Sarah England 博士 无烟行动技术官员 世界卫生组织驻华代表处 中国烟草控制: MPOWER 系列政策 Sarah England 博士 无烟行动技术官员 世界卫生组织驻华代表处

慢性病: 全球面貌

2005年全球预计死亡人数 非传染性疾病 传染性疾病 来源：世界卫生组织2005年慢性病报告 艾滋病 结核 疟疾 心血管疾病 癌症 慢性 呼吸道疾病 糖尿病 来源：世界卫生组织2005年慢性病报告

非传染性疾病 预期全球死亡 (2004-2030) 癌症 缺血性心脏病 中风 急性 呼吸道感染 公路交通 事故 围产期 艾滋病 肺结核 疟疾 死亡（百万） 急性 呼吸道感染 公路交通 事故 围产期 2008年10月27日发布 艾滋病 肺结核 疟疾 预期全球死亡 (2004-2030)

慢性非传染性疾病流行: 全球趋势中的中国部分 在中国，80%的死亡和70%的残疾调整寿命年损失由慢性非传染性疾病造成 75 非传染性疾病 伤残 传染性疾病、生产和围产期疾病以及营养缺乏症 50 25 AFR EMR SEAR WPR AMR EUR 非洲区 东地中海区 东南亚区 西太区 美洲区 欧洲区

风险因素 当前证据显示四种非传染性疾病 – 心血管疾病, 癌症, 慢性呼吸道疾病和糖尿病 –是在大部分低、中等收入国家中造成死亡的最大原因. 这些疾病可以通过有效的干预方法预防，这些方法能够处理共同风险因素: 吸烟, 不健康饮食, 缺乏运动和酒精的有害使用。

烟草使用: 全球威胁

西太平洋地区 2000年归因于部分主要风险因素的死亡人数 烟草 死亡人数（单位：千人）

烟草使用: 一种大范围流行疾病 烟草使用是世界八大死因中六种的危险因素 来源：世界卫生组织，2008年 死亡人数（百万，2005） 其它烟草所致疾病* 缺血性心脏病 脑血管疾病 下呼吸道 慢性阻塞性 艾滋病 腹泻疾病 结核 气管、 烟草使用 感染 肺疾病 支气管、 肺部癌症 来源：世界卫生组织，2008年

烟草流行 负担的变化 从现在到2030年，烟草将会造成全球超过1.75亿人死亡 2005-2030年，烟草相关疾病累积死亡人数 烟草流行 负担的变化 从现在到2030年，烟草将会造成全球超过1.75亿人死亡 2005-2030年，烟草相关疾病累积死亡人数 烟草相关疾病死亡累积人数（百万） 全世界合计 发展中国家 发达国家

发展中国家的烟草消费上涨 发展中国家卷烟生产和消费比例 转变中的烟草流行 烟草企业将市场触角伸向发展中国家 发展中国家占世界卷烟生产的比例 发展中国家占世界卷烟消费的比例

烟草流行性将要更加恶化…… 当前烟草每年扼杀五百万人，但是在几十年内将会增加到每年杀死一千万人 如果现在的吸烟模式继续的话, 由吸烟导致的死亡人数是 (Peto, 2008年世界卫生大会) : 2000 – 2025 ~ 1.5亿 2025 – 2050 ~ 3亿 2050 – 2100 > 5亿 21世纪总计为10亿人 (半数死亡是在中年) 20世纪总计为 1亿人

烟草使用: 对中国的巨大负担

全世界约三分之一的吸烟者生活在中国 More than 40% live in just 2 countries 中国 印度 印度尼西亚 The MPOWER Package 全世界约三分之一的吸烟者生活在中国 More than 40% live in just 2 countries 占全世界吸烟者的比例 The tobacco epidemic will cause the most harm to low-income and moderate-income countries with high population The tobacco industry is expanding its advertising, marketing and promotion to the developing world to capture these growing millions of potential customers Tobacco use is growing fastest in these countries, fueled by steady population growth. This will create a ‘perfect storm’ of future tobacco-related disease and death Because developing countries are still in the early stages of the tobacco epidemic, they have yet to experience the full impact of tobacco-related disease and death already evident in wealthier countries where tobacco use has been common for much of the past century Many of these countries have fewer resources to respond to the health, social and economic problems caused by tobacco use, which will exacerbate the tobacco epidemic’s impacts Tobacco-related disease and death will hit these countries very hard in the coming decades 中国 印度 印度尼西亚 日本 巴西 孟加拉国 德国 土耳其 俄罗斯联邦 美国 14 14 14

