Advances in tobacco control in the Region of the Americas, 2020.

This report describes the current status of the tobacco control measures contained in the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 (Pan American Health Organization) and the advances made in its application, identifying achievements from 2016 to 2020 and challenges that still need to be addressed in order to reach the expected goals. This analysis relied on data from the World Health Organization (WHO) Report on the Global Tobacco Epidemic from 2015, 2017, and 2019, and national regulations were analyzed to determine their consistency with WHO criteria. Significant progress has been made in implementation of the WHO Framework Convention on Tobacco Control in the Americas. By 2020, most countries had regulations on 100% smoke-free environments in indoor public places, workplaces, and public transport, and large graphic health warnings on tobacco packaging. The number of countries that ban tobacco advertising, promotion, and sponsorship and that tax tobacco at the minimum level recommended by WHO has doubled since 2016. However, the 2022 targets have not yet been reached for any of these measures or for ratification of the relevant international agreements. Although progress has been made in the Region, it has not been uniform. Unless the pace of application of the tobacco control measures contained in the Strategy and Plan of Action accelerates, it is unlikely that its targets will be met. Tobacco industry interference remains one of the main challenges.

Se describe el estado actual y los avances en la aplicación de las medidas de control del tabaco contenidas en la Estrategia y Plan de Acción para Fortalecer el Control del Tabaco en la Región de las Américas 2018-2022 y se identifican los logros alcanzados entre los años 2016 y 2020 y los retos que aún se deben enfrentar para cumplir las metas previstas. Para ello se utilizaron los datos del Informe de la Organización Mundial de la Salud (OMS) sobre la Epidemia Mundial de Tabaquismo de los años 2015, 2017 y 2019, así como las normativas nacionales para determinar su consistencia con los criterios de la OMS. Se constatan importantes avances en la aplicación del Convenio Marco de la OMS para el Control del Tabaco en las Américas. Al 2020, la mayoría de los países contaban con normativas sobre ambientes 100% libres de humo en lugares cerrados públicos y de trabajo, y el transporte público, y advertencias sanitarias gráficas grandes en los paquetes de tabaco. Desde el 2016 se duplicó el número de países que prohíben la publicidad, la promoción y el patrocinio del tabaco y que aplican impuestos al tabaco al nivel mínimo recomendado por la OMS. Sin embargo, aún no se ha alcanzado la meta prevista al 2022 para ninguna de esas medidas ni para la ratificación de los tratados internacionales en el tema. Aunque se ha avanzado en la Región, el avance no ha sido uniforme, y a menos que el ritmo de aplicación de las medidas de control del tabaco contenidas en la Estrategia y Plan de Acción se acelere, es poco probable que se logren las metas establecidas. La interferencia de la industria tabacalera se mantiene como uno de los principales retos.

Este artigo descreve a situação atual e o progresso na implementação das medidas para o controle do tabagismo prescritas na Estratégia e plano de ação para fortalecer o controle do tabagismo na Região das Américas 2018-2022, reconhece as conquistas realizadas no período entre 2016 e 2020, e identifica os desafios a serem enfrentados para alcançar as metas planejadas. A análise se baseou em dados obtidos do Relatório da OMS sobre a Epidemia Global do Tabaco, publicado em 2015, 2017 e 2019, e em regulamentações nacionais para determinar o cumprimento dos critérios da OMS. Observam-se avanços na implementação da Convenção-Quadro da OMS para o Controle do Tabaco nas Américas. Em 2020, a maior parte dos países dispunha de regulamentações para ambientes 100% livres da fumaça do tabaco em locais públicos fechados, locais fechados de trabalho e meios de transporte público, e advertências sanitárias com ilustrações gráficas grandes nas embalagens dos produtos de tabaco. O número de países que proíbem publicidade, promoção e patrocínio do tabaco e adotaram impostos sobre os produtos do tabaco no padrão mínimo recomendado pela OMS dobrou desde 2016. No entanto, as metas planejadas para 2022 ainda não foram atingidas ­ tanto em relação a estas medidas quanto à ratificação dos respectivos tratados internacionais. Apesar dos avanços, o progresso na Região não é uniforme. Se as medidas para o controle do tabaco prescritas na Estratégia e plano de ação não forem implementadas em um ritmo acelerado, as metas dificilmente serão alcançadas. A interferência da indústria do tabaco continua sendo um dos maiores desafios.

