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ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 2  |  Page : 218-223

Tracking WHO MPOWER in South East Asian region: An opportunity to promote global tobacco control


1 Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh, India
2 Department of Public Health Dentistry, Amrita School of Dentistry, Kochi, Kerala, India

Date of Web Publication10-Jun-2016

Correspondence Address:
Ravneet Malhi
Department of Public Health Dentistry, D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.183808

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  Abstract 


Introduction: Tobacco use is a major public health challenge worldwide and to counter the global tobacco epidemic, the World Health Organization (WHO) developed the WHO Framework Convention on Tobacco Control (WHO FCTC) to provide new legal dimensions for international health cooperation. Further WHO introduced the MPOWER package to monitor the tobacco control programs among the countries to accomplish the FCTC objective. Aim: The aim is to quantify the implementation of MPOWER tobacco control policies in South East Asia Region (SEAR) from the year 2008 to 2015. Materials and Methods: Information was collected from the WHO report on the Global Tobacco epidemic program SEAR from 2008 to 2015 using MPOWER. This assessment was based on the checklist which was designed previously by Iranian and International tobacco control specialists in their study on tobacco control. Results: Various countries of SEAR were ranked by scores and these scores were obtained from each indicator for each activity. Among SEAR region, Thailand got the highest scores and significant positive change was seen from a score of 8 in 2008 to 32 in 2015 where certain countries like Korea and Timore-Leste showed no significant positive change. Conclusion: Tobacco control policies have reduced the tobacco consumption, but still multisectoral efforts are needed toward effective enforcement of the law to bring about a significant decline in the prevalence of tobacco use.

Keywords: Control, scores, tobacco, tobacco control World Health Organization


How to cite this article:
Gupta R, Malhi R, Patthi B, Singla A, Jankiram C, Pandita V, Kumar JK, Prasad M. Tracking WHO MPOWER in South East Asian region: An opportunity to promote global tobacco control. J Indian Assoc Public Health Dent 2016;14:218-23

How to cite this URL:
Gupta R, Malhi R, Patthi B, Singla A, Jankiram C, Pandita V, Kumar JK, Prasad M. Tracking WHO MPOWER in South East Asian region: An opportunity to promote global tobacco control. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Jul 20];14:218-23. Available from: http://www.jiaphd.org/text.asp?2016/14/2/218/183808




  Introduction Top


Health is a multi-dimensional concept and many factors combine to affect the health of people and communities. Among them, adverse habits such as smoking and alcoholism are the ones with whom people unintentionally hurt their body. For the past few decades, it has been widely known in developed countries that tobacco is hazardous, but still it is insufficiently widely known how large these are.[1]

Many people inaccurately believe that experimenting with smoking or even casual use will not lead to any serious dependency. However, actually consumption of smoking as well as smokeless tobacco (SLT) cause's cancers of different sites in the human body and its usage is harmful to all human biological systems; including the oral cavity.[2] Smokers are not the only ones killed by tobacco. Second-hand smoke also has serious and often fatal health consequences.[3]

According to the estimates of World Health Organization (WHO), tobacco is second leading causes of the mortality worldwide and fourth most common risk factor for disease worldwide. Globally, about six million people die due to tobacco use annually. Approximately 250 million adults use SLT in 11 countries of the WHO South-East Asia Region (SEAR).[2],[3]

The harmful effects associated with the tobacco usage make it a serious public health issue which needs to be addressed with powerful methods.[2] It is beyond doubt that without effective tobacco control measures, it is estimated that by the year 2030 the annual global death toll will reach 8 million.[4]

So to counter the global tobacco epidemic, WHO Framework Convention on Tobacco Control was developed to provide new legal dimensions for international health cooperation. As of 12 February 2012, the treaty has been ratified by 174 parties who wish to decrease the supply and demand of tobacco.[5] To make it easy, WHO introduced the MPOWER measures to monitor the tobacco control programs among the countries. “MPOWER is the only document which is strategic in nature; providing a source of information on the spread of tobacco epidemic, as well as provides suggestions concerning specific actions for supporting the fight against this epidemic.”

