Beleidsontwikkelingen in tabaksontmoediging

Transcriptie

1 Beleidsontwikkelingen in tabaksontmoediging Marc Willemsen Nascholingsavond Kwaliteitsregister Stoppen met Roken Trimbos-instituut 17 September 2015

2

3 1. Inleiding: Tabaksontmoediging in Nederland 2. Symposium op SRNT-E over ondermijnen van tabaksbeleid door de industrie 3. Symposium of SRNT-E over de nieuwste resultaten uit het ITC Nederland project 4. Symposium of SRNT-E over kankerpreventie: vergoeding van stoppen met roken

4 Framework Convention on Tobacco Control (FCTC) Wat: WHO-Kaderverdrag inzake tabaksontmoediging Doel: Wereldbevolking beschermen tegen de schadelijke effecten van tabak Middel: samenhangend pakket van effectieve maatregelen Start: geratificeerd door Nederland op 27 januari 2005

5

6 Schaduwrapport 2011

7 Schaduwrapport 2011

8

9 Niet in overeenstemming met FCTC verplichtingen Alomvattende strategie en centrale coördinatie (Art. 5.1 & 5.2) Bescherming tegen belangen tabaksindustrie (Art. 5.3) Bescherming tegen blootstelling aan tabaksrook (Art. 8) Inhoud tabaksproducten en informatieverschaffing (Art. 9 & 10) Verpakking en etikettering (Art. 11) Educatie, communicatie en training (Art. 12) Niet in overeenstemming met FCTC aanbevelingen, maar wel met (eventuele) verplichtingen Niet in overeenstemming met FCTC suggesties, maar wel met (eventuele) verplichtingen en/of aanbevelingen In overeenstemming met FCTC verplichtingen, aanbevelingen en/of suggesties Prijs- en belastingmaatregelen (Art. 6) Samenvattend: Nog weinig vooruitgang in termen van voldoen aan FCTC Reclame, promotie en sponsoring (Art. 13) Tabaksverslaving en stoppen met roken (Art. 14) Illegale handel (Art. 15) Verkoop aan en door minderjarigen (Art. 16) Onderzoek en monitoring (Art. 20) Financiële middelen (Art. 26)

10 Positieve ontwikkelingen sinds 2011 Leeftijdsgrens verkoop tabak van 16 naar 18 jaar Herintroductie van de rookvrije (kleine) horeca Terugkeer van vergoeding van stopondersteuning in het basispakket Weer aandacht voor campagnes Publieke informatievoorziening t.a.v. tabaksingrediënten Grote accijnsverhoging in 2013 Steun voor de Europese Tabaksproductenrichtlijn (grafische gezondheidswaarschuwingen en maatregelen t.a.v. additieven)

11 Zorgpunten Tabaksontmoediging onvoldoende prioriteit Gebrek aan een alomvattend tabaksbeleid Onvoldoende maatregelen tegen de invloed van de tabaksindustrie Nog geen volledige bescherming tegen meeroken Gebrek aan voorlichting (en kennis) over de schadelijkheid van (mee)roken Geen algeheel reclameverbod op verkooppunten Accijnsinstrument niet vanwege de volksgezondheid Verslechteringen: minder budget, minder monitoring

12 Aanbevelingen Ontwikkel een omvattend tabaksontmoedigingsbeleid met substantieel budget, ondersteund met structurele inzet van het accijnsinstrument Start bewustwordingscampagne over de schadelijkheid van roken Elimineer alle tabaksreclame en promotie: display ban en plain packaging

13

14

15

16 Symposium 1 Preventing tobacco industry interference in health policymaking: challenges, successess, and missed opportunities

17 Implementing WHO Framework Convention on Tobacco Control Article 5.3 in the EU: Challenges and Opportunities Heide Weishaar MRC/CSO Social and Public Health Sciences Unit, University of Glasgow

18 FCTC Article 5.3 In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.

19 Nederland September 2014: Stichting Rookpreventie Jeugd dagvaardt Overheid om artikel 5.3 na te komen Mei 2015: Advies van ANR aan de Overheid over implementatie van artikel 5.3 Kamerbrief van Rijn over artikel 5.3 verwacht