Advances in tobacco control in the Region of the Americas, 2020 / Avances en el control del tabaco en la Región de las Américas 2020 / Avanços no controle do tabagismo na Região das Américas 2020

ABSTRACT This report describes the current status of the tobacco control measures contained in the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 (Pan American Health Organization) and the advances made in its application, identifying achievements from 2016 to 2020 and challenges that still need to be addressed in order to reach the expected goals. This analysis relied on data from the World Health Organization (WHO) Report on the Global Tobacco Epidemic from 2015, 2017, and 2019, and national regulations were analyzed to determine their consistency with WHO criteria. Significant progress has been made in implementation of the WHO Framework Convention on Tobacco Control in the Americas. By 2020, most countries had regulations on 100% smoke-free environments in indoor public places, workplaces, and public transport, and large graphic health warnings on tobacco packaging. The number of countries that ban tobacco advertising, promotion, and sponsorship and that tax tobacco at the minimum level recommended by WHO has doubled since 2016. However, the 2022 targets have not yet been reached for any of these measures or for ratification of the relevant international agreements. Although progress has been made in the Region, it has not been uniform. Unless the pace of application of the tobacco control measures contained in the Strategy and Plan of Action accelerates, it is unlikely that its targets will be met. Tobacco industry interference remains one of the main challenges.

RESUMEN Se describe el estado actual y los avances en la aplicación de las medidas de control del tabaco contenidas en la Estrategia y Plan de Acción para Fortalecer el Control del Tabaco en la Región de las Américas 2018-2022 y se identifican los logros alcanzados entre los años 2016 y 2020 y los retos que aún se deben enfrentar para cumplir las metas previstas. Para ello se utilizaron los datos del Informe de la Organización Mundial de la Salud (OMS) sobre la Epidemia Mundial de Tabaquismo de los años 2015, 2017 y 2019, así como las normativas nacionales para determinar su consistencia con los criterios de la OMS. Se constatan importantes avances en la aplicación del Convenio Marco de la OMS para el Control del Tabaco en las Américas. Al 2020, la mayoría de los países contaban con normativas sobre ambientes 100% libres de humo en lugares cerrados públicos y de trabajo, y el transporte público, y advertencias sanitarias gráficas grandes en los paquetes de tabaco. Desde el 2016 se duplicó el número de países que prohíben la publicidad, la promoción y el patrocinio del tabaco y que aplican impuestos al tabaco al nivel mínimo recomendado por la OMS. Sin embargo, aún no se ha alcanzado la meta prevista al 2022 para ninguna de esas medidas ni para la ratificación de los tratados internacionales en el tema. Aunque se ha avanzado en la Región, el avance no ha sido uniforme, y a menos que el ritmo de aplicación de las medidas de control del tabaco contenidas en la Estrategia y Plan de Acción se acelere, es poco probable que se logren las metas establecidas. La interferencia de la industria tabacalera se mantiene como uno de los principales retos.

