World No Tobacco Day: Plotting Smoking’s Endgame

May 28/2015

Sunday, May 31 is World No Tobacco Day.  According to the World Health Organization (WHO), tobacco kills nearly six million people each year, and the annual death toll could rise to more than eight million by 2030.

Canada is at the vanguard of tobacco control, with Ontario taking the lead in many tobacco control measures.  The Ontario Government recently passed the Making Healthier Choices Act, banning flavoured tobacco products to make them less attractive to youth and regulating the sales and promotion of electronic cigarettes.

“Measures that reduce youth uptake and encourage smoking cessation are vital to avoiding billions of dollars in healthcare costs from sickness caused by tobacco use and could save the lives of tens of thousands of Ontarians,” said Robert Schwartz, Director of the Ontario Tobacco Research Unit (OTRU), located at U of T’s Dalla Lana School of Public Health.

This year, WHO is focusing on the illegal sale of tobacco as its theme for World No Tobacco Day.

While contraband tobacco is a serious issue in Ontario, Health Canada’s Canadian Tobacco Use Monitoring Survey indicated that only 18 per cent of Ontario smokers purchased contraband cigarettes in the previous six months.

“Our research suggests that the best course of action is two-pronged:  bold measures to decrease tobacco use and effective action to curtail contraband,” said Schwartz.

Bold measures are crucial to jumpstart a decline in Ontario’s smoking rate, which has stalled at 18 per cent, with no significant change since 2008.

What strategies will be needed to put a stop to the tobacco epidemic to reach the tobacco “endgame” in Ontario and elsewhere?  What are some of the options to move the tobacco control agenda forward?

The Globe and Mail’s long-time public health editor Andre Picard has also described such revolutionary and evolutionary measures to reduce smoking in a recent column urging Canadians to take bolder steps to stamp out smoking.

Here are a few potential disruptive tobacco control strategies that could usher in a tobacco endgame:

Tax and Pricing Policies. Raising taxes on tobacco is an effective measure to reduce adult and youth smoking prevalence, frequency, and intensity, and increase quit intentions, quit attempts, and successful quitting. Increasing taxes substantially, by doubling or tripling taxes, rather than initiating smaller incremental increases has been effective in creating significant and rapid declines in cigarette consumption in France and South Africa.

Banning Sales of Tobacco Products:  Banning cigarettes and other tobacco products continues to be a controversial area in tobacco control. Banning cigarette sales would decrease access to a product with clear harms, creating significant reductions in morbidity and mortality. The potential unintended harms such as possible increases in illegal supply would have to be effectively addressed. Finally, any product bans that are considered should be accompanied by a concomitant, significant increase in the availability of cessation aids and support.

Changing the Regulatory Environment.  Designated retail outlets with a monopoly on distribution through wholesale or retail sales, creation of nicotine regulatory body with oversight from supply to sales, a regulated market model where a publicly owned tobacco products agency would be the sole buyer from manufacturers or importers, or the creation of a non-profit enterprise with a mandate to achieve planned reductions in tobacco use have been proposed as important regulatory options for an endgame strategy.

In most jurisdictions, including Ontario and Canada, there are private, for-profit tobacco manufacturers, importers, and retailers, with tobacco control managed across many levels of government, not-for-profit organizations and bureaucracies and advocacy coalitions.

OTRU has reviewed and presented various endgame options at provincial meetings of stakeholders.  Professor Schwartz is co-chairing a steering group to plan discussions of endgame measures at a national level.

Photo: Professor Robert Schwartz outside the Dalla Lana School of Public Health (photo by Jackie Atlas).