540, 000, 000 中国有 被动吸烟者 No safe level of second-hand smoke Smoke-free environments protect non-smokers’ health, help smokers quit & encourage smoke-free homes Completely smoke-free indoor areas with no exceptions Smoke-free laws very popular & do not harm business Protect worker safety 被动吸烟者

来自中国疾控中心的数据：中国卷烟销售趋势 1953-2007年卷烟销售量 单位：十亿 1534.1

发达国家中，死亡人数到达最高的时间 比吸烟人数达到最高的时间晚30年 2035年前，中国患病和死亡人数将持续攀升 男性吸烟者 女性吸烟者 男性死亡着 女性死亡者 2005 阶段 I 阶段 III 阶段 IV 阶段 II 2035 吸烟导致死亡的百分比 成年人中吸烟者百分比 年 卷烟流行模型 采自：Amos 1996 Br Med Bull 52(1):77

你可以阻止即将到来的烟草疾病如海啸般袭击中国 2006年中国烟草估计成本： 100万人死亡； 740亿元直接成本； 占卫生总支出的8%； 4.2 亿个工作日丧失

防止烟草海啸 使你的工作场所和卫生医疗机构无烟 提供戒烟支持作为首要卫生保健的一部分而且对所有吸烟的住院患者 作无烟的模范：自己戒烟 作为医生，你们是解决问题的主力军之一

《烟草控制框架公约》在中国 2003年11月8日签署 2005年8月17日通过 2006年1月8日批准 2007年1月建立中国履行《公约》部际协调机制 2007年3月卫生部成立世卫组织《烟草控制框架公约》履约领导小组办公室 In order to facilitate FCTC implementation in China, the State Council approved the establishment of the China Convention Inter-Ministerial Coordination Mechanism (CICM) on January 2007, 20

世界卫生组织烟草控制框架公约和mpower 世界卫生组织烟草控制框架公约（世卫组织框架公约） 全球抵抗烟草流行的奠基石 mpower: 六项烟草控制政策 加强烟草控制的重要切入点 帮助各国家建立对世卫组织框架公约的承诺 世界卫生组织预防与控制非传染性疾病行动计划的有机组成部分 As of April 2008, there were 154 parties to the FCTC The population of the Parties to the WHO FCTC represent more than 80% of the world's population. FCTC: Establishes tobacco control as a priority on the public health agenda FCTC: Introduces a mechanism for firm country commitment and accountability

....烟草流性能被停止

MPOWER：全球烟草控制一揽子政策 世界卫生组织MPOWER一揽子政策中的六项政策能够遏制制烟草流行，减少烟草导致的死亡人数 The WHO Report on the Global Tobacco Epidemic provides the roadmap to reverse the global tobacco epidemic The solution to the epidemic is MPOWER, and the implementation and enforcement of its six proven effective policies in every country This report – and future editions – will show countries how to reverse the tobacco epidemic The reports also will keep track of global, regional and country progress of the fight against the epidemic 23

MPOWER：已被证明的扭转烟草流行的六项政策 The MPOWER Package MPOWER：已被证明的扭转烟草流行的六项政策 监测烟草使用与预防政策 保护人们免受烟草烟雾危害 提供戒烟帮助 警示烟草危害 确保禁止烟草广告、促销和赞助 提高烟税 MPOWER is six proven policies that, when implemented and enforced as a package, will reduce tobacco use and reverse the global tobacco epidemic MPOWER will decrease the initiation of smoking among young people, increase the number of current smokers who successfully quit, and protect everyone from exposure to second-hand smoke, a known carcinogen and health hazard Tobacco is unique among today’s leading public health epidemics in that the means to curb this epidemic are clear and within the reach of every country If countries have the political commitment to implement the MPOWER policy package, they can save hundreds of millions of lives Countries now have the support they need to reverse the tobacco epidemic through the World Health Organizations and its global partners 24 24 24