RESUMO Este artigo descreve a situação atual e o progresso na implementação das medidas para o controle do tabagismo prescritas na Estratégia e plano de ação para fortalecer o controle do tabagismo na Região das Américas 2018-2022, reconhece as conquistas realizadas no período entre 2016 e 2020, e identifica os desafios a serem enfrentados para alcançar as metas planejadas. A análise se baseou em dados obtidos do Relatório da OMS sobre a Epidemia Global do Tabaco, publicado em 2015, 2017 e 2019, e em regulamentações nacionais para determinar o cumprimento dos critérios da OMS. Observam-se avanços na implementação da Convenção-Quadro da OMS para o Controle do Tabaco nas Américas. Em 2020, a maior parte dos países dispunha de regulamentações para ambientes 100% livres da fumaça do tabaco em locais públicos fechados, locais fechados de trabalho e meios de transporte público, e advertências sanitárias com ilustrações gráficas grandes nas embalagens dos produtos de tabaco. O número de países que proíbem publicidade, promoção e patrocínio do tabaco e adotaram impostos sobre os produtos do tabaco no padrão mínimo recomendado pela OMS dobrou desde 2016. No entanto, as metas planejadas para 2022 ainda não foram atingidas - tanto em relação a estas medidas quanto à ratificação dos respectivos tratados internacionais. Apesar dos avanços, o progresso na Região não é uniforme. Se as medidas para o controle do tabaco prescritas na Estratégia e plano de ação não forem implementadas em um ritmo acelerado, as metas dificilmente serão alcançadas. A interferência da indústria do tabaco continua sendo um dos maiores desafios.

[Advances in tobacco control in the Region of the Americas, 2020Avanços no controle do tabagismo na Região das Américas 2020]. / Avances en el control del tabaco en la Región de las Américas 2020.

This report describes the current status of the tobacco control measures contained in the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 (Pan American Health Organization) and the advances made in its application, identifying achievements from 2016 to 2020 and challenges that still need to be addressed in order to reach the expected goals. This analysis relied on data from the World Health Organization (WHO) Report on the Global Tobacco Epidemic from 2015, 2017, and 2019, and national regulations were analyzed to determine their consistency with WHO criteria. Significant progress has been made in implementation of the WHO Framework Convention on Tobacco Control in the Americas. By 2020, most countries had regulations on 100% smoke-free environments in indoor public places, workplaces, and public transport, and large graphic health warnings on tobacco packaging. The number of countries that ban tobacco advertising, promotion, and sponsorship and that tax tobacco at the minimum level recommended by WHO has doubled since 2016. However, the 2022 targets have not yet been reached for any of these measures or for ratification of the relevant international agreements. Although progress has been made in the Region, it has not been uniform. Unless the pace of application of the tobacco control measures contained in the Strategy and Plan of Action accelerates, it is unlikely that its targets will be met. Tobacco industry interference remains one of the main challenges.

Este artigo descreve a situação atual e o progresso na implementação das medidas para o controle do tabagismo prescritas na Estratégia e plano de ação para fortalecer o controle do tabagismo na Região das Américas 2018-2022, reconhece as conquistas realizadas no período entre 2016 e 2020, e identifica os desafios a serem enfrentados para alcançar as metas planejadas. A análise se baseou em dados obtidos do Relatório da OMS sobre a Epidemia Global do Tabaco, publicado em 2015, 2017 e 2019, e em regulamentações nacionais para determinar o cumprimento dos critérios da OMS. Observam-se avanços na implementação da Convenção-Quadro da OMS para o Controle do Tabaco nas Américas. Em 2020, a maior parte dos países dispunha de regulamentações para ambientes 100% livres da fumaça do tabaco em locais públicos fechados, locais fechados de trabalho e meios de transporte público, e advertências sanitárias com ilustrações gráficas grandes nas embalagens dos produtos de tabaco. O número de países que proíbem publicidade, promoção e patrocínio do tabaco e adotaram impostos sobre os produtos do tabaco no padrão mínimo recomendado pela OMS dobrou desde 2016. No entanto, as metas planejadas para 2022 ainda não foram atingidas ­ tanto em relação a estas medidas quanto à ratificação dos respectivos tratados internacionais. Apesar dos avanços, o progresso na Região não é uniforme. Se as medidas para o controle do tabaco prescritas na Estratégia e plano de ação não forem implementadas em um ritmo acelerado, as metas dificilmente serão alcançadas. A interferência da indústria do tabaco continua sendo um dos maiores desafios.

