世卫组织-二十年行动：推进西太平洋烟草控制的战略 Two Decades of Action - Strategiesto Advance Tobacco Control in the Western Pacific

TWoDecadesofAction:

strategiestoAdvanceTobaccocontroIinthewesternpacific

TWODecadesofAction:

strategiestoAdvanceTobaccocontrolinthewlesternpacific

Twodecadesofaction:strategiestoadvancetobaccocontrolintheWesternPacific.®WorldHealthOrganization2024

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CONTENTS

Foreword

Acknowledgements

Abbreviations

Executivesummary

Introduction

Strategies

Lessonsandinsights

Introduction

Methodology

EffectiveandpromisingstrategiestoadvancetobaccocontrolintheWesternPacific

Strategy1:Unitingbehindasharedvisionandcollectiveaction

Casestudy:Theunifyingpowerofdevelopingastrongsharedvision

Casestudy:Whyasharedvisionmustbeaccompaniedbysharedactions

Lessonlearnt

Strategy2:Usingevidencetodriveaction

Casestudy:Usingdataforaction–monitoringplatformsforaccountability

Lessonlearnt

Strategy3:Utilizingstrategicentrypointsandsynergies

Casestudy:Fromthesmoke-freeBeijingOlympicstoasmoke-freeBeijing

Casestudy:TheSDGs,theNCDepidemicandtobaccocontrolinthePacific

Lessonlearnt

Strategy4:Findingalliesbeyondthehealthsector

Casestudy:Raisingtobaccotaxes–ittakesacoalition

Casestudy:Smoke-freeheritagesitesandtourism

Casestudy:Counteringtheillicittradeintobaccoproducts

Lessonlearnt

Strategy5:Buildingamovement,notaprogramme

Casestudy:Workingfromthegroundup–subnationalapproachesforsmoke-free

publicplaces

Casestudy:Gettingtoatobacco-freefuturetogether–noislandleftbehind

Casestudy:Workingwithcivilsociety·

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Lessonlearnt·

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Strategy6:Nurturingtobaccocontrolchampions

Casestudy:Findingcommunitychampions–smoke-freemonks

Casestudy:BalangaCity,Philippines–championsforatobacco-freegeneration

Casestudy:Haltingtheglamorizationoftobaccouse–politicalwill

fortotalTAPSbans

Casestudy:Headingoffafuturepandemic–addressinge-cigarettes,

otherelectronicsmokingdevicesandheatedtobaccoproducts

Lessonlearnt·

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CONTENTS

Strategy7:Innovatingforfuture-readiness

Casestudy:Thecouragetoinnovate–plainpackaging

Casestudy:Lookingtothefuture–thetobacco-freegeneration

Lessonlearnt

Strategy8:Engagingthemedia

Casestudy:Theimportanceofstrategiccommunicationandmassmedia

Casestudy:TobaccoandCOVID-19intheWesternPacific

Lessonlearnt

Strategy9:Exploringlegalmeanstocontroltobacco

Casestudy:TheMcCabeCentreforLaw&Cancer–trainingtobaccocontrol

legalexperts

Casestudy:BuildinganallianceoflawyersinChina

Lessonlearnt

Strategy10:Across-cuttingpriority–protectinghealthfromthetobaccoindustry

Casestudy:MongoliaaddressesArticle5.3head-on

Lessonlearnt

Insightsfrom20yearsofprogress

Facingforward:emergingandpersistentchallengestotobaccocontrol

Finalword

References

Annex1.Technicalnotes–MPOWERandthehighestlevelofachievementforeachmeasure

Monitoring·

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Protectingpeoplefromtobaccosmoke·

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Offeringhelptoquittobaccouse

Warningaboutthedangersoftobacco

Enforcingbansontobaccoadvertising,promotionandsponsorship·

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Raisingtaxesontobacco

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FOREWORD

Thefirst20yearsoflifeforahumanbeingaremarkedbydramaticgrowthandchanges–joyfulmomentsandchallengingtimes,learningandthrivingfrominfancytoyoungadulthood.Similarly,tobaccocontrolinourRegionhasundergonesignificantgrowthandtransformation.TheWHOFrameworkConventiononTobaccoControl(FCTC)emergedfromthecollectiveeffortsofMemberStatesandtobaccocontrolcommunitiesworldwide.TheConventionrepresentedourcommitmentandhope–commitmenttoreversingtheglobalepidemicandhopeforaworldfreefromsufferingfromtobacco-relateddeathsanddiseases.TheWesternPacificRegionwasthefirstandonlyWHOregionwhereallMemberStatesbecamePartiestotheWHOFCTC.Withthispowerfultool,countriesintheRegionhavestrivedtocombattobaccouse,protectingourhealthandfuture.