20 BAT interests for impact assessment and stakeholder consultation hidden behind credible third parties Corporations Lobbying groups Member States Group 1 included*: Business groups (British Chambers of Commerce, CBI & Federation of Small Businesses) and companies (BAT, Enron, KPMG, NTL, Rolls Royce, Telewest, Zurich financial services). British American Tobacco Group 2 included**: Baxter, Bayer, Bouygues, British Petroleum, Coca Cola, Dow, Du Pont de Nemours, Edelman, Elf Aquitaine, GCPF (Crop Protection Association), HSBC, ICI, Johnson & Johnson, Marks & Spencer, Mars, NatWest, Pirelli, Shell, Siemens, SmithKline Beecham, Solvay, Tesco, Zeneca Public Policy Unit Fair Regulation Campaign Trade & economic organisations (including OECD, CBI, UNICE & IBEC) European Policy Centre Risk Assessment Forum Weinbergs UK government German government Irish government Dutch government EU Policymaking institutions European Council European Parliament and MEPs European Commission Smith KE, Fooks G, Collin J, Weishaar H, Mandal S, Gilmore AB. Working the System British American Tobacco's Influence on the European Union Treaty and Its Implications for Policy: An Analysis of Internal Tobacco Industry Documents. PLoS Medicine 2010; 7(1): e

21 Tobacco industry s assault on democratic policy making: the case of the EU Tobacco Products Directive Co-researchers: H. Costa, D. Stuckler, M. McKee, & A.B. Gilmore R01CA Silvy Peeters SRNT Europe 16 th Annual Conference Maastricht, 10 September 2015

22 Belangrijkste TPD maatregelen per mei 2016 Verbod op tabaksproducten met kenmerkend aroma Gezondheidswaarschuwingen (tekst + plaatje) 65% op voor en achterzijde verpakking + stoppen met roken informatie Nadere eisen misleidende eisen etikettering (geen additief vrij, geen nicotine, teer en CO gehaltes) Verbod promotie elektronische sigaretten Maximaal nicotinegehalte en volume, verschillende veiligheidseisen Keuze plain packaging wordt aan de lidstaten overgelaten Overgangstermijn 1 jaar (mei 2016 mei 2017). Nederland: E-sig onderdeel tabakswet (wat betreft leeftijdsgrens en reclameverbod)

23

24 Context 2001: Tobacco Products Directive (TPD)1 adopted : Revision TPD1 started 2014: TPD2 adopted WHO Framework Convention on Tobacco Control (FCTC) Better Regulation 2 Impact Assessment, Stakeholder Consultation 1 Mandal S, Gilmore A, Collin J, Weishaar H, Smith K, McKee M, Block, amend, delay: tobacco industry efforts to influence the European Union s Tobacco Products Directive (2001/37/EC). Other. Brussels: Smokefree Partnership/CRUK, Smith KE, Fooks G, Collin J, Weishaar H, Mandal S, Gilmore A. "Working the system": PLOS Medicine 2010

25 Overall TI strategy AMEND, DELAY, & BLOCK extreme policy options Shift debate away from health to economic consequences Commission Parliament EU Council Block DG SANCO s extreme policy options Break Health Committee s control over TPD2 Create blocking minority to extreme measures

26 Significant delays TPD1 2.5 years TPD2 5.5 years Commission Parliament & Council Impact Assessment: Additional studies Public consultation flooded: 85,000+ submissions Inter-Service Consultation (ISC): Postponed 3 times (25 Jul, 23 Sept, 22 Oct 2012)

27 ITC Netherlands Wave 1 to 8 National Report ( ) Summary of Findings Marc C. Willemsen Maastricht University

28 ITC Netherlands Team ITC Netherlands Investigators Dr. Marc Willemsen* Maastricht University (CAPHRI) Dr. Gera Nagelhout Maastricht University (CAPHRI) Dr. Hein de Vries Maastricht University (CAPHRI) Karin Hummel PhD Student, Maastricht University (CAPHRI) Dr. Ciska Hoving Maastricht University (CAPHRI) Dr. Bas van den Putte University of Amsterdam (ASCoR) ITC International Team Dr. Geoffrey T. Fong* Dr. Mary E. Thompson Dr. Christian Boudreau ITC Netherlands Project Management Thomas Agar Project Manager, University of Waterloo, Canada Ruth Loewen Survey Manager, University of Waterloo, Canada Dr. Gera Nagelhout Maastricht University (CAPHRI) Karin Hummel PhD Student, Maastricht University (CAPHRI) *Principal Investigators 28

29 29

30 Methods Longitudinal study: survey waves over 6 years ( ) Telephone (Waves 1 & 3) and web (Waves 1-8) surveys Representative random sample Cohort of about 2,000 youth (15-17) and adult (18+) smokers Replenishment of respondents lost to attrition at Waves 4-8 Survey questions Adapted from ITC Project surveys across 22 countries Measures relevant to each FCTC policy domain New questions adapted for Netherlands tobacco control policy environment e.g. E-cigarettes, mass media campaigns, insurance reimbursement for SSMs 30

