Reaching Outside the Comfort Zone: Realising the FCTC’s Potential for Public Health Governance and Regulation in the European Union; Comment on “The Legal Strength of International Health Instruments – What It Brings to Global Health Governance?”

In their paper, Nikogosian and Kickbusch show how the effects of the adoption by the World Health Organization (WHO) of the Framework Convention on Tobacco Control (WHO FCTC) and its first Protocol extend beyond tobacco control and contribute to public health governance more broadly, by revealing new processes, institutions and instruments. While there are certainly good reasons to be optimistic about the impact of these instruments in the public health sphere, the experience of the FCTC’s implementation in the context of the European Union (EU) shows that further efforts are still necessary for its full potential to be realised. Indeed, one of the main hurdles to the FCTC’s success so far has been the difficulty in developing and maintaining comprehensive multisectoral measures and involving sectors beyond the sphere of public health

Reaching Outside the Comfort Zone: Realising the FCTC’s Potential for Public Health Governance and Regulation in the European Union Comment on “The Legal Strength of International Health Instruments – What It Brings to Global Health Governance?”

Abstract In their paper, Nikogosian and Kickbusch show how the effects of the adoption by the World Health Organization (WHO) of the Framework Convention on Tobacco Control (WHO FCTC) and its first Protocol extend beyond tobacco control and contribute to public health governance more broadly, by revealing new processes, institutions and instruments. While there are certainly good reasons to be optimistic about the impact of these instruments in the public health sphere, the experience of the FCTC’s implementation in the context of the European Union (EU) shows that further efforts are still necessary for its full potential to be realised. Indeed, one of the main hurdles to the FCTC’s success so far has been the difficulty in developing and maintaining comprehensive multisectoral measures and involving sectors beyond the sphere of public health

Study: An Assessment of Citizens' Exposure to Tobacco Marketing

This report provides the European Commission with a comprehensive overview of channels through which EU citizens, and in particular young people, are exposed to the marketing of tobacco products and e-cigarettes. The study investigates the reality of tobacco advertising and marketing in a representative sample of EU Member States. The detailed evidence provided in this report will shed light on how current EU- and national- level regulation of tobacco and e-cigarette advertising is working in practice. Exposure is measured both by looking at actual advertising spend, what advertising activity is occurring in different channels and looking at what advertising citizens recall, as measured through a citizens' survey. These are complemented by a survey of national experts and a review of secondary data. We examine exposure to advertising through a wide range of channels including print, outdoor, TV and radio, online, sponsorship and corporate social responsibility. Strategies for selling tobacco at point of sale are also assessed, including a review of the different kind of retailers, such as specialised retailers (tobacconists), retail outlets (including supermarkets) and vending machines. Where information exists, we assess the extent to which young people in particular are exposed to this marketing.The report takes into account the regulatory context at EU and national levels, given that certain forms of advertising (e.g. billboards, point of sale) are still allowed in some Member States. The report covers the following work packages: Work package 1: Overview of advertising strategies Work package 2: Printed media Work package 3: Internet and mobile applications Work package 4: Billboards, posters and other types of advertising outside the home Work package 5: TV and radio (electronic cigarettes) and product placement (all products) Work package 6: Points of sale, sample, giveaways and promotional items Work package 7: Sponsoring, corporate responsibility, brand stretching and imitation products Work package 8: Compilation of the key forms of advertising, promoting and sponsorship that EU citizens are exposed to. Consortium Partners: Burson-Marsteller; Smoke Free Partnership Expert Subcontractors: University of Stirling; VVA Europ

An investment case for the prevention and management of rheumatic heart disease in the African Union 2021-30: a modelling study.

BACKGROUND: Despite declines in deaths from rheumatic heart disease (RHD) in Africa over the past 30 years, it remains a major cause of cardiovascular morbidity and mortality on the continent. We present an investment case for interventions to prevent and manage RHD in the African Union (AU). METHODS: We created a cohort state-transition model to estimate key outcomes in the disease process, including cases of pharyngitis from group A streptococcus, episodes of acute rheumatic fever (ARF), cases of RHD, heart failure, and deaths. With this model, we estimated the impact of scaling up interventions using estimates of effect sizes from published studies. We estimated the cost to scale up coverage of interventions and summarised the benefits by monetising health gains estimated in the model using a full income approach. Costs and benefits were compared using the benefit-cost ratio and the net benefits with discounted costs and benefits. FINDINGS: Operationally achievable levels of scale-up of interventions along the disease spectrum, including primary prevention, secondary prevention, platforms for management of heart failure, and heart valve surgery could avert 74 000 (UI 50 000-104 000) deaths from RHD and ARF from 2021 to 2030 in the AU, reaching a 30·7% (21·6-39·0) reduction in the age-standardised death rate from RHD in 2030, compared with no increase in coverage of interventions. The estimated benefit-cost ratio for plausible scale-up of secondary prevention and secondary and tertiary care interventions was 4·7 (2·9-6·3) with a net benefit of $2·8 billion (1·6-3·9; 2019 US$) through 2030. The estimated benefit-cost ratio for primary prevention scale-up was low to 2030 (0·2, <0·1-0·4), increasing with delayed benefits accrued to 2090. The benefit-cost dynamics of primary prevention were sensitive to the costs of different delivery approaches, uncertain epidemiological parameters regarding group A streptococcal pharyngitis and ARF, assumptions about long-term demographic and economic trends, and discounting. INTERPRETATION: Increased coverage of interventions to control and manage RHD could accelerate progress towards eradication in AU member states. Gaps in local epidemiological data and particular components of the disease process create uncertainty around the level of benefits. In the short term, costs of secondary prevention and secondary and tertiary care for RHD are lower than for primary prevention, and benefits accrue earlier. FUNDING: World Heart Federation, Leona M and Harry B Helmsley Charitable Trust, and American Heart Association