MUSIC [Iskander] Hello, I'm Dr. John Iskandar.
Welcome to CDC's Beyond the Data.
I'm here today with Dr. Indu Ahluwalia chief
of CDC's Global Tobacco Control Branch.
Welcome. [Ahluwalia] Thank you.
[Iskander] So Dr. Ahluwalia
about six years ago we produced a Public Health Grand Rounds
about global tobacco control.
Can you bring us up to date about first of all,
what is the global burden of disease related to tobacco
and are we making progress in controlling that?
[Ahluwalia] Certainly.
We know about 1 billion people in this century will die
of tobacco smoking, and of those,
about 700,000 per year die
from direct tobacco-related tobacco use and about 600
or 890 die from secondhand tobacco smoke.
And, these are people who don't smoke themselves.
So burden continues to be quite large, and in terms of you know
when we think about the CDC's role,
we are able to help countries make critical decisions.
And international organizations use the data that we collect
through our surveillance systems to monitor what is going
on in terms of both the burden of tobacco use as well
as the solutions the countries have undertaken
and potential impact of that.
Recent report that was released
by the World Health Organization indicated
that there is certainly progress in terms
of globally there is a reduction in tobacco use
and what we find is within the report it also had some alarming
things that the rate of decrease among low
and middle income countries is slower.
So we still have a lot of work to do, and we think
that the data that we generate and we help countries
to translate into action actionable policies
and programs are critical to moving the needle forward.
[Iskander] So clearly we have ways then
to monitor different aspects of smoking and tobacco globally.
Can you tell our audience a little bit
about how we monitor everything from smoking,
to exposure, to advertising?
[Ahluwalia] Sure.
So, the CDC Global Tobacco Program,
this is where the Global Tobacco Surveillance System is housed,
and we have three different components which we are able
to work with each country side by side to implement.
We have the Global Youth Tobacco Surveillance, which is GYTS,
active in 188 countries.
It is the largest surveillance system, continues to be so,
and it is targeting kids who are 13 to 15 years
of age and in schools.
We're very proud of our system.
And then we have the GATS
which is the Global Adult Tobacco Surveillance system
which is active in about 34 countries,
and it targets adults 15 years of age or older
and it is a it covers about 70% or it represents 70%
of the world's population and about 75% of the smokers
in the world which is quite remarkable.
The third, we have a set of tools called tobacco questions
for surveys which are systematic standardized set of questions
that countries can use and integrate
into ongoing surveillance systems,
and with the three components,
we feel that there is a sustainable way
to monitor tobacco globally.
And our role is to work with countries to figure
out what their needs are.
And then, we work side-by-side with countries ministries
of health, ministries of education,
even the global partners are at the table.
And what we do is we systematically make sure the
training is standardized, the data collection is standard,
so we can compare the data
across time and across countries.
And that's an important part of having a surveillance system
that contributes to the landscape.
[Iskander] So, and you shared with me earlier some examples
of countries that have used that monitoring and surveillance
as part of their tobacco control strategies.
I wonder if you could maybe just share one
of those examples with us now.
[Ahluwalia] So using the data for tobacco control,
I think you know otherwise we're just groping in the dark
and countries are very eager to have data.
And I will share an example from Uganda first.
You know, they had first wave of data
and they passed a National Tobacco Control Act in 2015.
Prior to that, they were the country who used both GYTS
and GATS data quite effectively to rally the troops so to speak.
They use the data to educate and mobilize their stakeholders.
So there was support for passing the law.
They are other examples of countries
that had multiple waves of data.
India comes to mind since they just released their data
very recently.
And, India saw quite a great decline in tobacco
from the first survey which was done in 2009-2010,
and the most recent survey which was completed in 2016-2017.
And part of that allowed India to know that the law
that they passed under their food safety provision,
Food Safety Act in 2011 banned gutka,
which is a flavored tobacco with areca nut
and the state subsequently in India adapted some of that law
and stronger provisions
to ban other flavored products that contain tobacco.
