Meeting to Develop a Standardized Tax Share Indicator for Alcoholic and Sugar-Sweetened Beverages (Washington, D.C., 24-25 July 2018)

[Executive summary]. Noncommunicable diseases (NCDs) are a major driver of morbidity and mortality in the Region of the Americas. They represent a major public health challenge that undermines social and economic development. The WHO Global Action Plan for Prevention and Control of Noncommunicable Diseases 2013-2020, endorsed by the 66th World Health Assembly, provides a road map and a menu of policy options. It recognizes implementing taxes on unhealthy products associated with NCDs—namely tobacco, alcoholic beverages, and sugar-sweetened beverages (SSBs)—as one of the most cost-effective regulatory policies to prevent NCDs. Although, the World Health Organization (WHO) does calculate and publish biennially a standardized and comparable indicator on tobacco taxation for all Member States, it does not count with comparable measurements of taxation on alcoholic beverages and SSBs. Such measurements are necessary to monitor tax policies, analyze trends and establish best practices in using taxation for NCD prevention. Since 2016, the Department of Noncommunicable Diseases and Mental Health (NMH) of the Pan American Health Organization/World Health Organization (PAHO/WHO) has worked towards addressing the gap measuring progress on alcoholic beverages and SSBs taxation in the Americas. NMH collected country-level information on prices as well as tax legislation and developed a methodology for calculating a tax share indicator. This indicator, estimating the share of total and excise taxes in the price of alcoholic beverages and SSBs, was calculated for ten countries. In order to receive feedbacks on its proposed methodology, discuss the progress and challenges in monitoring and evaluating taxation policies, and establish a roadmap to periodically collect tax legislation and prices and calculate the tax share for alcoholic beverages and SSBs in the Americas, NMH convened researchers and ministries of finance personnel for a two-day meeting in July 2018, in Washington D.C. The participants provided inputs on how to strengthen the proposed tax share indicator to adequately capture the intricacies, unique characteristics, and regional consumption patterns of these products. These valuable inputs will help to improve the methodology and facilitate future efforts to develop a standardized and comparable tax share indicator for alcoholic beverages and SSBs.

Tobacco control law implementation in a middle-income country: Transnational tobacco control network overcoming tobacco industry opposition in Colombia.

The objective of this paper is to examine the implementation of Colombia's tobacco control law. Methods involved are triangulated government legislation, news sources, and interviews with policy-makers and health advocates in Colombia. Colombia, a middle-income country, passed a tobacco control law in 2009 that included a prohibition on tobacco advertising, promotion, and sponsorship; and required pictorial health warning labels, ingredients disclosure, and a prohibition on individual cigarette sales. Tobacco companies challenged the implementation through litigation, tested government enforcement of advertising provisions and regulations on ingredients disclosure, and lobbied local governments to deprioritise policy responses to single cigarette sales. A transnational network including international health groups and funders helped strengthen domestic capacity to implement the law by; promoting public awareness of Ley [Law] 1335; training local health department staff on enforcement; facilitating health agencies' sharing of educational strategies; and providing legal defence assistance. This network included vigilant efforts by local health groups, which continuously monitored and alerted the media to noncompliance, engaged government officials and policy-makers on implementation, and raised public awareness. Support from international health NGOs and funders and continuous engagement by local health groups enhanced implementation capacities to counter continued tobacco industry interference and ensure effective tobacco control implementation.

Defending strong tobacco packaging and labelling regulations in Uruguay: transnational tobacco control network versus Philip Morris International.

