WEBCAST OF PANEL DISCUSSION

REFLECTIONS

The Global Tobacco Control Leadership Program 2008 has accentuated the need to deglamorize, denormalize and delegitimize tobacco use in order to achieve tobacco control on a global scale. The program has reiterated the dire need to get people in the drumbeat of tobacco control.
It has been a great learning experience here at the Johns Hopkins Bloomberg School of Public Health where 70 participants from 15 countries have met and shared one another’s experiences and success stories in tobacco control.

The program rolled out a platform for learning and sharing the diverse issues pertinent to tobacco control. The two – week long training has unfolded a holistic outlook to tobacco control and has highlighted the need for a multi- disciplinary approach.
Apart from helping the participants to acquire competencies, strengthen skills and apply principles and theories of evidence-based policies in tobacco control, the program has enhanced the leadership and networking skills to implement effective policy change; we’ve been inspired, all over again, to provide sustained inputs for creating a continuum of effective action plans in order to achieve remarkable results in tobacco control.

Truly, Tobacco Control is not a sprint but a long term marathon and the 2008 Global Tobacco Control Leadership Program has provided the momentum for it; the program has voiced out loud and clear, the need to create a critical mass of people from varied sections of the society for effective and sustained tobacco control efforts.

As the two-week long program comes to a close, let us all commit ourselves to leave behind a legacy of a tobacco-free world for our future generation.

Dr. Niki Shrestha
Junior Public Health Professional
Tobacco Free Initiative (TFI)
World Health Organization, South-East Asia Regional Office

UNITED STATES V. PHILIP MORRIS

Dr. Sharon Eubanks, who served as the lead counsel for the United States in the largest civil Racketeering Influenced and Corrupt Organizations (RICO) enforcement action ever filed, United States v. Philip Morris, et al, spoke to a room full of attentive audience members on the nuts and bolts of expert witness in fighting against the tobacco industry. In this 9-month landmark case in tobacco control history, the federal district court found the defendants liable for RICO violations and ordered injunctive relief.

Eubanks first explained the difference between a fact witness (one who observed the happening of an event) and an expert witness (one who has the knowledge for the trial of the facts) and emphasized the importance of selecting qualified expert witnesses with supporting publications, documents, and credibility. Dr. Jonathan Samet and Dr. Frank Chaloupka, both speakers in the Tobacco Control Leadership Program, both participated as expert witnesses in this trial.

During her lecture, Eubanks highlighted 20 expert witnesses who testified in the trial. They consisted of professionals from various fields including economics, psychology, epidemiology, medicine, social behavioral research, and mass communication. Eubanks stressed the importance of having expert witnesses in this case and also shared a memorable testimony by Dr. Fiori whose patient quit smoking for her grandchild but then passed away from cancer soon after she quit.

Eubanks advised the participants that in preparing for a similar lawsuit of their own they should target the obvious weakness of the tobacco industry—fraudulence which includes marketing to youth, the health effects, low-tar tactics, and the development of less hazardous cigarette products.

-Alice Tsai, Institute for Global Tobacco Control

WOMEN AND TOBACCO

“Women and Tobacco - Policy Guidelines and Gender Framework” – the session by Soon Young-Yoon started with a very lively introduction of all the participants. The session echoed an emphasis on the need to work on issues related to gender equality and tobacco.

It was highlighted that a gender approach to tobacco control policy is important as it identifies the ways in which the health risks, experiences and outcomes of tobacco use are different for women and men and for boys and girls. The session zeroed in on the fact that the tobacco industry has segmented the tobacco market by gender roles and this fact needs to be duly considered while addressing tobacco control issues. The session also explained that the preamble of the WHO FCTC commits governments to mainstream gender into tobacco control policies and programs. The M POWER roadmap through a gender lens was discussed. Monitoring tobacco use by gender and ensuring gender–sensitive prevention policies was highlighted. Offering help to women and girls of all ages to quit tobacco and warning the women and girls about the dangers of tobacco were discerned as important aspects for comprehensive tobacco control.

“The exposure to Second Hand Smoke is a gender equality issue” said Soon Young-Yoon. The session called for a consolidated effort on working through issues related to gender equality and tobacco.

