I did a short radio interview today, prompted by developments in tobacco control in South Korea, including a doubling of tobacco prices and the introduction of new regulations in 2015. I’ll put up the audio soon, and here are my notes on the questions. As usual, with this topic, it is difficult to present these things in a ‘neutral’ language when talking about how ‘leading’ or ‘lax’ some countries are.
Interview Questions tbs efm Primetime (Seoul, South Korea) 5.1.15 6.40pm (9.40am)
Q1. In your view, what makes some countries lax in regulating smoking?
- Almost all have signed up to tobacco control – the World Health Organisation-led Framework Convention on Tobacco Control
- But many countries face more obstacles when they try to turn that commitment into something fully implemented
- Their ‘environments are not conducive to tobacco control
5 factors involved:
- Defining the problem – economic or public health?
- Institutions – is the department of health in charge?
- Networks – do policymakers exclude tobacco companies from policymaking?
- Socioeconomic – what is smoking prevalence? Public attitudes? Contribution to the economy?
- Ideas – how much of the evidence is accepted in government (smoking, passive smoking) in a meaningful way.
The answer to those Qs is very different in ‘leading’ and ‘laggard’ countries.
Q2. How can the gap between the evidence of a major problem and a proportionate response be narrowed?
- The answer, for most countries, is to implement the FCTC they signed up to
- FCTC measures include:
- Tobacco taxation policy – price and tax measures to reduce demand for tobacco
- Smoke-free policy – protection from exposure to secondhand smoke
- Tobacco product regulation – regulation of contents of products (toxic ingredients)
- Ingredient disclosure – regulation of public tobacco product disclosures
- Health warning labels – at least 30% of the package of tobacco products should be a health warning
- Education and advocacy – to improve health education, communication, training and public awareness
- Banning tobacco advertising, promotion and sponsorship
- Smoking cessation services
- Prohibiting the illicit trade in tobacco products
- Banning tobacco sales to minors (under 18)
- Litigation against tobacco companies
- Research to monitor and evaluate tobacco control
- Support for economically viable alternatives to tobacco growing
Q3. How would you assess smoking controls in South Korea?
- When income rises, smoking rates may go up as tobacco becomes more affordable
- The shift from (a) smoking being mostly a male activity, with very low rates of smoking among women; to (b) reduced smoking among men, but increased among women, until they converge (as in the UK). Currently its 47% in men and 7% in women (UK now is 21% men, 20% women).
- World trade liberalisation from the 1980s gave tobacco companies the chance to enter new markets See: http://researchonline.lshtm.ac.uk/768502/
Tobacco control may be geared specifically towards addressing those 2 first predictions and the third new issue
- In short, you might say that South Korea has (a) fewer controls than the UK now, but (b) potentially stronger controls than the UK had when its income levels and smoking rates were comparable
- g. ‘compliance score’ on smoking in public places is 10/10 for UK and 5/10 for SK (more public places; a fine on owners), more support in the UK for cessation treatment, more health warnings on packs, more bans on advertising, and cigarettes appear to be 3x as expensive in the UK
- The potential is there to learn from countries with stronger controls while the ‘epidemic’ is less visible
See: http://www.who.int/tobacco/surveillance/policy/country_profile/kor.pdf?ua=1 (SK)
Q4. You mentioned in the article you wrote that UK is one of the few countries that has a “comprehensive” tobacco controls. Please explain to us on UK’s main policy instruments designed to reduce smoking in the population.
- As above, in regard to FCTC – but UK has mostly gone ahead of it
- Top of the European ‘Tobacco Control Scale’ (one of 4 leaders) – based on its high prices/ tax, ban on smoking in public places, ban on advertising tobacco in most places, treatment services (smoking cessation/ support) plus health warnings on packs and information campaigns
Q5. Then, what are the international agencies’ efforts to address global tobacco problems so far?
- To take that broad commitment to the FCTC, monitor implementation, help spread the evidence on ‘good practice’, help countries fulfil their commitments (and challenge the role of tobacco companies in each country)
Q6. You mentioned that there is a key irony of the WHO’s framework convention on tobacco control. Could you elaborate on that?
- One aspect of the FCTC is that it can be used by many countries to avoid the experience of others
- Countries like the UK are acting because historic smoking rates were high and the problem is highly visible – in smoking-related illnesses – after a significant time lag
- Countries with historically lower smoking rates (especially among women) could avoid those problems
- In other words, they stand to benefit most from the FCTC
- However, they are also, in many cases, far less likely to implement the FCTC
- The irony is that the countries that could benefit most from the FCTC are often the least likely to act to implement it
- Many commentators describe this problem in terms of the role of tobacco companies – they see their markets fall in the ‘West’, so they seek markets in the rest of the world; and many countries have limited experience in challenging that behaviour
Q7. At the end of the day what would be the remaining challenges facing the global community to achieve a more cohesive tobacco control policy?
- Some countries now talk about smoke-free policies
- Some focus on challenging the role of tobacco companies – to exclude them from policymaking
- Some face rising levels of smoking that could possibly be averted
- The challenge is to recognise how different each country is, and to support tobacco control groups operating in very different policy environments