Theyear2025willmarkthe20thanniversaryoftheentryintoforceofthislandmarkinternationaltreaty.Overthelasttwodecades,theWesternPacifichaswitnessedtheprofoundimpactoftheWHOFCTContobaccocontroland,subsequently,onpublichealth.Wemovedfromhavingprojectedincreasesinoveralltobaccouse,tosignificantlyreducingthesmokingprevalenceinsomecountries.Thisprogresswasdrivenbythededicationandeffortsofgovernments,civilsocieties,researchinstitutionsandmanyothertobaccocontrolpartnersacrosstheRegion.

However,thepasttwodecadeshavenotbeensolelyaboutvictories.TheWesternPacifichasfacedchallenges,includingintensifiedinterferencebythetobaccoindustryanditsallies.Wehavelearntvaluablelessonsfromaddressingthesechallenges,whichhavestrengthenedourresolveandstrategies.

Reflectingonthesetwodecades,thisreporthighlightsessentialstrategiesthatcontributedtothesignificantaccomplishmentsintobaccocontrolintheWesternPacific.Thereportalsoprovidesreal-worldexamplesoftheirapplicationandsharesinsightsfromourexperiences.

Despitethedecliningtrendintobaccouse,moreworkremains.WhilesixcountriesintheRegionareontracktomeettheglobalvoluntarytargetofa30%relativereductionintobaccouseby2025,therestarenot.WemustcontinuestrivingforahealthierandsaferfutureforallintheWesternPacificRegion,navigatingtheevolvinglandscapeoftobaccocontrol.Withinsightsandinspirationsfromthepasttwodecadesofexperiencepresentedinthisreport,wecancollectivelydrivepositivechangesoverthenexttwodecadesandachieveatobacco-freefuture.

DrSaiaMa’uPiukala

RegionalDirectorfortheWesternPacific

Twodecadesofaction:strategiestoadvancetobaccocontrolintheWesternPacific

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ACKNOWLEDGEMENTS

TheWorldHealthOrganization(WHO)intheWesternPacificRegiongratefullyacknowledgesthecontributionstothedraftingofthispublicationbyAnnetteDavidofHealthPartners,Ltd.aswellasWHOconsultantsandstaffmembers:MelanieAldeon,MinaKashiwabara,Joung-EunLee,AdaMoadsiri,XiYinandXiuyanYu.

Specialthankstothefollowingindividualsfortheiroverallcontributionsandcommentsonthedraft:WHOglobaloffice:HebeNaomiGoudaandVinayakPrasad

WHOcountryofficesintheWesternPacificRegion:TsogzolmaaBayandorj,ElenaCutmore,SemensonEhpel,AnupGurung,TomoKanda,EunyoungKo,KeweiLi,PriscillaNad,LamNguyenTuan,NazirulShamsudin,MatthewShortus,WendySnowdon,BolormaaSukhbaatar,DouangkeoThochongliachi,JosaiaTiko,FloranteTrinidad,KolisiViki,NataliaWroblewska,DaravuthYel

WHOthanksthemanyrepresentativesoftheministriesofhealthacrosstheWesternPacificRegionwhohavetakenthetimetoreviewthedraftcasestudies,aswellasthetobaccocontrolexpertsandstakeholderswhoparticipatedinthesurveythatcontributedtothedevelopmentofthisreport.

