Healthy Caribbean Coalition - The Bloomberg Global Initiative - To Reduce Tobacco Use

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INTRODUCTION

The Heart & Stroke Foundation of Barbados (HSFB), the Heart Foundation of Jamaica (HFJ) (for The Jamaica Coalition for Tobacco Control), the Trinidad & Tobago Cancer Society and the Guyana Chest Society have received a grant from the Bloomberg Global Initiative to ensure the implementation of rotating picture-based package warnings on all tobacco products sold in Caribbean countries. This grant will be administered through the Campaign for Tobacco Free Kids.

PROJECT DETAILS
Project title	"Introducing a Picture-Based Health Warning System on Cigarette Packages in the Caribbean"
Amount of grant	USD$627,824
Duration of project	24 months
Proposed start date of project	APRIL 1, 2008
Project scope	Regional – The Caribbean – including Barbados, Guyana, Jamaica and Trinidad & Tobago
Project outreach:	The population of the 4 countries involved in the project

BACKGROUND

The Bloomberg Initiative

The Bloomberg Initiative was established in 2006 by funds contributed by Michael R. Bloomberg (New York City’s Mayor), to reduce tobacco use globally by investing in developing countries, with a particular focus on the 15 countries with the most smokers in the world:
The five partner organizations in the initiative are:

• The Campaign for Tobacco Free Kids (US),
• Centers for Disease Control and Prevention (CDC) Foundation (US),
• Johns Hopkins Bloomberg School of Public Health (US)
• World Health Organization (international), and
• The World Lung Foundation (US).

The Framework Convention on Tobacco Control (FCTC)

The FCTC is a legally binding treaty which was negotiated by the 192 member states of the World Health Organization (WHO). The world's first public health treaty, the FCTC contains a host of measures designed to reduce the devastating health and economic impacts of tobacco. The final agreement provides the basic tools for countries to enact comprehensive tobacco control legislation. Key provisions in the treaty encourage countries to:

• Enact comprehensive bans on tobacco advertising, promotion and sponsorship.
• Obligate the placement of rotating health warnings on tobacco packaging that cover at least 30 percent (but ideally 50 percent or more) of the principal display areas and can include pictures or pictograms.
• Ban the use of misleading and deceptive terms such as "light" and "mild".
• Protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places.
• Combat smuggling, including the placing of final destination markings on packs; and
• Increase tobacco taxes.

The FCTC also contains numerous other measures designed to promote and protect public health, such as mandating the disclosure of ingredients in tobacco products, providing treatment for tobacco addiction, encouraging legal action against the tobacco industry, and promoting research and the exchange of information among countries. To date, 168 countries have signed and ratified the treaty, including nine Caribbean nations.

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Heart & Stroke Foundation of Barbados

The Heart & Stroke Foundation of Barbados was established in 1985 as a non-profit organisation and is a member of the InterAmerican Heart Foundation and the World Heart Federation. The Foundation is involved in prevention and rehabilitation programmes for cardiovascular disease and emergency cardiac care programmes. The Foundation’s Chief Executive Officer is a member of the Policy Committee of the international Framework Convention Alliance on tobacco control.

THE BLOOMBERG PROJECT

The Bloomberg Project’s primary objective is to achieve a strong CARICOM (Caribbean Community and Common Market) cigarette labelling standard, which is currently being updated and circulated for comment in countries, and to ensure implementation of the standard or equally strong requirements in four target countries: Barbados, Guyana, Jamaica, and Trinidad & Tobago. This includes liaising with the Ministries of Health and Bureaus of Standards in the target countries.

This project aims to ensure the implementation of rotating picture-based package warnings on tobacco products sold in Caribbean countries, of a minimum size of 50% of the top of each main face of the packaging. Project strategies will include lobbying of national politicians, raising awareness among key decision makers and community leaders, and mobilizing and informing strategic sectors of the public, including the media, in support of the warnings.

The other Caribbean-based non-governmental organisations (NGOs) committed to the project are The Heart Foundation of Jamaica, The Guyana Chest Society and The Trinidad and Tobago Cancer Society. In addition, three of the four countries have tobacco control coalitions committed to the project. The Heart Foundation of Jamaica and The Heart & Stroke Foundation of Barbados have previously played leadership roles in tobacco control in their respective countries, including lobbying for FCTC ratification.

