Transcript Tobacco Working Group - Oxford Health Alliance

Saïd Business School
1-3 September 2004
Tobacco Working Group
Learning from tobacco to address diet
and nutrition more effectively
Professor Martin McKee
2 September 2004
Remit
Prepare a report of the experience
of those involved in tobacco
control to inform those working to
tackle other risk factors for
chronic disease
Areas for examination
• The epidemiology of tobacco
– And the need for evidence!
• The strong pressures exerted on
policies
– Globalization
• Policies that can make a difference
– Who are the major players?
CAVEAT: FOOD
= TOBACCO
The difficulty with epidemiological
evidence for diet
The difficulty with epidemiollogical
evidence for diet
• Varying intakes over lifetimes
• Recall of consumption
• Varying nutritional content of natural
foodstuffs
• Processing of food
WHO Technical Report 916
Obesity
Type 2
diabetes
CVD
P+
C+
Cancer
Dental
disease
Osteoporosis
Energy and fats
Hi intake energydense foods
Saturated fats
C+
Transfatty acids
C+
Dietary cholesterol
P+
Fish and fish oils
P-
Carbohydrate
High intake dietary
fibre
Free sugars
C-
P-
PC+
Vitamins
Vitamin D
C-
Minerals
High sodium
Local fluoride
C+
C-
C-
Pressures for change
Litigation has been
successful against
tobacco in the US
Investment banks are
looking at the risks
associated with food &
drink companies
Tobacco control
What works
What doesn’t
€£$¥
Taxes
Education in schools
Ad bans
Voluntary agreements on
ad bans
Smokefree
Voluntary agreements on
smoke-free areas
Litigation
How might FCTC policies be relevant to
diet and physical activity?
€£$¥
Make fruit & vegetables more
affordable; research effect of taxation
Restrict advertising to children;
discourage unhealthy lifestyles
Health warnings and disclosure of
nutritional information; labelling
guidelines, health claims
How might FCTC policies be relevant to
diet and physical activity?
• Product content: Regulation of harmful of
ingredients; food safety regulations
• Education campaigns: in schools, workplaces and
sites reaching the general public
• Clinical interventions: based on collaborative goalsetting, skill-building, self-monitoring, personalized
feedback, planned follow-up & links to community
resources
Many key players in tobacco
control
Agenda setters:
• Researchers
• NGOs
• Globalink, Framework
Convention Alliance
Governments:
• Health Ministries
• Treasuries
International:
• UN
• WHO
• World Bank
• IMF
Private sector:
• Pharmaceutical
companies
• Tobacco companies
Twelve lessons from tobacco
1. Address the issue of individual responsibility
versus collective/environmental action early
and often
2. Evidence of harm is necessary but not
sufficient to motivate policy change
3. Decisions to act need not wait for evidence
of the effectiveness of interventions
Twelve lessons from tobacco
4. The real and perceived needs and concerns
of developing countries need to be
addressed even if they involve going
beyond the initial scope of the risk being
addressed
5. The more comprehensive the package of
measures considered, the greater the
impact
6. Broad-based, vertical and horizontal
coalitions, well networked, are key
Twelve lessons from tobacco
7. Media-savvy individual and institutional
leadership matters
8. Change in support for tobacco control took
decades of dedicated effort by all
9. Modest, well-spent funds can have a
massive impact. But without clear goals
they may not be sustainable
Twelve lessons from tobacco
10.Complacency that past actions will serve
well in future may retard future progress
11.Rules of engagement with the tobacco and
food industries need to be different and
continually under review
12.Risk factor envy is harmful!
Tobacco Working Group
Learning from tobacco to address diet
and nutrition more effectively
Saïd Business School
1-3 September 2004