And what the data really showed for India was
that there was a decline in smokeless as well
as combustible tobacco products because there was fear of course
that you know you ban smokeless tobacco,
and it might be an increase in combustible
and that didn't happen.
So what that really demonstrated to India and the states
and others watching this very closely is
that when a strong legislation is passed there is an impact
and our data were critical in measuring that impact.
[Iskander] So, yeah, very important
of course my understanding is Asia is now home to half
of the world smokers so very important to hear
of that substantial progress being made in India.
I think a lot of our viewers may wonder
about the changing landscape of tobacco products.
We have e-cigarettes now but particularly in low
and middle income countries we also have people may know them
by different names shishas, hookahs, water pipes,
other different kinds of products.
What do we know in general about use and control
of those types of tobacco products?
[Ahluwalia] I think you bring up a very important point in terms
of the changing landscape and what's interesting
about the global landscape is that you know if you look
at the data what they are showing us is there's been
astronomical uptake of vaping products like e-cigarettes
and e-pens and all their iterations.
So there is a very rapid progression
in the global market of these products.
I think it's anticipated to be reaching 55 million users
by 2021 which is only two years away from about a 7 million
that was observed in 2011.
So huge increase anticipated by 2021.
And what the other interesting thing
about the changing landscape is that when you look
at the 10 top global markets for sales of these products
of course the western countries are there but what's remarkable
to me is that both India
and China are among the top 10 purchasers
of these electronic products that are available.
And one of the things we find, with our you know,
we've been in the forefront in terms
of surveillance our both GYTS
and the GATS surveillance have collected some information
about from a number of countries about whether the kids are aware
of the products and what the use is, and for adults as well.
And what we find is there is a high level of awareness
when we look upwards of 20
to 95 percent among kids similarly among adults.
It varies by country of course, and the use is still low
which tells us that it's very possible that as the cost
of these products goes down and marketing is very aggressive
as we see that there is potential for these
to increase worldwide.
[Iskander] So certainly something that that will need
to be monitored going forward.
[Ahluwalia] Absolutely.
[Iskander] So you gave a couple
of examples earlier of India and Uganda.
Both of those involved laws.
There are, have been a number of types of laws and policies
that have been proven to be effective
in decreasing tobacco use and harms from tobacco.
Could you briefly review what some of those are?
[Ahluwalia] Sure.
So most of the countries are signatories
to the World Health Organization's framework
convention on tobacco control and with that comes a set
of guidelines that countries can follow
and reporting requirements.
And in addition to those guidelines there is the Mpower
demand reduction measures.
In those demand reduction, these are proven strategies
that countries can adapt for their tobacco control efforts.
They include everything from monitoring, to raising taxes
on tobacco products,
and monitoring the tobacco industry for example.
So all of those combined provide guidance to countries on how
to measure what's going on.
That's the Mpower is monitoring tobacco surveillance
and policies and then also to enact programs that allow them
to tackle different you know from anything from legislative,
to monitoring of the industry, raising taxes,
to protecting people from secondhand smoke in public
and other places, having legislation and other efforts,
and helping people to quit.
Another very important aspect of, as the landscape changes,
you know we need to have services
to assure the people who want to stop can.
[Iskander] Dr. Ahluwalia,
going forward really what is the bottom line
about global tobacco control and monitoring?
[Ahluwalia] We know surveillance is essential.
Data tell's us where we are, where we need to go,
and what we've done well.
And I think in terms of millions of lives are at stake,
and we have an opportunity to save them
and in fact a hundred million lives is the goal
for tobacco control.
And our data will be really important to measure
where we are, and what gets measured gets done.
[Iskander] Thank you very much Dr. Ahluwalia for your work
and for being here with us today.
[Ahluwalia] It is my pleasure.
[Iskander] Thank you for joining us for Beyond the Data.
MUSIC