Avances en el control del tabaco en la Región de las Américas 2020 / Advances in tobacco control in the Region of the Americas, 2020 / Avanços no controle do tabagismo na Região das Américas 2020

RESUMEN Se describe el estado actual y los avances en la aplicación de las medidas de control del tabaco contenidas en la Estrategia y Plan de Acción para Fortalecer el Control del Tabaco en la Región de las Américas 2018-2022 y se identifican los logros alcanzados entre los años 2016 y 2020 y los retos que aún se deben enfrentar para cumplir las metas previstas. Para ello se utilizaron los datos del Informe de la Organización Mundial de la Salud (OMS) sobre la Epidemia Mundial de Tabaquismo de los años 2015, 2017 y 2019, así como las normativas nacionales para determinar su consistencia con los criterios de la OMS. Se constatan importantes avances en la aplicación del Convenio Marco de la OMS para el Control del Tabaco en las Américas. Al 2020, la mayoría de los países contaban con normativas sobre ambientes 100% libres de humo en lugares cerrados públicos y de trabajo, y el transporte público, y advertencias sanitarias gráficas grandes en los paquetes de tabaco. Desde el 2016 se duplicó el número de países que prohíben la publicidad, la promoción y el patrocinio del tabaco y que aplican impuestos al tabaco al nivel mínimo recomendado por la OMS. Sin embargo, aún no se ha alcanzado la meta prevista al 2022 para ninguna de esas medidas ni para la ratificación de los tratados internacionales en el tema. Aunque se ha avanzado en la Región, el avance no ha sido uniforme, y a menos que el ritmo de aplicación de las medidas de control del tabaco contenidas en la Estrategia y Plan de Acción se acelere, es poco probable que se logren las metas establecidas. La interferencia de la industria tabacalera se mantiene como uno de los principales retos.

ABSTRACT This report describes the current status of the tobacco control measures contained in the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 (Pan American Health Organization) and the advances made in its application, identifying achievements from 2016 to 2020 and challenges that still need to be addressed in order to reach the expected goals. This analysis relied on data from the World Health Organization (WHO) Report on the Global Tobacco Epidemic from 2015, 2017, and 2019, and national regulations were analyzed to determine their consistency with WHO criteria. Significant progress has been made in implementation of the WHO Framework Convention on Tobacco Control in the Americas. By 2020, most countries had regulations on 100% smoke-free environments in indoor public places, workplaces, and public transport, and large graphic health warnings on tobacco packaging. The number of countries that ban tobacco advertising, promotion, and sponsorship and that tax tobacco at the minimum level recommended by WHO has doubled since 2016. However, the 2022 targets have not yet been reached for any of these measures or for ratification of the relevant international agreements. Although progress has been made in the Region, it has not been uniform. Unless the pace of application of the tobacco control measures contained in the Strategy and Plan of Action accelerates, it is unlikely that its targets will be met. Tobacco industry interference remains one of the main challenges.

RESUMO Este artigo descreve a situação atual e o progresso na implementação das medidas para o controle do tabagismo prescritas na Estratégia e plano de ação para fortalecer o controle do tabagismo na Região das Américas 2018-2022, reconhece as conquistas realizadas no período entre 2016 e 2020, e identifica os desafios a serem enfrentados para alcançar as metas planejadas. A análise se baseou em dados obtidos do Relatório da OMS sobre a Epidemia Global do Tabaco, publicado em 2015, 2017 e 2019, e em regulamentações nacionais para determinar o cumprimento dos critérios da OMS. Observam-se avanços na implementação da Convenção-Quadro da OMS para o Controle do Tabaco nas Américas. Em 2020, a maior parte dos países dispunha de regulamentações para ambientes 100% livres da fumaça do tabaco em locais públicos fechados, locais fechados de trabalho e meios de transporte público, e advertências sanitárias com ilustrações gráficas grandes nas embalagens dos produtos de tabaco. O número de países que proíbem publicidade, promoção e patrocínio do tabaco e adotaram impostos sobre os produtos do tabaco no padrão mínimo recomendado pela OMS dobrou desde 2016. No entanto, as metas planejadas para 2022 ainda não foram atingidas - tanto em relação a estas medidas quanto à ratificação dos respectivos tratados internacionais. Apesar dos avanços, o progresso na Região não é uniforme. Se as medidas para o controle do tabaco prescritas na Estratégia e plano de ação não forem implementadas em um ritmo acelerado, as metas dificilmente serão alcançadas. A interferência da indústria do tabaco continua sendo um dos maiores desafios.