OBJECTIVE: Describe the process of enacting and defending strong tobacco packaging and labelling regulations in Uruguay amid Philip Morris International's (PMI) legal threats and challenges. METHODS: Triangulated government legislation, news sources and interviews with policy-makers and health advocates in Uruguay. RESULTS: In 2008 and 2009, the Uruguayan government enacted at the time the world's largest pictorial health warning labels (80% of front and back of package) and prohibited different packaging or presentations for cigarettes sold under a given brand. PMI threatened to sue Uruguay in international courts if these policies were implemented. The Vazquez administration maintained the regulations, but a week prior to President Vazquez's successor, President Mujica, took office on 1 March 2010 PMI announced its intention to file an investment arbitration dispute against Uruguay in the International Centre for the Settlement of Investment Disputes. Initially, the Mujica administration announced it would weaken the regulations to avoid litigation. In response, local public health groups in Uruguay enlisted former President Vazquez and international health groups and served as brokers to develop a collaboration with the Mujica administration to defend the regulations. This united front between the Uruguayan government and the transnational tobacco control network paid off when Uruguay defeated PMI's investment dispute in July 2016. CONCLUSION: To replicate Uruguay's success, other countries need to recognise that strong political support, an actively engaged local civil society and financial and technical support are important factors in overcoming tobacco industry's legal threats to defend strong public health regulations.

The importance of legislative measures on tobacco control in Brazil.

INTRODUCTION: In the tobacco control program, educational, socioeconomic, ecological and legislative actions should be planned. Legislative actions should include the federal, state and municipal spheres, have a primarily preventive purpose and federal reach. OBJECTIVE: Survey of bills presented in both legislative houses at federal level, House of Representatives and Senate (which together form the National Congress) and the resulting laws. METHOD: In the period from 1965 to 2015, 254 bills were filed with the House of Representatives and, from 1971 to 2015, 68 others were presented to the Senate. RESULTS: In the House of Representatives, of the 254 bills, 68.9% were archived/rejected/returned, 14.9% did not have a result, 12.2% are currently being processed/analyzed by commissions, 2.0% refer to the inclusion of amendments/law annexes, 1.2% were transformed into legal norm/proposition of origin and 0.8% were transformed into laws. In the Senate, of the 68 bills, 19.1% were filed, 33.8% did not have a result, 4.4% were currently being processed, and 42.7% referred to changes in the law. Anti--tobacco actions were more prevalent in the periods 1979-1984 by the AMB, 1985-2007 by MS/INCA, and in 2008-2015 by the ACT. CONCLUSION: Tobacco control legislation has progressed constantly, with the provocation of legislators from both Houses triggered by the MS/INCA and civil entities committed to smoking control, such as a number of non-governmental organizations (especially the AMB and the ACT).

The importance of legislative measures on tobacco control in Brazil / Importância das medidas legislativas no controle do tabagismo no Brasil

Summary Introduction: In the tobacco control program, educational, socioeconomic, ecological and legislative actions should be planned. Legislative actions should include the federal, state and municipal spheres, have a primarily preventive purpose and federal reach. Objective: Survey of bills presented in both legislative houses at federal level, House of Representatives and Senate (which together form the National Congress) and the resulting laws. Method: In the period from 1965 to 2015, 254 bills were filed with the House of Representatives and, from 1971 to 2015, 68 others were presented to the Senate. Results: In the House of Representatives, of the 254 bills, 68.9% were archived/rejected/returned, 14.9% did not have a result, 12.2% are currently being processed/analyzed by commissions, 2.0% refer to the inclusion of amendments/law annexes, 1.2% were transformed into legal norm/proposition of origin and 0.8% were transformed into laws. In the Senate, of the 68 bills, 19.1% were filed, 33.8% did not have a result, 4.4% were currently being processed, and 42.7% referred to changes in the law. Anti--tobacco actions were more prevalent in the periods 1979-1984 by the AMB, 1985-2007 by MS/INCA, and in 2008-2015 by the ACT. Conclusion: Tobacco control legislation has progressed constantly, with the provocation of legislators from both Houses triggered by the MS/INCA and civil entities committed to smoking control, such as a number of non-governmental organizations (especially the AMB and the ACT).