Dr. Niki Shrestha

Junior Public Health Professional

Tobacco Free Initiative (TFI)

World Health Organization, South-East Asia Regional Office

ESTIMATING THE COST OF SMOKING

“Why do we study the cost of smoking?” asked Hana Ross of the participants in her session on Tuesday. Ross went on to explain to the participants that it is essential to study the cost of smoking to assess the economic impact of smoking behavior on society, individuals, state budgets and finally on business employers.

Ross provided examples of the various classifications of the cost of smoking: direct healthcare costs versus indirect cost of smoking; external and internal costs of smoking, tangible and intangible costs, avoidable and unavoidable costs etc. She then demostrated how to estimate excess healthcare costs due to smoking and provided case studies from countries in Asia and Europe.

-Naseeb Kibria, Institute for Global Tobacco Control

AN INTRODUCTION TO MEDIA ADVOCACY

“Media advocacy is an extremely powerful tool for advocates to use in working for change,” explained Mark Hurley, Director, International Communications from the Campaign for Tobacco Free Kids (CTFK), during his session Monday which described working with journalist for tobacco control advocacy. Hurley emphasized the importance of: incorporating media strategy into the work plan upfront, researching your target audience, determining which media is most effective for delivering the message, understanding who your opponents are, and how to promote your story. Hurley stated that the key to a successful media campaign is to have the same message conveyed through multiple channels, through both paid and earned media.

Following Hurley’s presentation was a case study by Zhong Lu, CTFK advocacy coordinator China, highlighting activities undertaken in China such as: workshops for journalists, partnerships with both governmental and non-governmental organizations, and actions surrounding smoke free Beijing.

-Naseeb Kibria, Institute for Global Tobacco Control

USING PUBLIC POLLS FOR TOBACCO CONTROL ADVOCACY

Citizens of NYC are more supportive of a smoke-free workplace law than their own beloved Yankees – such a headline grabbed the attention of even the international participants in the room. Nicole Veatch, Director of Primary Research at CTFK, captivated the audience’s interest this morning by illustrating creative ways of using polling data to spread tobacco control messages to the media. Veatch also presented a case study from Nebraska where polls were used to show that even a republican governor could raise taxes and get reelected. Stressing that it was important to develop a strategy around a specific issue and then “test test test” those messages, Veatch drove her point home.

Dr. Toker Erguder of Turkey followed Veatch’s message with a rundown of the current tobacco control measures in his country. The Turkish website, Havani Koru, made everyone grin as tons of smiley faces floated by on the main page suggesting that clean air is so cheerful. Others were tickled to see Turkey was able to get both their top super model and a famous football player to endorse their smoke-free campaign.

Comments were a plenty including Dr. Dinesh Bhatnagar from India on the need for enforcement and the potential use of air monitoring in all countries including Turkey. Daria Khaltourina, of Russia emphasized the need to learn from your polls – if the polls show lack of support you might need to do some more education on the issue.

Whether it was baseball or football, Veatch’s and Toker’s message was a homerun hit among the fans today.

-Lisa Hepp, Institute for Global Tobacco Control

TOBACCO INDUSTRY ADVERTISING, PROMOTION, & SPONSORSHIP

“Does tobacco advertising actually lead to increased tobacco consumption?” This was just one of the questions Johanna Birckmayer addressed during her “Advertising, Promotion, and Sponsorship” presentation on Friday.

While all other lectures on Friday focused on counter-advertising, social marketing & strategic communication for tobacco control, Birckmayer focused on how the Industry uses advertising and marketing methods to normalize and glamorize tobacco use, mislead the public, target specific groups, and weaken tobacco control campaigns. She informed participants that there is scientific evidence to show that tobacco advertising does in fact lead to increased consumption by enticing young people to smoke, encouraging smokers to smoke more and decreasing smokers’ motivation to quit.

Birckmayer exposed industry tactics such as brand-stretching to clothing, objects, stores, and even services; targeting youth; targeting women by portraying cigarettes as “slim, sexy, & liberating;” and targeting the poor by associating affluence with cigarettes. Birckmayer stressed that countries implement comprehensive bans on all tobacco advertising, promotion, and sponsorship because the Industry is “very good at changing their tactics” to circumvent partial bans that are put in place. The session ended with participants sharing experiences from their own countries of tobacco advertising tactics including product placement in movies, clothing lines manufactured by tobacco companies and industry sponsored events held exclusively for “smokers and their friends.”