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Twodecadesofaction:strategiestoadvancetobaccocontrolintheWesternPacific

ABBREVIATIONS

ADRA-Cambodia

AdventistDevelopmentandReliefAgency-Cambodia

ASEAN

AssociationofSoutheastAsianNations

BTI

brieftobaccointervention

CSR

corporatesocialresponsibility

ENDS

electronicnicotinedeliverysystems

ENNDS

electronicnon-nicotinedeliverysystems

HTP

heatedtobaccoproduct

MANA

PacificMonitoringAllianceforNCDAction

NCD

noncommunicabledisease

NGO

nongovernmentalorganization

PICs

Pacificislandcountriesandareas

PIHOA

PacificIslandsHealthOfficers’Association

SDG

SustainableDevelopmentGoal

SEATCA

SoutheastAsiaTobaccoControlAlliance

SHS

second-handsmoke

STOP

StoppingTobaccoOrganizationsandProducts

TAPS

tobaccoadvertising,promotionandsponsorship

TFG

tobacco-freegeneration

TFI

TobaccoFreeInitiative

TFP

TobaccoFreePacific

UNESCO

UnitedNationsEducational,ScientificandCulturalOrganization

WHO

WorldHealthOrganization

WHOFCTC

WHOFrameworkConventiononTobaccoControl

Twodecadesofaction:strategiestoadvancetobaccocontrolintheWesternPacific

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EXECUTIVESUMMARY

Introduction

Overthepast20years,theWorldHealthOrganization(WHO)WesternPacificRegionhasmadesignificantstridesintobaccocontrol,drivenbytheadoptionandimplementationoftheWHOFrameworkConventiononTobaccoControl(WHOFCTC).TheRegion,oncegrapplingwithoneofthehighestsmokingratesglobally,hassuccessfullyreversedthistrend,showcasingadecreaseinsmokingprevalenceacrossMemberStates.Thisprogressisattributedtoacombinationofcomprehensivestrategies,politicalcommitmentandinnovativeapproaches.

TheWesternPacificistheonlyWHOregionwithallMemberStatesasPartiestotheWHOFCTC.Furthermore,theWesternPacificisoneofonlytwoWHOregionswithnoMemberStateexhibitingincreasingtrendsintobaccouseprevalence.However,onlysixcountriesareontracktomeetthetargetofa30%relativereductionintobaccouseby2025laidoutbytheWHOGlobalActionPlanforthePreventionandControlofNoncommunicableDiseases2013-2020.

Strategies

TenessentialstrategieshavebeeninstrumentalinadvancingtobaccocontrolintheWesternPacific.Thesestrategiesarebackedbycasestudiesillustratingtheirpracticalapplicationandeffectiveness:

1.Unitingbehindasharedvisionandcollectiveaction:establishingaunifiedvisionthatallstakeholderscansupportiscrucial.Politicalleadershipplaysavitalroleintranslatingthisvisionintoconcreteactionsandsustainedprogress.

2.Usingevidencetodriveaction:effectivetobaccocontrolpoliciesaregroundedinrobustdataandevidence,whichguidestrategicdecisionsandinterventions.

3.Utilizingstrategicentrypointsandsynergies:aligningtobaccocontrolwithothernationalprioritiesandsectorsenhancesitsrelevanceandimpact,creatingbroadersupportandintegration.

4.Findingalliesbeyondthehealthsector:engagingpartnersfromdiversesectors,includingfinance,educationandagriculture,strengthenstobaccocontroleffortsandensurescomprehensive

implementationoftheWHOFCTC.

5.Buildingamovement,notaprogramme:creatingasocialmovementaroundtobaccocontrolhelpsde-normalizetobaccouseandbuildswidespreadcommunitysupportfortobacco-freeenvironmentsandpolicies.

6.Nurturingtobaccocontrolchampions:identifyingandsupportingleaderswhoadvocatefortobaccocontrolisessentialfordrivingpolicychangesandsustainingmomentum.

7.Innovatingforfuturereadiness:theRegionhasledthewayinimplementinggroundbreakingtobaccocontrolmeasures,suchasplainpackagingandbansone-cigarettes,demonstratingtheneedfor,andimpactof,continuousinnovationtocombatemergingchallenges.

8.Engagingthemedia:collaborationwithmediaprofessionalsamplifiesthereachandimpactoftobaccocontrolmessages,counteringthetobaccoindustry’snarrativesandmobilizingpublicsupport.

