Challenges for Tobacco Control in Romania

1
Challenges for Tobacco Control in Romania

• Silviu Radulescu
• Health Specialist
• The World Bank, Romania Office
• Effective Advocacy and Movement Building for
  Tobacco Control,
• April 24-26, Bucharest Romania

2
Outline of the presentation

• The context - tobacco epidemic in ECA
• Effective measures for tobacco control
• What is known to work
• A closer look to price measures in ECA
• What Governments could do
• How the World Bank can help

3
Tobacco Epidemic in ECAHighest adult prevalence
rates in the world, but women catch up as
economics improve and cultural norms change
Source Nations Data Base, 2002
4
Smoking attributed male deaths increasing,
especially in Romania
Peto and Lopez, 2002
5
Smoking-attributed deaths also increasing fast
among women in the region
Source Peto and Lopez et.al., 2002
6
High smoking-attributed deaths, especially in ECA
7
Romania has one of the highest cigarette
consumption in the region
8
and some of the heaviest smokers in ECA
9
Increasing Trend in Cigarette Consumption in most
ECA
10
Smoking epidemic is also higher among health
professionals in the region
11
Tobacco does not affect only health but also
budgets of smokers families
Source Data from IMF, USDA, WHO and WB sources,
calculations by the WB
12
Cigarette expenditures are significant part of
GDP in many countries
13
Measures that we know that work for controlling
the tobacco epidemic

• Higher cigarette taxes
• Non-price measures
• Better consumer information
• strong warning labels, counter-advertising
  disseminate research findings
• Comprehensive ban on advertising and promotion
• Restrict/ban smoking in public and work places
• Cessation help (NRT)

14
Tobacco Tax Rates and Prices Where ECA fits in
the Globe!
15
Total and Excise Tobacco Taxes as of Retail
Price
16
Price and Tax per pack in Accession Countries,
1999
17
Tobacco taxes are a highly variable part of total
tax revenues
18
But low value of tobacco tax revenue (US) Who
earns how much?
Source OECD Revenue Statistics 1965-2000, IMF
and WB Calculation
19
High value of tobacco tax revenue (US) How much
could be earned?
Source OECD Revenue Statistics 1965-2000, IMF
and WB Calculation
20
Smuggling is a chronic problem in the region, but
we know tobacco smuggling tends to rise in line
with the degree of corruptionSmuggling as a
function of transparency index
21
Tobacco control efforts varyGood legislation is
not enough enforcement matters!
22
Treating Nicotine Dependence

• Willingness to quit smoking is an important step
• Increase smokers knowledge on adverse health
  affects and availability of cessation help
• Cessation support from health professionals is
  key
• Smoke free hospitals, and health professionals is
  essential
• Cessation treatments should be easily available
  and affordable
• Quit lines, community support, etc., work

23
Recommendations

• Governments can control the tobacco epidemic with
  sound economic and health policies
• adopt a comprehensive set of proven measures,
  tailored to each country
• implement and enforce policies
• increase prices/taxes to effectively reduce
  demand, especially in children, adolescents and
  lower income groups
• help current smokers quit
• inform the public well
• educate enlist health professionals

24
World Bank support for tobacco control measures
of the Romanian Government

• Knowledge sharing
• Curbing the Epidemic translation
• http//www.worldbank.org/tobacco/
• Policy advice
• Lending Health Sector Reform Project
• Public information campaigns
• Setting up smoking cessation services training
  of staff
• Health education in schools
• Building capacity in public health