While there are several obstacles to reducing tobacco use and exposure to secondhand smoke, improved tobacco control is one of the most effective ways to reduce premature CVD-related mortality, according to authors of a World Heart Federation Roadmap for tobacco control published in Global Heart.
The WHO Global Action Plan for Prevention and Control of Noncommunicable Diseases 2013-2020 established a goal to achieve a 25% reduction in premature mortality from noncommunicable disease by 2025. As part of this goal, WHO has targeted a 30% reduction in tobacco use worldwide by 2025.
“The tobacco epidemic is a leading cause of premature CVD mortality,” the authors wrote. “Without accelerating the implementation of comprehensive, effective tobacco control policy around the world, it will be virtually impossible to reduce premature mortality from noncommunicable diseases by 25% by 2025.”
They outlined the following WHO Framework on Tobacco Control (WHO FCTC) strategies for comprehensive tobacco control:
- surveillance of tobacco use/prevention policies;
- increasing efforts to protect individuals from secondhand smoke;
- providing smoking cessation support, and training health care workers to ask about tobacco exposure, keep records of patient responses and offer advice on cessation
- providing warnings about the harmful effects of tobacco use through mass media campaigns and graphic warning labels;
- issuing and enforcing bans on tobacco advertising, promotion and sponsorship; and
- increasing taxes on tobacco products.
Roadblocks to successful tobacco control include interference from the tobacco industry via lobbying and litigation, insufficient political will or government interest on a national level, lack of financial and technical resources, poor inter-sectoral coordination and weak capacity for providing smoking cessation support or handling the consequences of tobacco use in low- and middle-income countries, the authors wrote.
The roadmap presented the following strategies to overcome these obstacles to comprehensive tobacco control:
- Address interference from the tobacco industry by limiting its interactions with governments and requiring transparency in any existing interactions; preventing collaboration between the industry and international organizations or networks; and tracking and exposing any attempts to undermine tobacco control policies.
- Improve political will to develop laws for tobacco control by assisting advocacy organizations, producing data on the negative effects of tobacco and seeking support for control from political groups.
- Collaborate with organizations that advocate for issues influenced by but not directly related to tobacco use, such as deforestation, child labor and women’s or workers’ rights. Also, engage with community and private sector organizations to raise awareness, monitor and enforce policy compliance and deliver or improve health services.
- Work with health care providers, administrators and policymakers to improve the ability of care systems to address tobacco dependence.
- Engage media outlets to solicit support for tobacco control policies, as well as to influence societal perceptions and norms with regard to tobacco use.
“The roadmap offers a tool for reviewing tobacco control strategy at regional and national levels,” the authors concluded. “By focusing on the gaps in policy and implementation and opportunities for filling the gaps, stakeholders can tailor the roadmap to local circumstances and capacities and use it to develop coordinated, multi-sectoral action that changes the policies, practices, and perceptions that influence tobacco use.”
Disclosure: Several authors report participation in projects funded by pharmaceutical companies producing medication for the treatment of tobacco dependence.