9.Implementinglegalmeasurestocontroltobacco:strengtheninglegislativeframeworksandensuringrigorousenforcementarecriticalcomponentsofeffectivetobaccocontrol.

10.Protectinghealthfromthetobaccoindustry:vigilanceagainstthetobaccoindustry’sinterferenceisnecessarytosafeguardpublichealthpoliciesandmaintainprogress.

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Twodecadesofaction:strategiestoadvancetobaccocontrolintheWesternPacific

Lessonsandinsights

TheWesternPacific’sexperienceoverthepasttwodecadesprovidesvaluableinsightsintoeffectivetobaccocontrolstrategies.Despitesignificantprogress,challengesremain,includingtheneedforfasterdeclinesintobaccousetomeetglobaltargetsandcontinuedimpedimentsfromthetobaccoindustry.Keyinsightsandstrategiesformaintainingandacceleratingprogressinclude:

•Catalystforchange:theWHOFCTChasprovidedaclearglobalroadmapfortobaccocontrol,empoweringsmallercountriesandachieving100%ratificationintheRegion.

•Localandregionalefforts:localgovernmentsandsubregionalallianceshavedrivensignificantprogress,evenwhennationalsupportwaslimited.

•Contextualizedapproaches:tailoringeffortstolocalcontexts,suchasleveragingmajorinternationalandregionaleventsofhighpoliticalandpublicinterestsandengagingreligiousleadershasprovensuccessful.Partnershipsbeyondthehealthsector,includingcivilsocietyanddevelopmentstakeholders,havecreatedastrongsupportnetworkfortobaccocontrol.

•Scienceandadvocacy:combiningscientificevidencewithemotionalappealsandmediapartnershipshasbeencrucialingainingsupport.

•Innovativemeasures:pioneeringinitiatives,pushingtheboundariesoftraditionaltobaccocontrol,candriveaccelerateddeclinesintobaccouse.

•Leadershipandaccountability:strongleadershipandaccountabilitymechanismsareessentialincombatingtobaccoindustryinterference.

•Sustainablefunding:financialmodelssuchasGuam’sHealthyFuturesFundensureongoingsupportfortobaccocontrolprogrammes.

Continuedinnovation,politicalcommitmentandleadership,andmultisectoralcollaborationwillbecrucialinsustainingandacceleratingtobaccocontroleffortsintheRegion.Atthesametime,theRegionmustaddresstheevolvingtobaccoindustrytactics,includingnewproductsanddigitalmediastrategies.TheRegion’sexperiencesoffervaluablelessonsforglobaltobaccocontrol,highlightingtheneedforcreativity,collaborationandrelentlesscommitment.

Twodecadesofaction:strategiestoadvancetobaccocontrolintheWesternPacific

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INTRODUCTION

On21May2003,theFifty-sixthWorldHealthAssemblyoftheWorldHealthOrganization(WHO)unanimouslyadoptedtheWHOFrameworkConventionforTobaccoControl(FCTC)(1).ThatlandmarksessionwitnessedthebirthofWHO’sfirstglobalpublichealthtreaty,markingthefirsttimeinitshistorythatWHOhadharnesseditslegalpowertoestablishaninternationalregulatorymechanismtoadvanceaglobalhealthagenda:tobaccocontrol.

TheWHOFCTCremainsoneofthefastesttreatiestobenegotiated,adoptedandenteredintoforce.Atpresent,thereare183PartiestotheConvention,withthelatestParty,Malawi,havingratifiedtheWHOFCTCon18August2023.TheWHOFCTCcoversover90%oftheworld’spopulation(2),counteringaglobaltobaccoepidemicwiththeforceoflegallybindinginstrumentsandprotocols.Indeed,theWHOFCTChasrevolutionizedthelegalapproachtointernationalhealthcooperation,strengtheningtheresponsetoahealththreatthatispervasiveandpowerful.