About Our Partners

The Heart Foundation of Jamaica (HFJ) was established in 1971 and is a member of the InterAmerican Heart Foundation and the World Heart Federation. The Foundation is involved in prevention programmes for cardiovascular disease. The establishment of the Jamaica Coalition for Tobacco Control (JCTC) was spearheaded by The Heart Foundation of Jamaica and was launched on May 31, World No Tobacco Day, 2002.

The Guyana Chest Society was established in 1921 for the prevention and treatment of tuberculosis. It is a non-profit non-governmental organization. It is affiliated with The International Union against Tuberculosis and Lung Diseases.

The Trinidad and Tobago Cancer Society is a non-governmental, non-profit, voluntary service organization whose main purpose is to promote the early detection of cancer through screening, education and advocacy. It was established in 1971. They operate a screening clinic and two mobile units.

Project Staffing

The project office is situated in the HFJ with responsibility for implementation in four Caribbean countries. The office will be staffed by a Project Manager and a Communications Officer with additional administrative support from HFJ. The Executive Director of HFJ will oversee the entire project. Each of the other three countries will have a Project Officer in the NGO specified above.

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DEATHS DUE TO TOBACCO

Although tobacco deaths rarely make headlines, tobacco kills one person every six seconds.1 Tobacco kills a third to half of all people who use it, 2 on average 15 years prematurely.2,3,4.

Today, tobacco use causes 1 in 10 deaths among adults worldwide – more than five million people a year.1

In the Caribbean it is estimated that the prevalence of tobacco use is about 15% in youths and approximately 10% to 25% in the population over age 15.6,10 Data from the Global Youth Tobacco survey (GYTS) done in Jamaica in 2006, showed that one-fifth of students surveyed (13 -14 years old) currently use some form of tobacco; 17% currently smoke cigarettes: 12% currently other tobacco products12. In a recent presentation regarding tobacco deaths in Trinidad and Tobago, it was estimated that tobacco deaths as a percentage of medical deaths, ranged from 30% in males to 14 % in females.7

Second-hand smoke also has serious and often fatal health consequences. These include lung cancer deaths and heart disease deaths. Second-hand smoke has been linked to several cases of sudden infant death syndrome as well as the birth of low-birth-weight babies. 11

THE USE OF HEALTH WARNINGS

Picture-based health warnings on tobacco packaging motivate smokers to try to quit smoking, inform potential adolescent smokers of the harms of tobacco use, and inform smokers of the harm caused to loved ones by second hand tobacco smoke exposure.8

Regulations governing tobacco package warnings in the Caribbean in almost all countries are largely outdated or do not exist.9,10 Although each country has the authority to regulate tobacco packaging on a national basis, CARICOM, a regional integration group formalized by treaty in 1973, has overall authority to develop standards. Although these standards are not legally required, they are customarily adopted by CARICOM countries.

The Labelling Technical Committee of the Bureau of Standards (BOS) of Jamaica is the body designated by CARICOM to develop recommendations for tobacco package warnings. The last set of recommendations done by the BOS was several years ago. In 2005 the BOS Jamaica was asked by the regional Standards body, the Caribbean Regional Organization for Standards and Quality (CROSQ), made up of the national Bureaus of Standards of CARICOM member states, to revise the cigarette labelling standards for use as a prototype by Member States of CARICOM. This process is currently being done.

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About CROSQ

CROSQ, the CARICOM Regional Organisation for Standards and Quality, was established in 2003 by a CARICOM Community treaty as an Intergovernmental Organisation and the regional centre for promoting efficiency and competitive production in trade and services, through the process of standardisation and the verification of quality.

Located in Bridgetown, Barbados, CROSQ is the successor to the Caribbean Common Market Standards Council (CCMSC), and supports the CARICOM mandate in the expansion of intra-regional and extra-regional export of goods and services. CROSQ is mandated to represent the interest of the region in international and hemispheric standards work, to promote the harmonisation of metrology systems and standards, and to increase the pace of standards development in the region, as it facilitates the resolution of CARICOM trade disputes where standards are involved.

In the execution of its mandate, CROSQ serves as the Regional Accreditation Body, and as an enquiry, notification and information point for World Trade Organisation (WTO) related matters on behalf of Member States, and provides international representation for Member States on Standards related matters.