-Maggie Hawthorne, Institute for Global Tobacco Control

MAKING THE CASE FOR SMOKE-FREE ENVIRONMENTS

• “Why do we need a regulation on smoke-free public places anyway?”


• “Won’t we lose lots of business and tax revenue if we don’t make some accommodation for smokers”


• “It’s an election year and I don’t want to be confrontational! So, how can I accommodate everyone”


• “What do smoke-free public places regulations in New York and elsewhere have to do with our situation”

These were only a few of the questions that role-playing “Governors” Alejandro Madrazo (Mexico), Sergei Frolov (Russia), Chai Kritiyapichatkul (Thailand) and Debby Sy (Philippines) threw at their role-playing constituents who were trying to make the case for a totally smoke-free public places regulation. During Thursday’s role play group exercise four sub-groups of participants were given 10 minutes each to “make the case for smoke-free environments” to their respective “Governors.” The exchanges between the presenters their Governor were both challenging and lively, and there were many lessons learned including:

• Ten minutes with the Governor is a significant opportunity.


• Meetings with the Governor are almost always controlled by the Governor, not by the participants. It is a mistake to pretend otherwise.


• The Governor may not always be interested in what we have to say. We need to learn as much as possible about what the Governor is really interested in before the meeting and prepare accordingly.


• Listening carefully to what the Governor is saying and letting that guide the direction of the conversation can be quite important. We need to be careful not to over-focus on “getting through” all of our presentation and miss other opportunities.


• Not everything can be resolved in 10 minutes. Creating and taking advantage of opportunities for follow-up are important.


• Timing is more important than time!

-Steve Tamplin, Institute for Global Tobacco Control

SURVEILLANCE OF THE TOBACCO INDUSTRY

On a day packed with sessions discussing monitoring and surveillance of: tobacco use, the tobacco epidemic, and policy development Stella Bialous highlighted the importance of tobacco industry surveillance reminding us that the Industry plays a key role in the epidemic and that understanding their tactics is essential to the development of effective tobacco control.

Bialous explained that: “as unique as each of our countries are the strategies of the tobacco industry from country to country are very similar,” with their main goals being growth and profit, protecting market freedoms the industry and the smoker, and promoting a good public image.

During the session participants learned how to utilize the Industries own documents to expose their tactics and how to perform industry surveillance in their countries. Bialous ended by reminding the participants that the biggest challenge is not the surveillance of the industry but how to use the information gathered to achieve your goals.

-Maggie Hawthorne, Institute for Global Tobacco Control

PARTICIPATING IN A HISTORIC DAY

In one year, ACT, a tobacco control nongovernmental organization in Brazil, went from a one person organization to having representatives nationwide, explains Paula Johns, Executive Director of ACT in a press conference Wednesday in Manhattan. Johns shared her triumph in growing ACT with the help of funding from the Bloomberg Initiative and noted that while significant progress has been made in Brail and elsewhere, there is still a long way to go.

The participants were captivated during the press conference as Johns recognized the work tobacco control advocates have begun is proof of what can be accomplished in the future. Her opinion on what it will take for continued success? “...political will, leadership, and commitment from governments and civil society, as well as with continued hard work and resources.”

Johns described Wednesday's announcement of $500 million in funding from the Bloomberg and the Gates Foundations as “a historic moment for tobacco control... with one recognized global leader joining another to work together on saving millions of lives...we can be confident that there is no way we can lose this battle.”

LESSONS IN SMOKE-FREE POLICIES

“Educate then legislate!” explains Cynthia Hallett, Executive Director of the Americans for Non-Smokers Rights, as she shared her over 20 years of experience developing, implementing and enforcing smoke-free policies in the US with participants. Her experience has taught her that an educational campaign accompanying a smoke-free policy is critical. She noted that one of the major goals of smoke-free policies is to change social norms about smoking. Tobacco control advocates and policymakers should be thinking about how to educate the public before and after a law is passed.

Participants shared their experiences in helping Mexico City and several states in Argentina go smoke-free. As the participants noted, whether the push for smoke-free policies was from inside or outside the government, campaigns and other grassroots efforts played an important role during policy development and implementation. Hallett agreed, “a strong educational component is going to make everything else easier.”