31 Kennis gezondheidsschade 31

32 Kennis: roken en hartziekten 32

33 Kennis: hartaanval 33

34 Denken over gevolgen van het roken 34

35 Denken over schade van roken aan anderen 35

36 Beeldvorming 36

37 Gebrekkige blootstelling aan voorlichting 37

38 Prijs als reden om te stoppen 38

39 Opmerken van de waarschuwingslabels 39

40 Aanbevelingen 1) Promoot meer bewustzijn van de schade van het roken en voordelen van stoppen middels goedgefinancierde voorlichtingscampagnes 2) Verminder blootstelling aan tabaksmarketing in winkels 3) Verhoog tabaksaccijns tot minimal 70% van de verkoopprijs 4) Verminder prijsverschil tussen shag en sigaretten. 40

41 Symposium 7 Preventing cancer through smoking cessation: A symposium supported by the Dutch Cancer society (KWF) and Cancer Research UK -> Mijn presentatie: Should governments pay for smoking cessation?

42 FCTC Article 14 Tobacco users who need cessation support should be offered intensive specialised support, delivered by specially trained practitioners. Such services should offer behavioural support, and where appropriate, medications ( ). Where possible they should be provided free or at an affordable cost.

43 Vergoeding 2011: vergoeding voor stoppen met roken behandeling ingevoerd + campagne 2012: geen vergoeding : vergoeding opnieuw mogelijk.

44 Methode Literature search PubMed: reimbursement and Netherlands Inclusion: Before after comparison data available (covering ) National level data All outcome measures

45 Bevindingen: 6 studies 1. Willemsen MC, et al. Population impact of reimbursement for smoking cessation: a natural experiment in The Netherlands. Addict 2012;108(3): Troelstra, S., et al. Effect of tobacco control policies on information seeking for smoking cessation in the Netherlands: A Google Trends study. Eur J Public Health 2014;24(Suppl 2): Verbiest, ME. et al. An increase in primary care prescriptions of stop-smoking medication as a result of health insurance coverage in the Netherlands: population based study." Addiction 2013;108: Van Boven JFM, Vemer P. Higher Adherence during Reimbursement of Pharmacological Smoking Cessation Treatments. Nicotine Tob Res. First published online: March 16, Nagelhout, G. E., et al. Effectiveness of a national reimbursement policy and accompanying media attention on use of cessation treatment and on smoking cessation: a real-world study in the Netherlands. Tobacco Control 2014;24: Nagelhout, G., et al. Are there income differences in the impact of a national reimbursement policy for smoking cessation treatment and accompanying media attention? Findings from the International Tobacco Control (ITC) Netherlands Survey. Drug Alcohol Dependency 2014;140:

46 1. Willemsen et al (2012) Increases in calls to the national telephone quit line 2011

47 2. Troelstra Increase Google Quit smoking searches in 2011 and 2013 in the Netherlands

48 2. Troelstra (cont d) No increase Google Quit smoking searches in 2011 and 2013 in Belgium

49 3. Verbiest et al More prescriptions and less smokers

50 Proportion smokers in adult population (TNS-NIPO) 28 27, , , , ,

51 4. Van Boven & Vemer Number of prescriptions by pharmacies Adherence = at least 80% of the recommended number of tablets prescribed Recommended: Varenicline: 143 pills, 12 weeks Bupropion: 83 pills, 7 weeks.

52 4. Van Boven & Vemer(cont d) 15.4% 20.1% 13.9% 18.9%

53 5. Nagelhout (2014a) Reimbursement wave 1 wave 2 wave 3 wave 4 % Quit Attempt % Quit Success

54 5. Nagelhout (2014a) (cont d) Attention to media about reimbursement significantly associated with more quit attempts (Or=1.18) and more quit success (OR = 1.20). Awareness of reimbursement policy not a significant predictor, when controlling for media attention.

55 6. Nagelhout et al (2014b) ITC survey data

56 4. Nagelhout et al (2014b) Main findings of Nagelhout et al (2014a) were confirmed: Effect of reimbursement on quit attempts and quit success. Awareness of media campaign associated with more quit attempts. No differences according to income level

57 Conclusions More use of behavioural support More use of pharmaco-therapy Greater adherence to treatment regime more successful quitting more quitting activity in the population -> Impact on national smoking rate Impact is very much dependent on promotion of reimbursement through media campaign National reimbursement for smoking cessation will help governments in reaching national tobacco control targets, if properly executed

58 Bedankt!