监测烟草使用与预防政策 准确的监测非常重要 提供准确的国家和全球烟草使用数据 表明烟草对公共卫生和经济的影响 衡量烟草控制政策的有效性 揭露烟草行业市场营销、促销和游说的策略 在机构内： 对雇员进行调查。 跟踪记录政策的影 响。 Good monitoring provides information about the reality of the epidemic, both globally and in each country Global and country-by-country monitoring are critical to understand and reverse the tobacco epidemic The unique data in this report and in future reports will become the benchmark to accurately assess both the epidemic and the fight against it Monitoring informs leaders of governments and civil societies how the tobacco epidemic harms their countries and helps them allocate tobacco control resources where they are most needed Monitoring will reveal the true impact and reach of tobacco industry tactics. This is especially important for when the inevitable denials and obfuscations come from tobacco company representatives 25

保护人们免受烟草烟雾危害 烟草烟雾不存在安全暴露水平 无烟环境保护不吸烟者的健康，帮助吸烟者戒烟，并且鼓励创 建无烟家庭 室内区域完全无烟，无一例外 禁烟法律非常受欢迎，不会影响生意 保护工作人员的安全 烟草制品不搞促销，不用烟草制品送礼 餐厅和酒吧的销售没有损失 加利福尼亚1992-2001年间在提供食品和酒水的餐厅和酒吧禁烟前后的一季度销售 10亿美元 在餐厅禁止吸烟 在酒吧禁止吸烟 A total ban on smoking in public places and workplaces protects people from the dangers of second-hand smoke and helps convince smokers to quit Research clearly shows that there is no safe level of exposure to second-hand smoke. Second-hand smoke increases the risk of coronary heart disease by 25–30% and the risk of lung cancer in non-smokers by 20–30% Smoke-free environments help smokers who want to quit. Smoke-free policies in workplaces in several industrialized nations have reduced total tobacco consumption among workers by an average of 29% Smoke-free public places also encourage families to make their homes smoke-free, which protects children and other family members from the dangers of second-hand smoke. Public opinion surveys show that smoke-free legislation is extremely popular wherever it is enacted. In 2006, Uruguay became the first country in the Americas to go 100% smoke-free. The ban won support from eight out of ten Uruguayans. In California, 75% of the population approve of smoke-free workplace laws that included restaurants and bars In China, which has few smoke-free public places, more than 80% support a smoking ban in workplaces, and about half support banning smoking in restaurants and bars The effectiveness of smoke-free laws is greatly weakened or completely eliminated when smoking is permitted in designated areas. The tobacco industry itself acknowledges the effectiveness of smoke-free environments, and always pushes for exceptions such as designated indoor smoking areas 加利福尼亚州餐厅和酒吧禁止吸烟后营业额上升 26

提供戒烟帮助 尼古丁具有高度成瘾性 很多人想戒，但戒不掉 The MPOWER Package 提供戒烟帮助 尼古丁具有高度成瘾性 很多人想戒，但戒不掉 卫生保健系统有首要责任 去面对烟草依赖性：提供戒 烟支持作为初级护理部分并 对医院的患者 戒烟热线效果好 尼古丁替代疗法可以使戒烟率翻番 与非替代疗法相比，各种尼古丁替代疗法成功戒烟六个月的比例增加情况（%） The vast majority of the world’s 1 billion smokers want to quit, but they need help. Low-cost, effective and widespread smoking cessation services can help millions of people quit and prevent disease and death Helping people quit tobacco should be the responsibility of countries’ health care systems. One very important and inexpensive intervention is repeated advice at every medical visit on the need to stop using tobacco. Advice from health-care practitioners can greatly increase abstinence rates Well-staffed quit lines should be accessible to a country’s entire population through toll free phone numbers and waivers of access charges for mobile phone users. Quit lines are inexpensive to operate, easily accessible, and can be staffed for long hours. Effective treatment can also include pharmacological treatment such as nicotine replacement therapy in the form of patches, lozenges, gum and nasal sprays, and prescription medications such as bupropion and varenicline. Nicotine replacement therapy is usually available over-the-counter, whereas other drugs require a doctor’s prescription for them to be dispensed. These treatments show very good results. Treatment should be part of an overall tobacco prevention strategy. Treatment alone may be inefficient without other strong incentives for tobacco users to quit. That’s why treatment must be implemented along with the other MPOWER policies 尼古丁口香糖 尼古丁贴片 尼古丁鼻雾剂 尼古丁吸入剂 尼古丁舌下剂 27 27 27

