Brazil: reducing tobacco use is a ‘winnable battle’

Published in the Hindu on November 8, 2012

Brazil provides an excellent example of reducing the prevalence of smoking and, in turn, saving several thousand lives by adopting and strictly enforcing several strategies aimed at making tobacco consumption less attractive.

A study published in PLoS Medicine indicates that Brazil achieved a 46 per cent reduction in smoking prevalence during the period 1989 to 2010. This in turn saved an estimated 4.2 lakh lives by 2010. In 2010 alone, an estimated 58,000 lives were saved.

By 2050, about seven million lives would be saved and smoking prevalence reduced by another 35 per cent.

The reduction in smoking in males was from 43.3 per cent in 1989 to 22.9 per cent in 2008. The corresponding figures for females were 27 per cent and 13.9 per cent respectively. The maximum reduction in both males and females was seen in the 18- to 24-age group. This is significant as the policies have successfully prevented a huge population of youth from getting addicted to cigarette smoking.

A model

Little wonder that the paper states: “Brazil provides one of the outstanding public health success stories in reducing deaths due to smoking, and serves as a model for other low and middle income nations.”

As early as 1989, Brazil had implemented diverse policies to reduce tobacco consumption. These include increasing cigarette taxes, banning several tobacco marketing policies and making bold health warnings on packages mandatory.

For instance, after adjusting for inflation, cigarette prices had doubled by 1998. By 2010 it had increased 2.3 times the 1989 prices “largely because of higher taxes.” Cigarette-specific tax was introduced in 1990. Restrictions on cigarette advertising which started as early as 1988 became more broad-based by 2005. Though warnings on the packs were weak when it was started in 1996, in about five years time it had become a benchmark for many countries — graphic warnings that covered the entire back of the pack became mandatory. Several smoke-free laws and educations programmes were introduced.

But the outstanding feature is that access to cessation treatments went hand-in-hand with restriction. If getting people to give up smoking is challenging enough, the availability of cessation treatments will go a long way in helping those trying to quit.

And the results started showing as early as 2003 — a reduction of nearly 12.5 per cent in smoking prevalence between 1989 and 2003 (34.8 per cent in 1989 to 22.4 per cent in 2003). According to the paper, more recent data indicates that the prevalence had dropped further to 18.5 per cent in 2008.

Looking at the effect of individual policies implemented, the study found that almost half of the reduction came from price increases alone. Smoke-free air laws and stringent marketing restrictions contributed 14 per cent each. Health warnings on packs were responsible for eight per cent. But again the most significant factor was this — cessation treatment programmes (10 per cent).

The results once again reiterate the importance of having in place cessation treatment programmes. For instance, cessation treatment options had the greatest effect in females; taxes played a relatively major role in the case of males.

Brazil provides an excellent lesson for many countries on how to choose health warnings. It had extensively tested the effects of a strong health warning with the target group — younger smokers. It could possible be the reason why a maximum reduction in smoking prevalence was seen in the 18-24 age group.

“Brazil’s accomplishments demonstrate that, even for a middle income nation, reducing tobacco use is a “winnable battle,” the paper states.

The Editorial accompanying the paper cautions that since the model had used the data taken from other countries, its predictions “may not accurately reflect the situation in Brazil.”

It must however be noted that though the accuracy cannot be taken at face value, a huge reduction in smoking prevalence and number of deaths prevented cannot be ignored.