The Role of Jamaica’s Ministry of Health

The Ministry of Health in Jamaica has been strongly involved in tobacco control in Jamaica and the CARICOM region, having an important role in the ratification of the FCTC among the CARICOM countries. The Ministry of Health of Jamaica also sits on the Technical Committee of the BOS of Jamaica that has been developing the CARICOM standards and has been aggressively advocating for picture-based warnings in the draft standard.

It is as a result of this advocacy that, on August 9, 2007, the BOS of Jamaica released a strong draft standard for comment within Jamaica that proposed picture warnings, a deadline of August 24, 2007 for responses. The deadline was extended until February 2008. The Pan American Health Organization, at the request of the Jamaica Ministry of Health, sent detailed technical comments in support of the proposal and recommended that it be further strengthened.

The BOS of other countries were asked to send comments on the proposal by the end of 2007.

Trinidad and Tobago's deadline for complying with the FCTC requirement was February 28, 2008. Jamaica's deadline is Oct 5, 2008; Barbados’ is March 15, 2009 and Guyana’s, November 14, 2009.

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POLITICAL SUPPORT

Specifically, this project has the political commitment of the Ministries of Health of Guyana, Barbados, Jamaica and Trinidad and Tobago. This group of countries together represents more than 78.3% (4,986,000) of the population of the English speaking Caribbean.

A key barrier to the development of a strong recommendation by the Jamaica BOS is the fact that the tobacco industry representatives are very active. Effective political support across all Caribbean countries is required to counteract the pressure and lobbying that the tobacco companies are able to apply within the industry and the region.

This project will engage in advocacy to ensure that CROSQ receives additional comments in favour of best practices in support of a strong CARICOM standard.

Assuming the CARICOM recommendations remain strong, the effort will be focused on implementation by early 2009 in the four target countries participating in this project (Barbados, Guyana, Jamaica and Trinidad and Tobago).

This project will sensitize policy makers and key opinion leaders regarding the importance of communicating accurate, clear, strong, direct, specific and easy-to-understand information about the health hazards of tobacco use to smokers and second-hand tobacco smoke to smokers’ families.

RESOURCES AVAILABLE

This project will benefit from committed collaboration between CARICOM, regional NGOs and ministries of health in the Caribbean, supported by technical expertise of several international organizations including the InterAmerican Heart Foundation, the Non-Smokers' Rights Association (Canada) and the regional and country offices of the Pan American Health Organization/World Health Organization.

References

1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine, 2006, 3(11):e442.

2. Peto R et al, Mortality from smoking worldwide. British Medical Bulletin, 1996, 52(1):12–21.

3. U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004 (http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2004/chapters.htm, accessed 5 December 2007).

4. Peto R et al. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet, 1992, 339(8804):1268–1278.

5. Murray CJL, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet, 1997, 349(9064):1498-1504.

6. WHO Report on the Global Tobacco Epidemic, 2008 - The MPOWER package, Appendix III, Page 270-271 (http://www.who.int/tobacco/mpower/en/index.html)

7. NCDs and Tobacco in the Caribbean, Prof George Alleyne, Disease Control Priorities project, June 2007 (http://www.dcp2.org/file/133/Anniversary_Alleyne.pdf)

8. Text and Graphic Warnings on Cigarette Packages. Findings from the International Tobacco Control: Four Country Study. David Hammond, PhD, Geoffrey T. Fong, PhD, Ron Borland, PhD, K. Michael Cummings, PhD, Ann McNeill, PhD, Pete Driezen, MSc , America Journal of Preventive Medicine 2007;32(3)

9. E . Bianco , B . Champagne , J . Barnoya. The tobacco epidemic in Latin America and the Caribbean: A snapshot . Prevention and Control , Volume 1, Issue 4 , 2006, Pages 311 - 317

10. Introducing Picture-Based Health Warnings on Cigarette Packages in The Caribbean. Alliance Bulletin Issue #68, Framework Convention on Tobacco Control, July 2007 page 5 (http://www.fctc.org/x/bulletin/COP2_68.pdf)

11. California Environmental Protection Agency. Proposed identification of environmental tobacco smoke as a toxic air contaminant: executive summary. Sacramento, California Environmental Protection Agency, June 2005 (ftp://ftp.arb.ca.gov/carbis/regact/ets2006/app3exe.pdf, accessed 5 December 2007).

12. GYTS Fact Sheet – Jamaica/Centers for disease Control and Prevention/Global Youth tobacco Survey (http://www.cdc.gov/tobacco/global/GYTS/factsheets/paho/2006/Jamaica_factsheet.htm)

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