警示烟草危害 大多数人不了解烟草使 用和二手烟暴露带来的各 种健康危害 反烟草广告有助于改变吸烟的形象 在卫生机构内：教育和培训你们的员工 运用你们的设施进行公共教育运动 2/3人想戒烟 3/4人赞同警告 半数以上人改变了观点 烟盒警告的效果好 巴西烟盒警告的影响 Most tobacco users do not understand the full extent of their health risk – because they haven’t been told People may know generally that tobacco use is harmful, but they thing they can reduce or stop tobacco use before health problems occur. The reality is that most tobacco users will be unable to quit, and up to half will die from tobacco-related illnesses Comprehensive, graphic warnings about the dangers of tobacco can change tobacco’s image, especially among adolescents and young adults Governments and NGOs should launch anti-tobacco counter-advertising campaigns in all forms of media to publicize the full extent of tobacco’s dangers Pictorial health warnings on the packaging of all tobacco products are one of the most effective types of warning. Use of pictures with graphic depictions of disease and other negative images has greater impact than words alone, and is critical in reaching the large number of people worldwide who cannot read. Strong health warnings on tobacco packages, particularly pictorial warnings, are an important information source for young people 28

确保禁止烟草广告、促销和赞助 广告提高销量、患病和死亡 人数 只有全面广告禁令才有效 全面广告禁令增强其他干预措施的效果 实行禁令的国家实行10年后，消费量下降速度是没有实行国家的9倍 全面广告禁令增强其他干预措施的效果 广告提高销量、患病和死亡 人数 只有全面广告禁令才有效 A total ban on advertising, sponsorship and marketing can reduce tobacco consumption and protect people, particularly youth, from tobacco industry tactics Partial bans do not work. To be effective, bans must be complete and apply to all marketing, advertising and promotion. If only television and radio advertising is blocked, the tobacco industry will move its budgets to magazines and billboards. If all traditional advertising is blocked, the industry will convert advertising spending to sponsorship of events such as racing, sports and music festivals Widespread tobacco advertising “normalizes” tobacco, depicting it as being no different from any other consumer product. That makes it difficult for people to understand the hazards of tobacco use Marketing falsely associates tobacco with desirable qualities such as youth, energy, glamour and sex appeal 29

提高烟税 提高烟草税是减少消费量的最好方法 税收必须跟上通货膨胀和消 费者不断增长的购买力 烟草税通常被公认 提高烟税，降低消费量 尤其是年轻人和穷人的消费量 税收必须跟上通货膨胀和消 费者不断增长的购买力 烟草税通常被公认 税率与消费量对比，南非 提高烟税，降低消费量 Raising taxes, and therefore prices, is the most effective way to reduce tobacco use, and especially to discourage young people from using tobacco Higher taxes can provide countries with funding to implement and enforce tobacco prevention policies Contrary to tobacco industry propaganda, tobacco tax increases do not decrease government revenues. Increasing tobacco taxes by 10% generally decreases tobacco consumption by 4% in high-income countries and about 8% in low- and middle-income countries, while tobacco tax revenues increase by nearly 7% Tobacco tax increases are often the only type of tax increase popular with a majority of the public Higher taxes are especially important for deterring tobacco use among the young and the poor. People in these groups are much more sensitive to the price of goods Tax increases help the poor stop tobacco use and allow them to reallocate their money to essential goods, including food, shelter, education and health care. Tobacco use increases health care inequities around the world as poor people smoke more but have less access to health care. Tax increases work to help poor people use less tobacco 30

mpower：重点 监测 保护 提供 警示 确保 提高 监测数据的重要性 有效检测系统的特征 无烟环境的案例 有效无烟政策的特征 抵抗烟草业的反对 提供 初级护理 戒烟热线 药物治疗 警示 改变烟草形象 包装警示的任务 确保 全面禁止和所需的充分执行 实现有效的禁止 提高 提高烟税增加政府收入 提高烟税帮助年轻人和穷人 提高烟税不会增加走私

通过实行MPOWER一揽子政策，各国政府、卫生部门和民间团体可以帮助人们戒除烟草使用，防止初吸，并保护每个人不接触二手烟。MPOWER提高各国对世卫组织《烟草控制框架公约》的遵守，并且为各国采取切实行动和制定工作重点提供了平台 By taking action to implement and enforce the MPOWER policies, governments and civil society can reverse the tobacco epidemic Countries can help people quit tobacco use, prevent young people from starting to use tobacco and protect everybody from second-hand smoke The World Health Organization and its global partners stand ready to support countries as they face the challenges ahead in fighting this global killer 32

无烟行动 ….致力于一个无烟的世界 谢谢!