Prioritizing action on health inequities in cities: An evaluation of Urban Health Equity Assessment and Response Tool (Urban HEART) in 15 cities from Asia and Africa.

Following the recommendations of the Commission on Social Determinants of Health (2008), the World Health Organization (WHO) developed the Urban Health Equity Assessment and Response Tool (HEART) to support local stakeholders in identifying and planning action on health inequities. The objective of this report is to analyze the experiences of cities in implementing Urban HEART in order to inform how the future development of the tool could support local stakeholders better in addressing health inequities. The study method is documentary analysis from independent evaluations and city implementation reports submitted to WHO. Independent evaluations were conducted in 2011-12 on Urban HEART piloting in 15 cities from seven countries in Asia and Africa: Indonesia, Iran, Kenya, Mongolia, Philippines, Sri Lanka, and Vietnam. Local or national health departments led Urban HEART piloting in 12 of the 15 cities. Other stakeholders commonly engaged included the city council, budget and planning departments, education sector, urban planning department, and the Mayor's office. Ten of the 12 core indicators recommended in Urban HEART were collected by at least 10 of the 15 cities. Improving access to safe water and sanitation was a priority equity-oriented intervention in 12 of the 15 cities, while unemployment was addressed in seven cities. Cities who piloted Urban HEART displayed confidence in its potential by sustaining or scaling up its use within their countries. Engagement of a wider group of stakeholders was more likely to lead to actions for improving health equity. Indicators that were collected were more likely to be acted upon. Quality of data for neighbourhoods within cities was one of the major issues. As local governments and stakeholders around the world gain greater control of decisions regarding their health, Urban HEART could prove to be a valuable tool in helping them pursue the goal of health equity.

Industry Speed Bumps on Local Tobacco Control in Japan? The Case of Hyogo.

BACKGROUND: Despite being a signatory since 2004, Japan has not yet fully implemented Article 8 of the World Health Organization's Framework Convention on Tobacco Control regarding 100% protection against exposure to second-hand smoke (SHS). The Japanese government still recognizes designated smoking rooms (DSRs) in public space as a valid control measure. Furthermore, subnational initiatives for tobacco control in Japan are of limited effectiveness. Through an analysis of the Hyogo initiative in 2012, we identified key barriers to the achievement of a smoke-free environment. METHODS: Using a descriptive case-study approach, we analyzed the smoke-free policy development process. The information was obtained from meeting minutes and other gray literature, such as public records, well as key informant interviews. RESULTS: Hyogo Prefecture established a committee to propose measures against SHS, and most committee members agreed with establishing completely smoke-free environments. However, the hospitality sector representatives opposed regulation, and tobacco companies were allowed to make a presentation to the committee. Further, political power shifted against completely smoke-free environments in the context of upcoming local elections, which was an obvious barrier to effective regulation. Throughout the approving process, advocacy by civil society for stronger regulation was weak. Eventually, the ordinance approved by the Prefectural Assembly was even weaker than the committee proposal and included wide exemptions. CONCLUSIONS: The analysis of Hyogo's SHS control initiative shed light on three factors that present challenges to implementing tobacco control regulations in Japan, from which other countries can also draw lessons: incomplete national legislation, the weakness of advocacy by the civil society, and the interference of the tobacco industry.

Liverpool Active City 2005-2010: Increasing Population Physical Activity Levels Through Intersectoral Action.

BACKGROUND: The process of working together across sectors to improve health and to influence its determinants is often referred to as intersectoral action for health. The Liverpool Active City strategy and action plan were launched in 2005, bringing together partners from diverse sectors such as education, transport, and civil society to boost levels of physical activity among the city's residents. METHODS: The research material was based on semistructured interviews with key stakeholders and on review and analysis of gray literature and media reports. A case-study method was used to analyze the experience. RESULTS: The results show that Liverpool Active City succeeded in boosting levels of physical activity among the city's residents and demonstrate how intersectoral action benefited the goals of the program and promoted common aims. CONCLUSIONS: Important lessons can be drawn from the experience of Liverpool Active City for public health professionals and policy makers. Success factors include the involvement of a broad range of agencies from a variety of sectors, which reinforced the sense of partnership in the physical activity agenda and supported the implementation of activities. The experience also demonstrated how intersectoral action brought benefits to the physical activity goals of Liverpool Active City.