WHAT ABOUT YOUTH?

Kathy Staats and Morgan Wittman, two U.S. college students, are a breath of fresh air -- literally. The two students-- bright, articulate, hopeful, committed-- presented Friday's final panel on youth advocacy, ending a whirlwind week. Participants listened to the women outline how U.S. youth get involved in the movement as students. Then, they are groomed to become effective activists. When asked how many countries had similar efforts, only four hands shot up. A starting point.

Around the globe, public health officials know the battle ahead lies with the youth. Even in the U.S., where smoking by teenagers fell sharply between 1997 and 2003, these gains are leveling off. And in some countries, smoking among youth is soaring. This is the movement's new battleground. "I am charged up about this," says Niki Shrestha M.D., junior public health professional, Tobacco Free Initiative, WHO's South-East Asia Regional Office, in New Delhi. "The young people are the future."

INDONESIA

Widyastuti Soerojo, Msc

Chief, Tobacco Control Support Center

Indonesian Public Health Association

Jakarta, Indonesia

"I am from Indonesia. We are the only country in Asia that did not sign the FCTC. So we are behind other Asian countries. Now, two of three males are smokers-- about 66%. That is very high. Smoking prevalence in females is up from 1.3% in 2001 to 4.5% in 2005."

"In reference to youth, what is striking is not only the prevalence of smoking in the young people, but the increase of smoking initiation (when people start smoking). For those under 19-years-old, that rate increased from 64% in 1995 to 68.8% in 2001 to 78.2% in 2004. This information comes from the National Socioeconomic Survey, so it is very reliable."

"We don't have any laws to control tobacco products. Secondly, because we don't have laws, there is almost no regulation. Third, the population is increasing. Together, these factors are attracting industry to Indonesia. They are aggressively marketing. They are stimulating competition to become the market leader. The most effective thing we can do is have policies. So we are focusing on laws. But we haven't been able to get our bills into the national legislative agenda. We are trying, but it is very difficult."

INDIA

Ram Vashist

Head of Public Health

Government of Delhi

New Delhi, India

"Tobacco use among young people is a major concern in India. We are seeing more and more young people becoming addicted to tobacco. And they are using many diverse products. They are chewing tobacco in the form of many smokeless products as well as smoking bidis (an indigenous, leaf-rolled unfiltered cigarette which uses coarse tobacco) and cigarettes. On the whole, we are seeing the number of people using non-smoking tobacco products increasing and this is fast emerging as a bigger problem."

"Chewing tobacco and smoking bidis is more popular among the lower socio-economic group, whereas, people of higher socio-economic strata smoke cigarettes but may also consumer high-end smokeless tobacco products. Beedis are widely available locally and are very cheap. For example, a young person can buy almost 400 beedis for about $1."

"Numerous studies have found that smoking or chewing tobacco among youth is on the rise. There is evidence that sales of products is growing. We also have tobacco companies marketing pouches of smokeless tobacco in smaller pouches. The price is about 1/80th of a $1."

"To address this challenge, we have to make young people aware of the ill-effects of chewing tobacco and smoking. Secondly, we have a ban on the sale of tobacco to minors, but we have to enforce this ban stringently. Thirdly, we have to run educational programs targeting the youth. And fourthly, we have to bring them under the fold of tobacco cessation programs. But it is a gigantic task... it's a big job."

EGYPT

Randa Mostafa Abou El Naga, M.D.

National Program Officer

Global Tobacco Control Survey

World Health Office

Alexandria, Egypt

"In Egypt, we do not have a national study to tell to us incidence of tobacco prevalence. That's why we were among the countries selected by the Bloomberg Initiative to conduct a GATS survey. We have a few studies that show us prevalence is about 34% of adult males and roughly 10% of adult females, but there are no reliable national numbers."

"The most traumatic issue now: The youth are starting to the smoke, and the age of smoking initiation is dropping. They are smoking cigarettes, but, in Egypt, we have the growing problem of the water pipe, or Shisha. This used to be the way old men smoked in Egypt. But now it is used as social gathering in the cafes among young people, and it is growing in popularity every day."

"We are doing everything we can. We have legislation. We have a ban on smoking in public places. We have taxation. And we are putting information about the bad consequences in the school curriculum. We hope these measures will help. We are doing excellently, but now we need the enforcement. That is what we will be working on in Egypt. We still see the age of initiation dropping. We have children as young as 10-years and 11-years-old starting to smoke."