Resumo Introdução: No programa de controle do tabagismo, devem ser planejadas ações educativas, socioeconômicas, ecológicas e legislativas. As ações legislativas devem ser nos âmbitos federal, estadual e municipal, com visão prioritária preventiva, sendo as federais os atos mais importantes e prioritários. Objetivo: Levantamento dos projetos de lei apresentados em ambas as casas legislativas em âmbito federal, Câmara dos Deputados e Senado e das leis resultantes. Métodos: Na Câmara dos Deputados, foram apresentados 254 projetos de lei, no período de 1965 a 2015, enquanto no Senado, 68, entre 1971 e 2015. Resultados: Na Câmara dos Deputados, dos 254 projetos de lei, 68,9% foram arquivados/rejeitados/devolvidos, 14,9% não possuem resultado, 12,2% estão em tramitação/comissões, 2,0% se referem a alterações/anexos de lei, 1,2% foram transformados em norma jurídica/proposição de origem e 0,8% foram transformados em leis. No Senado, dos 68 projetos de lei, 19,1% foram arquivados, 33,8% não possuem resultado, 4,4% estão em tramitação e 42,7% se referem a alterações de lei. A atuação se mostrou mais ativa nos períodos de 1979-1984 pela Associação Médica Brasileira (AMB), 1985-2007 pelo Ministério da Saúde/Instituto Nacional de Câncer (MS/INCA) e 2008-2015 pela Aliança de Controle do Tabagismo (ACT). Conclusão: A legislação de controle do tabagismo tem permanentemente avançado, contribuindo aos parlamentares de ambas as Casas Legislativas, por parte do MS/Inca e da sociedade civil comprometida com o controle do tabagismo, como as organizações não governamentais (AMB e ACT).

The World Health Organization Framework Convention on Tobacco Control in the Brazilian political agenda, 2003-2005. / A Convenção-Quadro para o Controle do Tabaco da Organização mundial da Saúde na agenda política brasileira, 2003-2005.

This study analyses the development of a tobacco-control agenda in Brazil following the country's participation in the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC). This process started with the diplomatic negotiations for the participation of Brazil in the treaty, in 2003, and its ratification by the National Congress, in 2005, and was marked by substantial controversies between public health players, who are accountable for tobacco-control actions, and the high echelon of Brazilian diplomacy, emissaries of the tobacco industry, representatives of small tobacco farmers from the Southern region of the country, congress representatives, senators and ministers. The study is based on the contributions of John W. Kingdon on the development of an agenda for the formulation of public policies. It took into account secondary references, legislative and institutional sources from the 1995 to 2005 period. It concluded that the association of tobacco-related healthcare actions by technically skilled officials, the involvement of the high echelon of the Ministry of Foreign Affairs (policy flow), the initiative for the establishment of the WHO-FCTC (problem flow), and the existence of a favorable environment in both, executive and legislative (political flow), opened a window of opportunity for WHO-FCTC ratification and its inclusion in the government decision agenda.

The decision-making process in Brazil's ratification of the World Health Organization Framework Convention on Tobacco Control. / O processo decisório de ratificação da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde no Brasil.

Tobacco consumption is a leading cause of various types of cancer and other tobacco-related diseases. In 2003, the World Health Assembly adopted the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), which aims to protect citizens from the health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke. The Convention was to be ratified by the Member States of the WHO; in Brazil's case, ratification involved the National Congress, which held public hearings in the country's leading tobacco growing communities (municipalities). The current study analyzes this decision-making process according to the different interests, positions, and stakeholders. In methodological terms, this is a qualitative study based on document research, drawing primarily on the shorthand notes from the public hearings. We analyze the interests and arguments for and against ratification. The article shows that although preceded by intense debates, the final decision in favor of ratification was made by a limited group of government stakeholders, characterizing a decision-making process similar to a funnel.

Brazil: balance of the National Tobacco Control Policy in the last decade and dilemmas. / Brasil: balanço da Política Nacional de Controle do Tabaco na última década e dilemas.