Intersectoral action: local governments promoting health.

Many local governments around the world promote health through intersectoral action, but to date there has been little systematic evidence of these experiences. To bridge this gap, the World Health Organization Centre for Health Development conducted a study in 2011-2013 on intersectoral action for health (ISA) at local government level. A total of 25 cases were included in the final review. Various approaches were used to carry out ISA by local governments in low-, middle- and high-income countries. Several common facilitating factors and challenges were identified: national and international influences, the local political context, public participation and use of support mechanisms such as coordination structures, funding mechanisms and mandates, engaging sectors through vertical and horizontal collaboration, information sharing, monitoring and evaluation, and equity considerations. The literature on certain aspects of ISA, such as monitoring and evaluation and health equity, was found to be relatively thin. Also, the articles used for the study varied as regards their depth of information and often focused on the point of view of one sector. More in-depth studies of these issues covering multiple angles and different ISA mechanisms could be useful. Local governments can offer a unique arena for implementing intersectoral activities, especially because of their proximity to the people, but more practical guidance to better facilitate local government ISA processes is still needed.

Designated smoking areas in streets where outdoor smoking is banned.

Although Japan has been a signatory to the Framework Convention on Tobacco Control since 2004, progress in translating the recommendations into national policy has been limited. Globally, outdoor smoking bans cover outdoor dining areas, beaches, public parks, schools, etc. In Japan, most of existing outdoor smoking bans allow designated smoking areas (DSAs) in the no-smoking zones, thus limiting protection from second-hand smoke (SHS). We examined the impact of DSAs on air quality in the areas of Kobe City where such ordinance is in force. Air quality measurements were conducted near two DSAs in August 2012 by using personal aerosol monitors. Three measurements were performed, each for 15 minutes, by four investigators: a line-up measurement, a vertical and horizontal measurement, and a circle measurement. In the line-up measurement, over 150 µg/m³ of PM2.5 was detected by the monitor four metres from the ashtray, gradually reducing as the distance increased. In the vertical and horizontal measurement, 80-110 µg/m³ of PM2.5 was detected at 4, 11, 18 and 25 metres. In the circle measurement, similar concentrations of PM2.5 were detected at all testing points (mean concentration 94 µg/m³). The study indicates that DSAs are sources of SHS in zones where a street smoking ban is in force, since SHS spreads widely, both vertically and horizontally. Street smoking bans that permit DSAs strongly limit protection from SHS and should be eliminated if protection against SHS is to be effective where such bans are in force.

Mind your "smoking manners": the tobacco industry tactics to normalize smoking in Japan.

The tobacco industry has adapted its promotional strategies as tobacco-control measures have increased. This paper describes the tobacco industry's strategies on smoking manners and illustrates how these interfere with tobacco-control policy in Japan where tobacco control remains weak. Information on the tobacco industry's promotional strategies in Japan was collected through direct observation, a review of tobacco industry documents and a literature review. The limitation of the study would be a lack of industry documents from Japan as we relied on a database of a U.S. institution to collect internal documents from the tobacco industry. Japan Tobacco began using the manners strategies in the early 1960s. Collaborating with wide range of actors -including local governments and companies- the tobacco industry has promoted smoking manners to wider audiences through its advertising and corporate social responsibility activities. The tobacco industry in Japan has taken advantage of the cultural value placed on manners in Japan to increase the social acceptability of smoking, eventually aiming to diminish public support for smoke-free policies that threatens the industry's business. A stronger enforcement of the WHO Framework Convention on Tobacco Control is critical to counteracting such strategies.

The politics of avoidable blindness in Latin America--surgery, solidarity, and solutions: the case of Misión Milagro.