The six evidence-based components of MPOWER are Monitor tobacco use and prevention policies, protect people from tobacco smoke, offer help to quit tobacco use, warn about the dangers of tobacco, enforce bans on tobacco advertising, promotion and sponsorship, raise taxes on tobacco.

There have been a number of global surveys conducted to assess the tobacco control programs based on MPOWER strategyand one of such assessment was conducted by Joossens and Raw in European countries and Heydari et al. in 2014 in Eastern Mediterranean countries using MPOWER.[5],[6]

However, no such study has been reported in the SEAR. Thus, the aim of this study was to compare MPOWER programs among the countries of the WHO SEAR from 2008 to 2015 to highlight what has been achieved and what still needs to be addressed by the countries to strengthen these programs.


  Materials and Methods Top


The retrospective analysis was carried out to quantify the implementation of tobacco cessation policies over the period of 8 years from 2008 to 2015 in SEAR, based on MPOWER strategy. The information about various indicators for tobacco control for various countries was collected from the WHO report of Global Tobacco Epidemic program, SEAR for the year 2008, 2009, 2011, 2013, and 2015. This assessment was based on the checklist which was designed previously by Iranian and International tobacco control specialists in their study on tobacco control.[4]

According to the measures in the WHO report on MPOWER,[4] there were 7 questions with 5 options ranging from minimum 0 to maximum 4 scores, and 3 questions ranging from minimum 0 to maximum 3 scores. Each point, for which data was not available, would be scored as 0. Hence, the total possible score was 37 (7 × 4 + 3 × 3) as shown in [Table 1].
Table 1: World Health Organization MPOWER score on tobacco control based on the World health organization report

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The scores were compiled by one person who rates the scores and confirmed by two tobacco specialist who acted as supervisors. Data entry was performed independently and was checked by the supervisors with the checklist. The scores were summed and the rankings were computed. The checklist, with its scoring and scale, is shown in [Table 1].


  Results Top


We found changes in scores across SEAR over these 8 years. The results are shown in [Table 2], [Table 3], [Table 4], [Table 5].[7],[8],[9],[10],[11] Countries are assessed by total scores and the score obtained for each indicator for each activity. Among SEAR region, Thailand got the highest scores and significant positive change was seen from a score of 8 in 2008 to 32 in 2015. Though overall improvement has been seen among all the countries throughout 8 years yet there are some discrepancies in some countries such as Korea who got highest scores, i.e., 18 points in 2008 which gradually fell in 2015, to, 11 same as with Timor-Leste where highest scores in 2013, i.e., 10 which was decreased to 7 in 2015.
Table 2: Ranking of South East Asia region in 2008 and 2009 year

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Table 3: Ranking of South East Asia Region in 2011 and 2013 year

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Table 4: Ranking of South East Asia region in 2015 year

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Table 5: Overall improvements

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  Discussion Top


MPOWER is successful, and popular tool for tobacco control as it galvanize the action at the global and country level against the tobacco epidemic. Moreover, the MPOWER policies are not complex as they are within the reach of governments. The MPOWER policy package can reverse the tobacco epidemic and prevent millions of tobacco-related deaths.[12]

Many countries have succeeded in reducing smoking prevalence dramatically over a short period with the help of MPOWER tobacco control package. This study also reveals the same, that after implementation of the MPOWER package for 8 years from 2008 to 2015 in SEAR countries, tobacco control programs in Thailand had favorable results as compared to other countries in the same region which could be due to strong, comprehensive tobacco control policy in Thailand.

