Drug policy Flashcards
What is a population health (Kindig and Stoddart, 2003)?
“The health outcomes of a group of individuals,
including the distribution of such outcomes within the group.”
What is the place and role of policies and interventions on population health outcomes, their distribution, and the patterns of health determinants?
[Policies and interventions at individual and social levels]
- influence the [patterns of health determinants over life course (independent variables)]
- aim to break the link between these patterns of health determinants and the [health outcomes and distribution in population (dependent variables)]
e.g.:
standardised tobacco packaging impact on smoking (independent variable) and the consequent rates of heart disease (dependent variable)
What are determinants of health (WHO, 1998)?
“The range of personal, social, economic, and environmental factors which determine the health status of individuals or populations.”
- > conditions into which people are born in, grown and live in
- > key reason on distribution of health outcomes (why some people are healthier than others)
What are the categories of health determinants?
- Genetic/biological factors
- Social environment
- Physical environment
- Economic environment
What is the relationship between income, social class and infant mortality?
In cities with highest GDP/capita AND in higher social classes, infant mortality is lower
-> consequent distribution of health
What is the relationship between smoking and deprivation?
People who are deprived are more likely to smoke
-> determinant of health (deprivation) is related to health outcome (addiction - smoking)
What is the alcohol paradox?
People in higher social strata drink more
BUT extreme drinking associated with lower social strata
What do we do when we find evidence of a relation between a health determinant and outcome?
Health promotion
- use policies and interventions to influence the effect of determinants of health on health outcomes
What does health promotion consist of (WHO, 1998)?
- Enable people to take control
- strengthening individuals skills and capabilities - Take action to change social, environmental and economic conditions
What are the key points of the Ottawa Charter for Health Promotion (1986)?
> Developed at 1986 WHO conference
> Delegates signed it on 21st November 1986
> Jakarta Declaration (1997) confirmed these strategies are relevant for all countries
What does the Ottawa Charter for Health Promotion (1986) consist of?
Building Healthy Public Policy
- Enable
- Mediate
- Advocate
- Reorient Health Services
- Creative Supportive Environments
- Develop Personal Skills
- Strengthen Community Action
What did the two health promotion policies aimed at smokers in Malaysia (Coe et al., 2014) consist of and result in?
- Anti-smoking media campaigns - “TAK NAK”
- 90% reported exposure to campaign
-> evidence smokers exposed were more likely to attempt to quit
- Smoke-free policies
- increase in bans and in homes that do not allow smoking
- > policies didn’t cover all public places and were not comprehensive
- > exposure didn’t change in restaurants and other areas
What is the difference between national policies on tobacco and alcohol, and actions by the tobacco and alcohol industry?
- National policies are legislated
- Actions by tobacco and alcohol industries are voluntary
What is the effectiveness of actions from the tobacco and alcohol industries?
Often ineffective and delay effective policy
What are the existing international policies on tobacco and alcohol?
> On tobacco:
- WHO Framework Convention on Tobacco Control (FCTC)
- European Union Tobacco Products Directive (EUTPD)
> No similar treaties or directives for alcohol
What is the Framework Convention on Tobacco Control (FCTC)?
- One of world’s first health treaties
- International treaty to reduce the demand and supply for tobacco
- In force in February 2006
- As of September 2016: 180 countries are parties to
What are the key articles of the Framework Convention on Tobacco Control (FCTC) for the reduction of tobacco demand?
> Art. 6: Price and tax measures
-> raise tobacco price
> Art. 8: Protection from second-hand smoking
- (e.g. smoke free policies in public spaces)
> Art. 9 and 10: Tobacco product regulation
> Art. 11: Packaging and labelling of tobacco products
> Art. 12: Education, communication, training and public awareness
> Art. 13: Tobacco advertising, promotion and sponsorship
> Art. 14: Tobacco dependence and cessation
What is one of the most effective policies to reduce tobacco and alcohol demand/use?
Raising the price
- e.g. raising taxes, minimum pricing, banning promotions
- > related to reductions in tobacco consumption
- > shown to reduce harmful use of alcohol
What is WHO’s tax recommendation on tobacco?
Minimum 75%
What are the key articles of the Framework Convention on Tobacco Control (FCTC) for the reduction of tobacco supply?
> Art. 15: illicit trade in tobacco products
> Art. 16: Sales to and by minors
> Art. 17: Provisions of support for economically viable alternative activates
- e.g. helping farmers convert to another crop
What does the effectiveness of policies normally depend on?
How well and fully they’re implemented
- e.g. comprehensive bans on advertising
- consider affordability when raising prices
What is the evidence on the effectiveness of a national policy on health warning labels on tobacco packs?
Large graphic health warning shown to be effective for educating about risks AND encouraging quitting
What is the evidence on the effectiveness of a national policy on alcohol?
Poor evidence
- less developed policy area, research ongoing
- few studies suggest exposures to warnings could increase risk-perceptions
- little evidence for effects of content labelling
(e. g. calories, ingredients, drinks)
What is the effectiveness of bans on misleading information on tobacco packaging?
Ineffective due to circumvention
- tobacco industries find ways around it
- e.g. “light cigarettes” become “blue cigarettes”
What is the effectiveness of tobacco advertising restrictions?
Advertising bans are effective in reducing tobacco use
BUT must be comprehensive
What is the effectiveness of alcohol advertising restrictions?
Advertising bans may be effective in reducing harmful use
What is the evidence on a national policy for educating people about tobacco?
- Well-designed campaigns can be effective
BUT are expensive - tobacco advertising generally illegal
What is the evidence on a national policy for educating people about alcohol?
Anti-driving campaigns are most popular
- little/no evidence of effectiveness
How can tobacco products be regulated with national policies?
- Additive restrictions
(all additives banned in Brazil) - Flavour restrictions
(flavoured tobacco use high among youth)
How can alcohol products be regulated with national policies?
- Minimum alcohol content to be considered alcohol
- Alcohol content limits
- growing research on reducing alcohol strength in some products
What is the evidence on the effectiveness on minimum age laws for buying and selling tobacco?
- Some evidence of effectiveness if enforced
- Momentum for raising minimum age
- Laws against consumption not favoured because they target addicts
What is the evidence on the effectiveness on minimum age laws for buying and selling alcohol?
Some evidence of effectiveness
What is the evidence for national policies on tobacco availability?
> Some countries restrict sales in certain places
(e.g. pharmacies, vending machines)
> Restrictions on number and place of outlets
> Restrictions on smoking in certain places of use:
- smoke-free public and workplaces reduce exposure to secondhand smoke
- > key policy to reduce harms from tobacco use
- evidence of reduced consumption
What is the evidence for national policies on alcohol availability?
> State monopoly and/or Licensing
-> Government control can reduce alcohol related harm
> Some countries restrict public consumption
- less attention given
- creation of special drinking areas at events
What is the consequence of few policies in place or their inadequate implementation?
Advertising and the environment in general may influence us to make bad choices
What is the consequence of good policies that are effectively implemented?
Many environmental triggers for unhealthy lifestyle habits disappear