Alison Commar

1. Alison Commar, Comprehensive
Information Systems on Tobacco
Control, WHO
Is the world achieving the
2025 target on tobacco use?

2. A 30% relative reduction in prevalence of
current tobacco use by 2025
Baseline: 2010
Each country has its own specific prevalence target
Working towards the target is voluntary
WHO monitors progress using data from countries
What is the tobacco target?

3. Tobacco's contribution to illness and death via
noncommunicable diseases has been well-
proven
Adopting the target will have a direct and
measurable impact on reducing NCD deaths
and disease
The target is achievable, but needs concerted
effort
Why the target?

4. “We acknowledge that the
global burden and threat of
NCDs constitutes one of the
major challenges for
sustainable development in
the twenty-first century”
(paragraph 141)
NCDs in the SDGs

5. NCDs included in the 2030 Agenda for Sustainable Development

6. By 2030:
 Reduce by one third
premature mortality from
NCDs by prevention,
treatment and promoting
mental health and well-
being
 Strengthen the
implementation of the
WHO FCTC
2030 Agenda for Sustainable Development

7. The work of WHO in fighting NCDs

8. Goal:
To reduce the
preventable and
avoidable burden of
morbidity, mortality and
disability due to NCDs by
means of multisectoral
collaboration and
cooperation at national,
regional and global levels
WHO Global NCD Action Plan 2013-2020

9. Halt the rise
in diabetes
and obesity
A 10% relative
reduction in
prevalence of
insufficient
physical activity
At least a 10%
relative
reduction in
the harmful
use of alcohol
A 25% relative reduction in
risk of premature mortality
from cardiovascular disease,
cancer, diabetes or chronic
respiratory diseases
An 80%
availability of the
affordable basic
technologies and
essential
medicines, incl.
generics,
required to treat
NCDs
A 30% relative
reduction in
prevalence of
current tobacco
use
A 30%
relative
reduction in
mean
population
intake of
salt/sodium
A 25% relative
reduction in
prevalence of raised
blood pressure or
contain the
prevalence of raised
blood pressure
At least 50% of
eligible people
receive drug
therapy and
counselling to
prevent heart
attacks and
strokes
Where to focus: 9 global NCD targets

10. How are we monitoring the tobacco target?

11. Smoking data are available from 181 countries
(women) and 178 countries (men).
To assess trends in smoking over time, we need
at least two surveys since 1990. We have
sufficient surveys for 149 countries.
Countries with little or no data are either in crisis or
have low commitment to tobacco control.
Global surveillance

12. Countries have various surveillance systems in place
Surveillance in countries

13. Source: WHO TFI database
National surveillance

14. Source: WHO TFI database
Surveys in 34 low-income countries

15. Regular
surveillance
Irregular
surveillance
No
surveillance
EU, excl Cyprus and Malta
Armenia
Azerbaijan
Iceland
Kazakhstan
Norway
Republic of Moldova
Russian Federation
Serbia
Switzerland
Turkey
Ukraine
Albania
Andorra
Belarus
Bosnia & Herzegovina
Cyprus
Georgia
Israel
Kyrgyzstan
Malta
Montenegro
Uzbekistan
Monaco
San Marino
Tajikistan
The FYR of Macedonia
Turkmenistan
Surveillance in Europe

16. • European Health Interview Survey
• Eurobarometer
• Demographic and Health Survey
• Global Adult Tobacco Survey
• Health Behaviour in School-aged Children (HBSC)
• Global School-based Student Health Survey (GSHS)
• Global Youth Tobacco Survey (GYTS)
Survey systems in Europe

17. WHO prevalence trend estimates
Global trends and projections for tobacco use, 1990–2025:
an analysis of smoking indicators from the WHO
Comprehensive Information Systems for Tobacco Control
A standard method for all countries
Internationally comparable results
Defendable and peer-reviewed statistical method
Easy for Member States to comprehend and adopt
University of Newcastle
Trevor Moffiet
Frank Tuyl
Irene Hudson
University of Tokyo
Ver Bilano
Stuart Gilmour
Kenji Shibuya
WHO
Edouard Tursan d'Espaignet
Gretchen Stevens
Alison Commar