UKRAINE

Vladimir Polonets

Social Marketing Expert

Kiev National Economic University

Kiev, Ukraine

"I am an expert at social marketing and I teach at the university. I am attending this conference because of my own interest, and because of what is happening in Ukraine. What is happening is terrible. For example, you can't go to restaurants because people everywhere are smoking. You can't walk along the streets because everywhere people are smoking."

"Young people are smoking in Ukraine. For example, in one 2005 study, of people who are 15-years-old to 29-years-old, 68% of the men reported smoking at least once a day and 30% of women reported smoking daily. So I started a two-week training course in the spirit of social marketing at Kiev National Economic University. The students of this course had to develop social marketing projects with the aim of reducing tobacco consumption."

"My aim is to develop a tobacco control campaign among the students, because I am a teacher at the university and I work there everyday. I can spread this idea among them. I want to make activities among students to promote healthier lifestyles."

AFTER A BAN: KEEP PUSHING

Once New York got its smoke-free ban in place in 2003, you'd think health advocates could rest a little, right? Hardly. That's when it was time to go into advertising overdrive, says Sandra Mullen, of the World Lung Association. The group helped push a nine-month advertising push, after the ban, about the dangers of second-hand smoke. That campaign, she says, helped New Yorkers stay focused.

Once the majority of the city was on board, Mullen says, the group moved toward advertising targeted at smokers to help them break their own habits. Questions focused on how to encourage health leaders and restaurant workers to support bans, even though they didn't want to offend smokers. One suggestion: Focus on advertising healthy, smoke-free environments as a selling point.

WHAT WORKS? EFFECTIVE ADS

In a crowded classroom, participants erupted into laughter. An especially effective anti-smoking advertisement from England flashed on the screen. It read--

Bad News: Smoking Causes Impotence.
More Bad News: These same ads are in the Ladies Room.

"Remember, you have to think about your goals, your target audience and what's going to work with them," says Karen K. Gutierrez, director of the Global Dialogue for Effective Stop Smoking Campaigns. In anti-smoking campaigns, advocates need to address two questions:

Why should I quit?
How can I quit?

Research shows campaigns that focus on these principals are most effective--, regardless of audience age. For the question of "why?," the most effective ads focus on graphic, dire consequences of smoking. For "how?," ads that lends support are most effective. By far, the best campaigns-- whether T.V., radio, print or elsewhere-- answer both.

NEW FIGHT: CIGARS ETC.

As participants gathered Friday for much-needed lunch, Baltimore City's Health Commissioner Joshua M. Sharfstein M.D., outlined successes of the host city. "When I took office," he says, "people called me to say you'll never see Baltimore smoke-free." Their prediction: Wrong.

In February, Baltimore's smoking ban in restaurants and bars became law-- and the economy hasn't gone up in smoke. Still, tobacco execs are firing back. They are marketing hip, new products-- especially mini-cigars-- that are gaining popularity with young people.

"One-third of young men in the city say they are smoking Black and Mild," Sharfstein says, referring to the popular pipe-tobacco cigar. Using regulatory power vested in the agency in the 1800s from the days of Yellow Fever, Sharfstein hopes to bring these products under scrutiny. First up: Forcing companies to sell cigars in packs of five, rather than marketing them cheaply as an individual smoke.

BEWARE: OPPOSITION

In Patricia Lambert's home country of South Africa, tobacco industry executives take shots at the activist by calling her a "neo-Nazi nanny." No matter. Opponents can call her whatever they like, Lambert says, as long as they don't impede her efforts at strict tobacco control. Lambert, director of the legal consortium for Campaign for Tobacco Free Kids, warns public health advocates that in order to make strides against tobacco deaths they must know their opposition.
"There is no magic wand," she admits. But three key principals will take nations far in establishing strong control measures: Align with the World Health Organization's Framework Convention on Tobacco Control (FCTC), use skill to navigate the political landscape of each country, and keep on guard for opposition because the tobacco industry is strong, powerful and sophisticated. "Hold onto these principals, make them work and shoot for the ceiling," she says. And of opponents? Know their actions. "But remember when a country wants to control malaria," she says, "They don't negotiate with mosquitoes."

