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Salud Pública de México

versión impresa ISSN 0036-3634

Salud pública Méx vol.59  supl.1 Cuernavaca  2017

http://dx.doi.org/10.21149/8210 

Editorials

Towards a tobacco-free Americas: the importance of measuring progress

Carissa Etienne, MSc, MBBS1 

1 National Pan American Health Organization consultant - Health Determinants, Health Risk, Non-Communicable Disease and Mental Health Technical Unit. Washington.

Tobacco use remains one of the eminently preventable causes of disease and premature mortality globally and in the Americas. It has been unequivocally established that there is no safe level of tobacco consumption, and the actions to be implemented to end the tobacco epidemic are well known.

The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is the response to the tobacco epidemic, and presents all of the evidence-based measures to control and prevent tobacco use and exposure. The WHO FCTC entered into force in February 2005 and has been one of the most rapidly and widely embraced treaties in the history of the United Nations. There are currently 180 Parties to the WHO FCTC, 30 of which are countries in the Americas. Regrettably, the level of the implementation of the WHO measures still remains lower than expected.

In the Americas, only four countries have fully implemented (as defined by 2015 WHO Report on the global tobacco epidemic), at least three out of the four very cost-effective and high impact demand reduction measures mandated in the WHO FCTC. Even though 17 countries are totally smoke-free in enclosed public places, workplaces and on public transportation, the relevant laws in these countries protect only 49% of the Region’s population. Similarly, graphic health warnings covering 50% or more of the principal surfaces of tobacco packages directly benefit only 58% of the population of the Americas.

The use of taxes as a means of decreasing the affordability of tobacco products is the single most effective tobacco control measure. Even though many countries in the Americas have increased these taxes, only one country has imposed a tax representing more than 75% of the final retail price as recommended by the WHO. During the Third International Conference on Financing for Development held in Addis Ababa, Ethiopia, in 2015, Heads of State and Government and national representatives identified price and tax measures on tobacco as an effective and important mechanism to reduce not only tobacco consumption and health costs, but also to serve as a revenue stream for national budgets.

Monitoring and surveillance are key tools to evaluate the implementation and the impact of these interventions,as documented in Article 20 of the WHO FCTC.

Since 1999, the Pan American Health Organization and the US Centers for Disease Control and Prevention have been jointly supporting countries of the Region in the implementation of the Global Tobacco Surveillance System (GTSS). This system currently includes one school based survey, the Global Youth Tobacco Survey (GYTS); one household survey, the Global Adult Tobacco Survey (GATS); and a set of Tobacco Questions for Surveys (TQS) that can be included in national or subnational surveys to harmonize indicators and promote comparability over time across countries.

With the exception of Canada and the United States of America, all countries in the Region have carried out the GYTS at least once, while several countries have already completed two to four surveys. The GATS has been implemented in six countries namely, Argentina, Brazil, Costa Rica, Mexico, Panama and Uruguay. Despite the fact that some countries such as Brazil, are integrating questions from GYTS and GATS into their national surveillance systems, only 10 countries have surveys both for youth and adults that are nationally representative and repeated every 4 to 5 years.

Eleven years after the entry into force of the WHO FCTC, the Region of the Americas has made several advances in its implementation, but progress has been uneven both among countries and with respect to the mandates. Much more needs to be accomplished in the near future in order to achieve the global NCD target of a 30% relative reduction in the prevalence of tobacco use by 2025.

The GTSS has been successfully implemented in the Americas and has served the purpose of gathering information, not only on tobacco use but also on the implementation of tobacco control policies to monitor the WHO FCTC.

The next step in our journey towards a Tobacco-Free Americas must be to scale up the use of data to monitor and report on strategies to ensure that countries comply with the WHO FCTC mand to strengthen their capacity to ensure the production of data in a periodic, systematic, standardized and sustainable way.

It is therefore both urgent and critical that we strengthen national surveillance systems in order to measure progress and to obtain the data necessary to build the evidence base for the impact of regulation. We must act urgently to scale up efforts to protect the people of the Region from the harmful effects of tobacco use.

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