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= Public Health Achievement: History of Tobacco Control and Non-Communicable Diseases Worldwide =

Non-Communicable Diseases (NCDs) in relation to tobacco
According to the WHO, non-communicable diseases (NCD) are the leading cause of mortality in the world. Non-communicable disease is a condition that is noninfectious. They are also known as chronic diseases, some examples include stroke, cancer, chronic respiratory diseases and many more. The total mortality due to NCD is 41 million of the 55 global deaths in 2019 (World Health Organization, 2021). Within the NCD cause, 80% of risk factors can be prevented including premature heart disease, stroke, and diabetes. According to the WHO, 77% of NCD deaths globally are from low and middle countries. Many of the factors that increase the risk of NCD primarily include modifiable behaviors in conjunction with inadequate access to health care and treatment costs. Peruga and authors discuss that tobacco use specifically is a risk factor common to most NCDs. Budreviciute and authors also discuss that NCDs have been directly linked to economic growth and terms as “diseases of the rich”. This indicates that as countries are developing the burden of NCDs are also increasing. Furthermore, the mortality in low to middle income countries has also doubled due to NCDs. Additionally, tobacco consumption contributes to being one of the major risk factors for NCDs as a whole and can contribute to one in six deaths.

Importance of addressing NCDs
While the mortality rate of NCDs is high, there is an increasing concern for society and governments. It is vital to address the problem of NCDs as they are a result of several factors includes genetic, physiological, behavioral, and environmental factors. As discussed in the Non-Communicable Disease’s section, the main risk factors are preventable as they involve unhealthy diets, physical inactivity, tobacco use, and alcohol misuse. This creates increasing concern and importance to address NCDs as poor diet creates an increased risk in causing chronic diseases and nutrition problems which are associated with long durations and slow progress.

Implications and impacts of NCDs
Poverty has been closely linked with NCDs in addition to psychosocial factors. As explained by Budreviciute and authors, there is a direct correlation between poor health and low-income. This correlation indicates that the increasing rate of NCDs can be due to food poverty, purchasing cheaper and unhealthy food, tobacco use, and expensive treatments. In settings where resources may not as available, exorbitant NCD treatment costs and limited access to health create a greater risk to developing NCDs. Globally, evidence has shown that the burden of NCDs diminishes the quality of life of individuals, impoverish families and increase the health disparities in countries. The costs spent on tobacco can contribute to poverty as resources are being diverted from basic needs of food and shelter to prioritize tobacco. The burden caused by tobacco can increase economic implications and induce health care costs in treating for diseases that have been caused by tobacco.

== Tobacco Statistics and Usage According to WHO ==


 * According to the fourth WHO report on global tobacco trends, there are 1.30 billion smokers worldwide, down from 1.32 billion in 2015. By 2025, it is anticipated that it will drop to 1.27 billion people.
 * 60 countries are on track to achieve the global target goal of a 30% decrease in tobacco use between 2010 and 2025
 * 2 years ago only 32 countries voluntarily complied
 * In 2020, 22.3% of global population used tobacco
 * 36.7% of all men and 7.8% of all women
 * Approximately 38 million children (aged 13-15) use tobacco
 * The goal is to achieve zero child tobacco users
 * Approximately 8 million people die from tobacco-related causes
 * Projections show that if trends were to continue, then 10 million will die annually by 2030

Tobacco Use Regional Trends According to WHO

 * Americas region trend: Data indicates that the Americas have the steepest decline in prevalence
 * Average tobacco use has gone down from 21% in 2010 to 16% in 2020
 * African region trend: Reports indicate that this region has the lowest average tobacco use and has decreased from 15% in 2010 to 10% in 2020.
 * European region trend: Reports indicate that European women have been the slowest to cut tobacco use as 18% of women continue to use tobacco
 * Eastern-Mediterranean region trend: Data reveals that in this region Pakistan is the only country in which is on track to reach the world’s target goal whereas the other 4 regions show that tobacco use is increasing. These regions are 4 out of 6 countries in the world that show increased tobacco use
 * Southeast Asian region trend: This region has the highest rates of tobacco use (29% of their population or approximately 432 million people)
 * Western Pacific region trend: This region is projected to have the highest tobacco use amongst men with more than 45% that will still be using tobacco in 2025.