While in some countries such as Indonesia, Maldives scores remain unchanged in spite of tobacco control regulations. Countries such as Korea, Timor-Leste, Sri Lanka has shown slight or no improvement in scores so there is a need for emphasizing the steps to be taken to control tobacco consumption. The findings of this study are similar to study done in Eastern Mediterranean Countries (EMR) by Heydari et al. in 2011 and 2013 in which after implementation of the MPOWER package for tobacco control programs the 10 indicators set increased from 2011 to 2013 and Iran got the highest scores.[4],[5]

Countries such as India, Sri Lanka, has <15% of adult daily smoking prevalence whereas no data are available for the countries such as Bhutan, Korea, and Timor-Leste. However, in the remaining countries, no change has been observed in the scores, i.e. 2 (20–29%).

In some countries such as Bhutan, Thailand and Nepal smoking is prohibited in almost all of the indoor public places, indoor workplaces, and public transport, outdoor places and lot of improvement has been seen in the scores (0–4) after the implementation of the MPOWER policies. This could be due to the reason that Thailand has complex sociocultural, political and even personal dynamics that interact to give the shape to Thai thinking.[13]

On the other side, Nepal has also strong policy making system as well as Tobacco Product (Control and Regulation) Act, 2010 which is the primary law governing tobacco control and regulate the policies.[13] Similarly countries like India, Sri Lanka are also forwarding towards smoke-free policies with moderate achievement. Hence, we can say that the success of tobacco control in these countries must also be attributed to a unique historical struggle.

Whereas in countries such as Bangladesh, Korea, Timor-Leste, Maldives, and Myanmar, many efforts have been done to regulate the smoke-free policies such as in Bangladesh, fines for noncompliance with smoke-free regulations have increased from 50 Taka (approximately US$ 0.6) to 300 Taka (US$ 3.9), but no change in scores has been seen, i.e., only 2–5 public places are smoke free as the provided laws may not be comprehensive or accurately identified.[14]

Mostly no change in scores has been observed for the health warning on cigarette packages, advertising bans and cessation programs in SEAR except countries like Thailand, Nepal, Sri Lanka, Bangladesh where larger warning with appropriate characteristics has been seen, i.e., drastic improvement in scores (0–4) that is just due to implementation of strong laws introduced by the Government on Tobacco Product Regulations which includes strict restrictions on tobacco advertising, promotion, and sponsorship and the graphic health warnings on cigarettes should be occupying 85% of the top of the front and back and misleading packaging and labeling, including terms such as “light” and “low-tar” and other signs, is prohibited in Thailand. In Nepal, pictorial health warnings were implemented in April 2014; the government has also issued a directive to increase the size of the pack warnings to 90% of the front and back of all tobacco product packaging in May 15, 2015.[15]

In spite of such efforts still, some barriers exist to these policies such as lobbying and partnering with organizations inside and outside of government, as well as asserting and maintaining a direct and indirect influence on policy-makers, political leaders, and researchers. Because the sound financial base of tobacco product manufacturing companies' lead to Tobacco Lobby efforts which won the legal battle. The tobacco lobby has also argued that tobacco control measures can negatively impact the economy by creating massive employment loss.[16]

Although countries have increased taxes in every fiscal year, over the last decade, cigarettes have become more affordable in many countries in the region as inflation rates have not been taken into account while raising taxes. In the case of a score of taxation, Bangladesh scored well (0–4) among all the countries. Even Thailand, India, and Nepal have set a good example on this in the region because part of their tobacco taxation revenue is earmarked for health issues.[16]

An increase in the state level tax in 16 states of India is one of the unique successes in tobacco control in the region as in other countries over the years; but still the Government has followed a dual policy towards tobacco production and consumption and was considered as a source of revenue from taxes and exports rather than a harmful commodity. On one hand, increased taxation has been justified on the grounds of public health protection, whereas, on the other hand, different Government Departments promoted tobacco by providing subsidies/incentives for cultivation, marketing, and exports.[16]

Hence overall we can say that effective tobacco control policies have increased the smoking cessation rates, reduced the tobacco consumption, and delayed smoking initiation among adolescents. However, still multisectoral efforts are needed towards effective enforcement of the law to bring about a significant decline in the prevalence of tobacco use and exposure to second-hand smoke. To monitor the key indicators of MPOWER policy package regular monitoring is required time to time.