Avoidable blindness, especially when caused by cataracts, is a disease primarily of the economically disadvantaged sectors of the population. With a focus on Latin America and the Caribbean, this paper focuses on the program Misión Milagro within its historical, political, and economic contexts. This initiative, led by the governments of Cuba and Venezuela, covers close to 35 countries across Latin America, the Caribbean, Asia, and Africa. It is well-known throughout Latin America as close to 2 million patients have undergone free screening, corrective surgery, and rehabilitation since its inception in 2004. Misión Milagro shows that implementation of a massive initiative to curb avoidable blindness caused by cataracts in a relatively short time is feasible. The program is also built upon a unique model of international cooperation, which stresses social objectives and solidarity rather than hegemonic international initiatives built on commercial relationships. It also provides elements that could be applied to other public health issues of global or national relevance, not only to other low-middle-income countries, but also to high-income countries such as Canada.

Walking to school in Japan and childhood obesity prevention: new lessons from an old policy.

OBJECTIVES: We analyzed the Japan's walking-to-school practice implemented in 1953 for lessons useful to other cities and countries. METHODS: We reviewed background documents (gray literature, online government information, local policy documents, and regulations) for existing regulations in several urban settings. We also contacted boards of education. RESULTS: Each municipality has a board of education in charge of public schools, which considers the geography, climate, and the transport situation to determine the method of commuting. Because there is high availability of schools in urban areas and most are located within walking range of the children's homes, walking is the most common method. There are different safety initiatives depending on the district's characteristics. Parents, school staff, and local volunteers are involved in supervision. CONCLUSIONS: The walk-to-school practice has helped combat childhood obesity by providing regular physical activity. Recommendations to cities promoting walking to school are (1) base interventions on the existing network of schools and adapt the provision to other local organizations, (2) establish safety measures, and (3) respond specifically to local characteristics. Besides the well-established safety interventions, the policy's success may also be associated with Japan's low crime rate.

Local governments and civil society lead breakthrough for tobacco control: lessons from Chandigarh and Chennai.

Smoke-free legislation is gaining popularity; however, it must accompany effective implementation to protect people from secondhand smoke (SHS) which causes 600,000 deaths annually. Increasing numbers of smoke-free cities in the world indicate that municipalities have an important role in promoting smoke-free environments. The objectives were to describe the local initiative to promote smoke-free environments and identify the key factors that contributed to the process. Observations were based on a case study on the municipal smoke-free initiatives in Chandigarh and Chennai, India. India adopted the Cigarette and Other Tobacco Products Act in 2003, the first national tobacco control law including smoke-free provisions. In an effort to enforce the Act at the local level, a civil society organization in Chandigarh initiated activities urging the city to support the implementation of the provisions of the Act which led to the initiation of city-wide law enforcement. After the smoke-free declaration of Chandigarh in 2007, Chennai also initiated a smoke-free intervention led by civil society in 2008, following the strategies used in Chandigarh. These experiences resonate with other cases in Asian cities, such as Jakarta, Davao, and Kanagawa as well as cities in other areas of the world including Mexico City, New York City, Mecca and Medina. The cases of Chandigarh and Chennai demonstrate that civil society can make a great contribution to the enforcement of smoke-free laws in cities, and that cities can learn from their peers to protect people from SHS.

Street smoking bans in Japan: a hope for smoke-free cities?

OBJECTIVES: This study analysed 112 municipalities enforcing municipal smoking restrictions on streets in Japan to examine anti-smoking measures implemented in urban settings from a health perspective and derive lessons for future tobacco control. METHODS: Municipal governments implementing ordinances which restrict smoking on streets were identified through grey literature review. Implementation period, characteristics, scope, and department responsible were examined. RESULTS: Since the first municipal regulation was introduced in 1997, many other municipalities have followed. Enforcement of fines started in 2002, which is now a common practice nationwide. Nevertheless, the health impact of exposure to secondhand smoke is not clearly articulated in the ordinances. Street smoking bans have been developed in connection with "beautification" and littering prevention for environmental purposes, and local health departments do not have responsibility for these ordinances. CONCLUSIONS: There is potential to further prevent secondhand smoke exposure if such measures are expanded to indoor environments and integrated into broader policies. For policy-makers and advocates, the Japanese experience provides information on an additional tobacco control intervention as well as clues in the process of design, implementation and enforcement of such municipal measures. A more comprehensive and health-driven approach is required to effectively address the harm of secondhand smoke in Japan.