THE STARTING POINT

In only 400 years, the small green leafy plant that Native Americans used for religious purposes has spawned a global epidemic. As early as 1938, Raymond Pearl, of the Bloomberg School's predecessor, the School of Hygiene and Public Health, concluded smokers do not live as long as non-smokers. Still, it took 30 years for governments to agree with scientific statements.

Jonathan M. Samet, MD, MS, director of the Institute for Global Tobacco Control hopes other countries will avoid making the mistakes of industrialized nations. "You don't have to do all the studies to learn from us," he says. "There is no difference between a lung in India, or a lung in China, or a lung in the United Kingdom." His point: Learn from mistakes and take action now to curb tobacco use and prevent disease.

FIVE YEARS: WHERE WE GO

The weary and jet-lagged participants stayed attentive to a four-member panel, entitled "Predictions of the Future: Where Will Tobacco Control be in Five Years?" even though for many it felt as if it were the wee hours of the morning. Then, they asked for practical advice about how to make change. Participants from Indonesia and Mexico expressed concern that tobacco is so closely linked to government that execs help to formulate regulations meant to watch-dog industry. Lambert points out that this underscores the necessity to stay vigilant. And, she suggests, reaching out to other allies-- women's movements, the environmental movement, workers' movements and alliances of farmers. "We need to get out of our silos," she says, "and make these broader alliances." The world's top public health officials and advocates were one step closer on Monday.

WHO: WHERE WE ARE

For 10 years, Douglas Bettcher, the United Nation's point person for tobacco control, has worked in the trenches on nitty-gritty details of the WHO's Framework Convention on Tobacco Control (FCTC). It sets minimum standards for countries to enact to protect people from inevitable tobacco deaths. Yet, he says, "We are at a turning point now."

Nine of 11 of the largest nations have signed and ratified the FCTC treaty, putting the effort on track to become one of the most successful in UN history. "We're only missing big names like the U.S. and Indonesia," he says. "But with peer pressure, I'm optimistic we will see these countries come on board soon" Hard work is at hand. The WHO is pushing for action to avoid what Bettcher calls epidemics "galloping out of control" in China and India. He also wants to head off what he sees as "a perfect storm brewing" in Africa, where countries could see death reaching the likes of those industrialized nations. "It's a make-it or break-it time," he says.

ONE CITY'S TRIUMPH

New York City Health Commissioner Thomas R. Frieden MD MPH has a reputation as a no-nonsense regulator who thinks nothing of passing out condoms, posting the calories for fatty foods and declaring all of New York City's public places off-limits to smoking. Know what? His tough-guy tactics work. For one, he's hiked cigarette prices so high, through increased taxes, that it's painful for almost anybody to buy them-- nearly $10 a pack, more than twice the nation average. The result: Since the tax increases in 2002, the city's smoking rate has dropped 21 percent.

So can the world learn from New York, preventing 1 billion deaths from tobacco over the next century? Drawing on The Bloomberg Initiative, Frieden points others to four key actions: tax increases, smoke-free legislation, advertising bans and counter-advertising measures such as pack warnings. "Nearly every smoking death is a preventable death, if we just implement what we already know," Frieden says. "So we need to fight now and we need to fight hard."

VOICES FOR CHANGE

After days of travel-- some originating in smoke-free airports, others not-- more than 70 of the world's leading public health officials and advocates gather this week at the Bloomberg School for the third annual Global Tobacco Control Leadership Program. Their voices are varied-- with stories from China, Mexico, India, the Philippines, elsewhere. Their question is the same: Can the world prevent 1 billion deaths from tobacco over the next century, by putting in place strategies already known by health professionals around the globe?

The lively debate will carry on for a fortnight, regarding everything from cigarette filters to tax hikes to smoking cessation. "I applaud your interest and commitment to tobacco control," says Bloomberg Dean Michael J. Klag, MD, MPH. "And I want you to know how committed we are as a school to tobacco control as well."

INDIA

Bhavna Mukhopadhyay
Director
Health Promotion & Development Communications
Voluntary Health Association of India
New Delhi, India

"In India, we have statistics that tell us we will have as many as 1 million people dying from tobacco use each year, starting in 2010. That's nearly double what we had in the last decade. That is a lot of people. And the most important thing: I see evidence that young people are getting into tobacco even younger. The tobacco industry is finding new ways to market to our children. We have people selling chewing tobacco for 1/40th of a U.S. dollar outside the schools, despite legislation. We are talking school children -- 12-years-old or 13-years-old."

