MS can introduce plain packaging

Future pack of cigarettes


No more ”lipstick packs”

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Presentation name / Author 25

13/03/2014


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28

Plain packaging

Only brand name and health warning on cigarette

packages

A law on plain packagaing was passed in

Australia in 2012


Illicit trade

• EU-wide tracking and tracing system at unit pack level

• Covering the supply chain excluding retail

Smokeless tobacco products

• Ban on oral tobacco maintained

• Reinforced labelling provisions

• No ingredients regulation for snus

29


Cross border distance (internet) sales

• Member States are entitled to ban cross border sales

• If not banned, notification obligation for cross border distance retailers and age verification system

Novel tobacco products

Herbal products for smoking

30


Electronic cigarettes (including nicotine)

• Regulatory framework: consumer vs. medicinal

• Safety and quality requirements

• Rules on packaging and labelling, advertising

• Rules on monitoring and reporting on market developments

National competence: regulation of flavours in e-cigarettes, age limits and sales points

31

Legislation of e-cigarettes in Finland

Nicotine liquids classified as medicinal products

Private persons can import for own use (Internet)

Device and nicotine-free liquids no-medicinal, can be

sold in shops

Advertising banned

Use of e-cigarettes in Finland, 2013

Adults

2 % daily or occasionally (15-64 years)

Adolescents, experimented

Boys Girls

16 years 29 % 21 %

18 years 29 % 27 %

– most often liquids with nicotine

– one in ten had never tried tobacco products

the worst scenario: e-cigarettes do not help to quit smoking, but make

adolescents addicted to nicotine and is a gateway to tobacco

products?!


Thank you!

Kiitos!

[email protected]

Is it possible?


Ncd meri paavola_110314 final

Health & Medicine

Transcript of Ncd meri paavola_110314 final