TheWesternPacifichasborneadisproportionateburdenfromtobaccoandsecond-handsmoke(SHS).BeforetheWHOFCTCcameintoforce,theRegionhadthesecondlargestnumberofsmokers,someofthehighestmalesmokingratesintheworldwithprojectedincreasesinprevalence,plusaburgeoningnoncommunicabledisease(NCD)burden(3).TheRegionalsofacedsomeformidablechallengestoeffectivetobaccocontrol.Thelong-standingandpervasiveinfluenceofthetobaccoindustrywithinthepoliticalandpublichealthspheresobfuscatedtherealscientificevidenceoftobacco’sharms(4),whileimpedingprogressinenactingsoundtobaccocontrolpoliciesandlaws(5,6).TheRegion’slargesize,withthehighestpopulationcomparedtootherWHOregions,alongwithitsgeographic,linguistic,socioculturalandeconomicdiversity,madethewidespreadimplementationandenforcementofeffectivetobaccocontrolmeasuresdifficultandarduous(7).Ofalltheregionsintheworld,theWesternPacificprobablymostneededtheprotectionfromtobaccoandthetobaccoindustrythattheWHOFCTCoffered.

withavailabledataaredemonstratingdeclinesintobaccouseprevalence.Sixofthesecountriesareontracktomeetthe30%relativereductiontargetby2025laidoutintheWHOGlobalActionPlanforthePreventionandControlofNoncommunicableDiseases2013–2020(8).ThenumberofmalesmokerswithintheRegionpeakedin2015andhasbeendecreasinggraduallysincethatyear.YetthesedeclinesarenothappeningfastenoughtoovertakethegrowthinpopulationwithintheRegion.TheyarealsoinsufficienttoensurethatthemajorityoftheRegion’speoplewillexperiencethehealthbenefitsfromasignificantreductionintobaccouse.Indeed,theWesternPacificisexhibitingtheslowestrateoftobaccousedeclinecomparedtootherWHOregions.Ithasthelargestnumberofsmokersintheworld(368millionin2022),withonly12%ofitspopulationlivingincountriesontracktomeetthetobaccousereductiontarget(9).Additionally,thetobaccoindustrycontinuestoimpedeprogressineffectivetobaccocontrol,enabledinpartbyweakgovernanceandinstitutionalcapacitytoprotectpublichealthinterests(10,11).

Someofthemostcutting-edgeandrobusttobaccocontrolinterventionsarisingfromtheimplementationoftheWHOFCTChavecomefromtheWesternPacific.ButtheRegionclearlyneedstodomoretoacceleratetheprogressagainstthetobaccoepidemic.Behindtheseinterventionsandactionsliestrategiesthatreflectthewisdomandperseveranceofgovernments,communitiesandnumerousindividuals.Someofthesestrategieshaveledtotangiblechanges,whileothershavefacedsetbacks.Howcanwehighlighttheseeffectiveandpromisingapproaches,learnfromthem,buildonthemandscalethemuptointensifyeffortstocurbtobaccouse?ThisdocumentaimstoaddressthisquestionbydelineatingtheRegion’sprogressinadvancingtobaccocontrolthroughtheWHOFCTCoverthepast20yearsandidentifyingthesuccessfulapproachesandkeyfactorsthatcanguidefutureeffortstoensurea“saferandhealthierRegion”,freedfromtheburdenoftobacco.

TwentyyearsaftertheWHOFCTC’sadoption,theRegionhasreversedtheupwardtrendinsmokingprevalenceandseenreductionsinsmokingratesacrossitsMemberStatesandareas.TheWesternPacificistheonlyRegionwhereallcountries

Twodecadesofaction:strategiestoadvancetobaccocontrolintheWesternPacific

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METHODOLOGY

Weusedatwo-prongedapproachtocollatetheinformationneededtodevelopthisreport:

•Firstly,weconductedanextensiveliteraturesearchanddeskreviewofexistingdocuments.TheseincludedpublishedacademicarticlesontobaccocontrolinitiativesintheWesternPacific,publiclyavailablereportsfromthewebsitesofministriesofhealth,nongovernmentalorganizations(NGOs)andothertobaccocontrolstakeholders,newsarticles,advocacypublications,socialmediapostsandotherrelevantdocuments.Weusedthefollowingsearchterms:tobaccocontrol,WesternPacific,Asia,Pacific,ASEAN,Oceania,FrameworkConventiononTobaccoControl