Timeline History of Major Achievements

 * 1) 1999 WHO initiated proceedings to create the Framework Convention for Tobacco Control (FCTC)
 * 2) * This was the first international treaty under WHO backing in which the global community recognized tobacco uses as a severe threat to global health, social, and economic problems
 * 3) WHO FCTC entered into force in 2005 as binding law for all treaty parties
 * 4) * 2018- The Protocol to Eliminate Trade in Tobacco Products (or Illicit Trade Protocol or ITP) was introduced under the WHO FCTC
 * 5) * January 2021- 62 WHO FCTC parties, 181 WHO member states, and the European Union adopted this protocol
 * 6) Since 2007, the number of people benefited from a minimum of one cost-effective tobacco control policy had quadrupled
 * 7) * 2008, in order to help with the implementation of the six best-practice, economically viable interventions outlined in the WHO FCTC, WHO developed the MPOWER package.
 * 8) * MPOWER initiatives is now being used to help 65% of the global population by utilizing at least one of the measures
 * 9) * Between 2007 and 2018, the number of people benefiting from a fundamental, all-encompassing strategy to help people quit smoking or a comprehensive prohibition on tobacco advertising, promotion, and sponsorship grew by nearly six times.
 * 10) Prevalence of exposure to secondhand smoke has been reduced
 * 11) * The percentage of persons in the world who are protected by smoke-free laws has climbed from 3.0% in 2007 to 21.1% in 2018.
 * 12) * According to data, nations that impose countrywide smoking bans benefit from improved health outcomes, particularly in the area of cardiovascular illnesses. These nations also minimize the population's exposure to passive smoke.
 * 13) Plain Packaging for Tobacco Trade and Investment
 * 14) * 2012: Australia was the first country to use plain tobacco packaging in 2012 in an effort to combat the tobacco industry's exploitation of packaging to both sell cigarettes and to minimize health warnings.
 * 15) * On tobacco products and product packaging, logos, brand graphics, and other pictures are prohibited under Australian law. Additionally, the cigarette pack must include graphic health warnings in which 75% of the front is covered and 90% of the back is covered
 * 16) * June 2020: World Trade Organization deemed this implementation law as fair and just as it would likely improve public health outcomes
 * 1) * June 2020: World Trade Organization deemed this implementation law as fair and just as it would likely improve public health outcomes

Challenges present

 * Pushback from tobacco industry against the FCTC

Pushback from the tobacco industry has been present against the FCTC and have made arguments that FCTC would cause harmful influential economic impacts that includes lost wages for tobacco farmers, reduced employment in specifically rural areas, and decreased tobacco crop revenue. These arguments have be used to counter the initiatives that have been enacted for tobacco control.


 * Tobacco control is an issue of high-income countries

The tobacco control issue initiatives have led developing countries to believe that it is only an issue of concerns for high-income countries and that they will not benefit from these initiatives. This has created tensions between less developed countries and the organization for economic cooperation and development countries and between public health and environmental diseases.


 * WHO’s authority on mandate

Transnational tobacco corporations have questioned the authority on WHO’s competence to develop an international treaty by arguing that it was not an international concern and should not be dealt at a global perspective.


 * The British American Tobacco conflicts with FCTC approaches and sovereignty

The WHO was also seen by BAT as undemocratic and only as a means of transferring power to "unaccountable and distant elites," while the FCTC was characterized as a "one-size-fits-all" strategy that was "certain to fail." Conflicts with this have also initiated conversations with governments to change treaties that restrict options for national legislations.


 * Countering Tobacco industry tactics

The issue of overcoming tobacco industry strategizes to undercut tobacco control policies is not new, but it has changed throughout time. For example, before the industry had claims that ranged from tobacco is not damaging to it is not addictive. Now claims on targeting youth are denied by the industry and are now committed to a ‘smoke-free future’ while promoting heated tobacco products with claims that they are less harmful than cigarettes.

Influences on Public Health Today
The influences on public health today range from various methods of how the tobacco industry has evolved and target their products and how measures have been placed to reduce the demand for tobacco. Some of these methods to oppose the tobacco industry include pictorial health warnings, tobacco advertising, taxes, and tobacco cessation methods. Today, a significant influence from tobacco industries plays on heated tobacco products (HTPs) and electronic nicotine delivery systems or also known as E-cigarettes. HTPs similar to other tobacco products are also very toxic and contain carcinogens. E-cigarettes also play a major role in public health outcomes today as they are known for their wide variety of flavors and are highly desired by younger individuals. This poses a problem to today as initiation of e-cigarette usage by non-smokers are increasing thus creating an avenue to tobacco addiction.