  Conclusion Top


The impact of six policies of MPOWER, if implemented in each country as a comprehensive package, would transform public health. As yet, however, no country has fully embraced them, and very few are even close to doing so. The Member States have a long way to go before they are effectively protecting their citizens from the tobacco epidemic.

It is essential to have a lead organization to push for tobacco control in both the nongovernmental and governmental sectors. Ideally, collaboration between the two sectors should enhance each other's work. Networking and coalition building, both domestically and internationally, are crucial to increasing the lobbying power of tobacco control advocates.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Peto R, Lopez AD, Boreham J, Thun M, Heath C Jr., Doll R. Mortality from smoking worldwide. Br Med Bull 1996;52:12-21.  Back to cited text no. 1
    
2.
Singla A, Patthi B, Singh K, Jain S, Vashishtha V, Kundu H, et al. Tobacco cessation counselling practices and attitude among the dentist and the dental auxiliaries of urban and rural areas of Modinagar, India. J Clin Diagn Res 2014;8:ZC15-8.  Back to cited text no. 2
    
3.
World Health Organization. MPOWER: A policy package to reverse the tobacco epidemic. Geneva: World Health Organization; 2008. p. 1-41.  Back to cited text no. 3
    
4.
Heydari G, Talischi F, Algouhmani H, Lando HA, Ahmady AE. WHO MPOWER tobacco control scores in the Eastern Mediterranean countries based on the 2011 report. East Mediterr Health J 2013;19:314-9.  Back to cited text no. 4
    
5.
Heydari G, Ebn Ahmady A, Lando HA, Shadmehr MB, Fadaizadeh L. The second study on WHO MPOWER tobacco control scores in Eastern Mediterranean countries based on the 2013 report: Improvements over two years. Arch Iran Med 2014;17:621-5.  Back to cited text no. 5
    
6.
Joossens L, Raw M. The Tobacco Control Scale: A new scale to measure country activity. Tob Control 2006;15:247-53.  Back to cited text no. 6
    
7.
World Health Organization. WHO Report on the Global Tobacco Epidemic, 2009: The MPOWER Package. Geneva: WHO Press; 2009.  Back to cited text no. 7
    
8.
World Health Organization. WHO Report on the Global Tobacco Epidemic, 2011: The MPOWER Package. Geneva: WHO Press; 2011.  Back to cited text no. 8
    
9.
World Health Organization. WHO Report on the Global Tobacco Epidemic, 2013: The MPOWER Package. Geneva: WHO Press; 2013.  Back to cited text no. 9
    
10.
World Health Organization.WHO Report on the Global Tobacco Epidemic, 2015: The MPOWER Package. Geneva: WHO Press; 2011.  Back to cited text no. 10
    
11.
World Health Organization. WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER Package. Geneva: WHO Press; 2015.  Back to cited text no. 11
    
12.
World Health Organization. MPOWER: Six policies to reverse the tobacco epidemic. Geneva: WHO Press; 2008.  Back to cited text no. 12
    
13.
Smoke Free Policies Fact Sheet – Thailand. Available from: http://www.tobaccocontrollaws.org/legislation/country/thailand. [Last accessed on 2015 Aug 29].  Back to cited text no. 13
    
14.
Smoke Free Policies Fact Sheet – Bangladesh. Available from: http://www.tobaccocontrollaws.org/legislation/country/bangladesh. [Last accessed on 2015 Aug 29].  Back to cited text no. 14
    
15.
Smoke Free Policies Fact Sheet – Nepal. Available from: http://www.tobaccocontrollaws.org/legislation/country/nepal. [Last accessed on 2015 Aug 29].  Back to cited text no. 15
    
16.
Singh PK. MPOWER and the Framework Convention on Tobacco Control implementation in the South-East Asia region. Indian J Cancer 2012;49:373-8.  Back to cited text no. 16
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