Thursday 19 May 2016

Canada scores 75% on a new index for sustainable tobacco control

A month ago, the International Union against Tuberculosis and Lung Disease launched an index to measure the sustainability of tobacco control programs. The index was published in the BMJ journal, Tobacco Control.

The Union and its network have identified 31 indicators that they considered to be associated with the future security of tobacco control programs. These included diverse and comprehensive adminstrative and legal structures -- whether there was someone assigned by government to implement tobacco control, whether that person was trained and funded, whether tobacco control laws were in place, etc.

The indicators were weighted based on their importance to the results, with a maximum total score of 131. Of these indicators, two were related to the circumstances of developing countries and were therefore not relevant to Canada. Discounting the scores for these 2 issues, a developed country like Canada might aspire to a total of 123 points.

Canada has long prided itself on being a "leader" in tobacco control, and might therefore be expected to do well on this score. A quick run-down, however, shows that there are many areas where Canada has not yet implemented measures that are expected by the Union and others of developing countries.

The list, annotated with our results for Canada, is pasted below. By our account, Canada gets a score of 92, or 75%.  In most schools that would be a B-.  Had Canada sustained the measures that were in place in the early 2000s (a national strategy, structures for input from civil society and experts, mass media, etc), the score would have been 104 (85%).

Until scores for other countries have been tallied, we won't know whether Canada is still a "leader". In the meantime, the index helps identify areas where we have lost ground -- demonstrating the usefulness of this as a "sustainability" index.


Index of tobacco control sustainability (ITCS): a tool to measure the sustainability of national tobacco control programmes

Indicators
Present/
Absent 2016
Weighted score
Score for Canada -2016
Score for Canada -2000
Prerequisite indicator: >4 MPOWER policies in place
P
9
9
9
National tobacco control (TC) budget (annual)
P
7
7
7
National TC law
P
6
6
6
National budget allocation for TC capacity-building
P
6
6
6
Tobacco taxation>75% of retail sales price (RSP)
P/A
6
3
3
Tobacco taxation increases faster than ‘inflation plus GDP growth
P/A
6
3
3
National TC unit/cell
P
5
5
5
Civil society TC network
P
5
5
5
Civil society representation in national TC advisory committees
A
5

5
Health promotion fund for/including TC
A
5

National policy against TI CSR
A
5

TC-related mortality and morbidity recording system
P
5
5
5
National evaluation framework/plan in place
P
5
5
5
Evaluation built into all major policy implementation plans
P
5
5
5
National TC strategy
A
4

4
TC and non-communicable diseases form part of the national health policy
P
4
4
4
TC forms part of the national Development Plan
N/A
4

Human resource for implementation (national)
P
4
4
4
GTSS surveys (GATS/GYTS)
P
4
4
4
Intergovernmental coordination mechanism
P
3
3
3
Capacity-building plan for TC-specific personnel
P
3
3
3
‘Developmental assistance’ funding includes TC
N/A
3

Code of conduct for government officials/staff
P
3
3
3
Ministry of health 5.3 policy
P
3
3
3
5.3 Policy across all Ministries
A
3

Economic/social TC costs data
P
3
3
3
National ‘focal point’ post
P
3
3
3
National advisory committee
A
2

2
Capacity-building plans on research and evaluation
P
2
2
2
Mass media campaigns funded
A
1

1
Capacity-building plan for non-TC specific personnel
P
1
1
1
Total Score (adjusted for measures not applicable to developing countries)
123
 92 (75%)
 104 (85%)



Tobacco Taxation: The index calls for tobacco taxes to represent 75% of the retail price, and for the taxes to increase greater than inflation and GDP growth. This is the case in some, but not all provinces. Quebec and Ontario stand out as jurisdictions which have allowed taxes to fall below the threshold of price and in which increases have not kept up with inflation.

Civil society representation in national TC advisory committees. A few decades ago, NGOs were included in the Steering Committee of the National Strategy to Reduce Tobacco Use. This structure was abandoned in the early 2000s.

Health promotion fund for /including TC:  There is no long-term funding mechanism for tobacco control at the federal or provincial levels. Unlike Australia, Switzerland and other countries, Canada has not established an independent health promotion fund, and parliamentary allocations for tobacco control are not secured against departmental decisions to reallocate funds, a common circumstance in some years.

National policy against TI CSR: There are no legal or policy barriers to the tobacco industry using corporate social responsibility to buy influence.

National tobacco control strategy.  The Canadian National Strategy to Reduce Tobacco Use, developed in 1985 and renewed in the late 1990s by federal and provincial governments and non governmental organizations, was abandoned in the early 2000s in favour of distinct federal and provincial strategies. 

5.3 Policy across all Ministries. There is no whole-of-government policy to protect against tobacco industry interference, as required by Article 5.3 of the Framework Convention on Tobacco Control.

National Advisory Committee:  There is no longer a forum established for input from tobacco control experts. The Ministerial Advisory Committee was abandoned in the early 2000s. 
re-allocation.

Mass media campaigns funded: There are currently no federal or provincial mass media campaigns to support tobacco control implementation. In 2000, the anticipated budget for such programs was over $50 million per year.