Kanagawa, Japan's tobacco control legislation: a breakthrough?

Kanagawa Prefecture became the first subnational government in Japan to implement an ordinance for the prevention of exposure to secondhand-smoke in public facilities. The ordinance aims to protect people from the negative health impacts of secondhand smoke; however, it has wide exemptions especially for hospitality and leisure business establishments. In addition, designated smoking areas are allowed in all public facilities, in contravention of the WHO Framework Convention on Tobacco Control. Nevertheless, its rapid enactment benefited from the political leadership of the governor as well as intensive communication between the government and a wide range of stakeholders in Kanagawa and beyond. The smoke-free efforts of Kanagawa could facilitate smoke-free action by other subnational and national governments for healthier environments.

Barrio Adentro and the reduction of health inequalities in Venezuela: an appraisal of the first years.

This article presents an update on the characteristics and performance of Venezuela's Bolivarian health care system, Barrio Adentro (Inside the Neighborhood). During its first five years of existence, Barrio Adentro has improved access and utilization of health services by reaching approximately 17 million impoverished and middle-class citizens all over Venezuela. This was achieved in approximately two years and provides an example of an immense "South-South" cooperation and participatory democracy in health care. Popular participation was achieved with the Comités de Salud (health committees) and more recently with the Consejos Comunales (community councils), while mostly Cuban physicians provided medical care. Examination of a few epidemiological indicators for the years 2004 and 2005 of Barrio Adentro reveals the positive impact of this health care program, in particular its primary care component, Barrio Adentro I. Continued political commitment and realistic evaluations are needed to sustain and improve Barrio Adentro, especially its primary care services.

Venezuela's Barrio Adentro: an alternative to neoliberalism in health care.

Throughout the 1990s, all Latin American countries but Cuba implemented health care sector reforms based on a neoliberal paradigm that redefined health care less as a social right and more as a market commodity. These reforms were couched in the broader structural adjustment of Latin American welfare states as prescribed by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program, Misión Barrio Adentro (Inside the Neighborhood). In this article, the authors review the main features of the Venezuelan health care reform, analyzing, within their broader sociopolitical and economic contexts, previous neoliberal health care reforms that mainly benefited transnational capital and domestic Latin American elites. They explain the emergence of the new health care program, Misión Barrio Adentro, examining its historical, social, and political underpinnings and the central role played by popular resistance to neoliberalism. This program not only provides a compelling model of health care reform for other low- to middle-income countries but also offers policy lessons to wealthy countries.

Challenging the neoliberal trend: the Venezuelan health care reform alternative.

Throughout the 1990s, all Latin American countries but Cuba implemented to varying degrees health care sector reforms underpinned by a neoliberal paradigm that redefined health care as less of a social right and more of a market commodity. These health care sector reforms were couched in the broader structural adjustment of Latin American welfare states prescribed consistently by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program called Misión Barrio Adentro (Inside the Neighbourhood). In this article, we introduce Misión Barrio Adentro in its historical, political, and economic contexts. We begin by analyzing Latin American neoliberal health sector reforms in their political economic context, with a focus on Venezuela. The analysis reveals that the major beneficiaries of both broader structural adjustment of Latin American welfare states and neoliberal health reforms have been transnational capital interests and domestic Latin American elites. We then provide a detailed description of Misión Barrio Adentro as a challenge to neoliberalism in health care in its political economic context, noting the role played in its development by popular resistance to neoliberalism and the unique international cooperation model upon which it is based. Finally, we suggest that the Venezuelan experience may offer valuable lessons not only to other low- to middle-income countries, but also to countries such as Canada.