"In certain areas of India, in the northeast, 8 out of 10 people are into tobacco use. Over 80% of the population is into tobacco in certain pockets. We have been pushing for picture warnings, smoke-free legislation and higher taxes. We have had mixed success. Our picture warnings aren't strong enough yet. On October 2, we will have smoke-free workplaces. But that's not enforcement. Our work has begun, but our work is not complete."


THE PHILIPPINES

Debby Sy
Legal Consultant for Health Justice Foundation

UP College of Law, Faculty Development Foundation, and FCTC Alliance - Philippines
Manila, Philippines

"In the Philippines, one of the more alarming statistics is the prevalence of tobacco use in children, aged 13 years to 15 years. The rate has increased 30 percent in two years, up from 20% of that population in 2005 to 27% of that population in 2007."

"That is despite tobacco regulation passed in 2003. Those provisions-- which are quite weak-- will be phased in. And it is only this year that we have a total advertising ban. Right now, we are working on legislation for picture warnings. We are working on smoke-free enforcement programs. So everything we learn will be helpful in moving these policies forward. In general, we are trying to build broader coalitions to help us with these efforts."


MEXICO

Alejandro Madrazo
Legal Expert
Mexican Office of the Inter-American Heart Foundation
Mexico City, Mexico

"In Mexico, it is quite complicated. In 2004, 53,000 Mexicans died of tobacco related illnesses. That estimate is now 60,000 deaths a year. The amount the government spends on tobacco related health care costs exceeds the amount spent on higher education."

"In 2006, Mexico City established a 100% ban on smoking in enclosed spaces. At the national level, the government passed comprehensive tobacco control legislation. But the federal legislation has major flaws. I am hoping to return to Mexico with a good idea about how to tighten that federal legislation, whether through litigation, lobbying. My first hope is to tighten that very loose legislation. My second hope is to move Mexico City's program to the country's 31 states. We need to push a national strategy, but in Mexico, we have to fight state by state."

CHINA

Jiang Yuan
Deputy Director
National Tobacco Control Office
Chinese Center for Disease Control and Prevention
Bejing, China

"In China, the situation is very different. In our country, the tobacco company belongs to the government. It is not like the United States, where it is easy to separate. We heard someone from Indonesia who talked about how tobacco is controlling decision-making in that country. In China, we almost have the same situation...."

"We have many leading people in the country who smoke. It is not just the young people. We have the leading people-- the teachers, the physicians. We have statistics where 50% of male doctors are smokers. It is not uncommon for a doctor to do a treatment, and he is also smoking."

"It is very difficult to change policies. It is very difficult to put in place a ban on smoking in public places. We have a comprehensive ban on advertising. But in China, that means a partial ban. The right priority now is to change the social norm. The right priority is to change the smoking behavior of the leading people-- our teachers, our doctors."

Welcome to the 2008 Global Tobacco Control Leadership Program Blog!!

As part of Mayor Michael Bloomberg’s global initiative to reduce tobacco use the Institute for Global Tobacco Control at Johns Hopkins Bloomberg School of Public Health is hosting its 3rd Annual Global Tobacco Control Leadership Program from July 21, 2008 to August 1, 2008. This year 70 tobacco control professionals from countries around the world are coming to Baltimore, Maryland to attend a comprehensive two-week leadership program focused on building global tobacco control capacity.

This year the program sessions will focus on a myriad of tobacco topics including: policy development; advocacy; communications; intervention planning; implementation and evaluation; and management and leadership. Faculty for the program will be comprised of internationally renowned experts in tobacco control policy, communications, research, advocacy, and surveillance. Participants represent country staff from the World Health Organization, Campaign for Tobacco Free Kids, and the Union for Tuberculosis and Lung Disease, as well as Bloomberg Initiative grantees and other identified tobacco control professionals.

This blog has been developed to help participants stay up to date on what is happening during the 2008 Leadership Institute!

The 2008 Leadership Institute Blog is an online space where you can find:

• summaries from presentations and events,
• reflections from colleagues, and
• areas to comment on your experiences