18. 0
5
10
15
20
25
30
35
40
45
50
0
5
10
15
20
25
30
35
40
45
50
2000 2005 2010 2015 2020 2025
Current tobacco smoking globally among persons aged 15+, crude adjusted
Prevalence (%) Prevalence (%)
men
women
overall
Source: WHO estimates
Global smoking trends

19. Source: WHO estimates
Smoking trends by income group

20. Source: WHO estimates
Smoking trends by WHO Region

21. Source: WHO estimates
Smoking trend – European Region

22. 44
79
4
22
45
0
10
20
30
40
50
60
70
80
90
Achieve 30% Decrease No change Increase Unknown
Number of countries globally, by trend in tobacco
smoking to 2025
Source: WHO estimates
Meeting the tobacco target by 2025

23. Source: WHO estimates
3
14
11 2
14
21
4
6
34
6
8
1
2
1
7 2
9
2
1
115
13
6
5
2 4
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
AFR AMR EMR EUR SEAR WPR
Number and proportion of countries in WHO Regions who might meet 30%
relative reduction in tobacco smoking between 2010 and 2025
Unknown
Increase
No change
Decrease
Achieve 30%
Meeting the tobacco target by 2025

24. Will meeting the tobacco target reduce mortality?

25. • Policy effects have been measured for:
– Higher taxes and prices
– Smoke-free laws
– Graphic health warnings
– TAPS bans
– Mass media campaigns
– Cessation services
What brings down prevalence?

26. • Policy effects are largely unknown for:
– Banning sales to minors
– Regulation of tobacco product contents
– Regulation of tobacco product disclosures
– Stemming illicit trade
– Supporting alternative livelihoods
– Promoting sensitization and awareness among
healthcare workers, educators, media
professionals, public and private agencies and
NGOs
What brings down prevalence?

27. WHO's Interactive Smoking Projection Tool

28. Source: WHO estimates
Smoking trends in Fiji

29. Fiji MPOWER levels

30. Source: ISPT
0%
10%
20%
30%
40%
50%
60%
2000 2010 2020 2030 2040
SmokingPrevalence
Year
Prevalence Trend: Male
Prev Trend
Business-As-Usual
With Policies
Target
Baseline Year
Policy Start Year
Target Year
Fiji
MPOWER scenario - Fiji

31. Source: ISPT
Mortality outcomes - Fiji

32. Contribution of six risk factors to achieving the 25×25
NCD mortality reduction target
Kontis, V et al., Lancet 2014; 384
• Authors from WHO, Imperial College London, Centre for Addiction
and Mental Health, Toronto, University of Toronto, Technische
Universität Dresden and University of Auckland. Funded by UK MRC.
• Findings: Even if the agreed risk factor targets are met, the
25% reduction in premature mortality target will not be met
– If risk factor targets are achieved, the probability of dying prematurely
from the four main NCDs will decrease by 22% in men and by 19% in
women
– If trends continue as per business-as-usual, the probability of dying
prematurely will decrease by only 11% in men and 10% in women
• If the tobacco use target were to be increased from 30% to a
50% reduction, the mortality target for men would almost be
achieved.
Global mortality outcomes

33. • Cut in youth initiation
• Increase in cessation rates
• Synergy effect - multiple policy actions
working together
• Network effect – background effects of policy
actions and public awareness over time
What will reduce prevalence?

34. • Multisectoral implementation of WHO FCTC
– Top levels of government
– Ministries of Health
– Ministries of Finance, Customs and Excise
Leadership
• WHO engages with non-State actors
– Donors and philanthropic organisations
– Academic institutions
– NGOs

35. • Civil society
• Mass media
• Communities
• Individuals
• Social movements
Ground swell

36. We are all advocates

37. Thank you
commara@who.int