Since 2005, Brazil has been a Party of the World Health Organization Framework Convention on Tobacco Control, an international treaty whose measures are the foundation of the National Tobacco-Control Policy (NTCP), of Brazil. The results evidence a significant decrease in the prevalence of smokers and in tobacco-related morbidity and mortality. These results, however, could have been even better if there wasn't the interference of the tobacco supply chain (TSC), controlled by transnational corporations, which has become more intense over the last 10 years. These companies made Brazil not only a repository for tobacco, but also for economic and political power capable of threatening NTCP achievements. This Essay recounts the development of NTCP and the tobacco supply chain modus operandi to hamper it, and discusses how the strengthening of policies to promote alternative crops for tobacco could shield NTCP from such interference.

O processo decisório de ratificação da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde no Brasil / El proceso decisorio de ratificación del Convenio Marco para el Control del Tabaco de la Organización Mundial de la Salud en Brasil / The decision-making process in Brazil's ratification of the World Health Organization Framework Convention on Tobacco Control

Resumo: O consumo de tabaco é um dos principais responsáveis por diferentes tipos de câncer e outras enfermidades relacionadas a esse uso. Em 2003, a Assembleia Mundial de Saúde adotou a Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde (CQCT-OMS), a qual visa a proteger os cidadãos das consequências sanitárias, sociais, ambientais e econômicas geradas pelo consumo e pela exposição à fumaça do tabaco. A Convenção deveria ser ratificada pelos países membros da OMS e, no caso brasileiro, sua ratificação envolveu o Congresso Nacional, que realizou audiências públicas nas principais cidades produtoras da erva. Neste trabalho, analisa-se esse processo decisório à luz dos diferentes interesses, posições e atores sociais envolvidos. Em termos metodológicos, trata-se de um estudo qualitativo fundamentado em pesquisa documental baseada, sobretudo, nas notas taquigráficas das audiências públicas. São analisados os interesses e os argumentos apresentados favoráveis e contrários à ratificação. O artigo demonstra que, apesar de precedida por intensos debates, a decisão final favorável à ratificação foi tomada por um grupo restrito de agentes públicos, caracterizando um processo decisório que se assemelha a um funil.

Resumen: El consumo de tabaco es uno de los principales responsables de los diferentes tipos de cáncer y otras enfermedades relacionadas con su consumo. En 2003, la Asamblea Mundial de la Salud adoptó el Convenio Marco para el Control del Tabaco de la Organización Mundial de la Salud (CQCT-OMS), que tiene como objetivo proteger a los ciudadanos de las consecuencias sanitarias, sociales, ambientales y económicas generadas por el consumo y por la exposición al humo del tabaco. El convenio debería ser ratificado por los países miembros de la OMS y, en el caso brasileño, su ratificación involucró al Congreso Nacional, que realizó audiencias públicas en las principales ciudades productoras de esta planta. En este trabajo, se analiza ese proceso decisorio a la luz de los diferentes intereses, posiciones y actores sociales involucrados. En términos metodológicos, se trata de un estudio cualitativo, fundamentado en una investigación documental basada, sobre todo, en las notas taquigráficas de las audiencias públicas. Se analizan los intereses y los argumentos presentados favorables y contrarios a la ratificación. El artículo demuestra que, a pesar de estar precedida por intensos debates, la decisión final favorable a la ratificación se tomó por parte de un grupo restringido de agentes públicos, caracterizando un proceso decisorio semejante por su dinámica al de un embudo.

Abstract: Tobacco consumption is a leading cause of various types of cancer and other tobacco-related diseases. In 2003, the World Health Assembly adopted the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), which aims to protect citizens from the health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke. The Convention was to be ratified by the Member States of the WHO; in Brazil's case, ratification involved the National Congress, which held public hearings in the country's leading tobacco growing communities (municipalities). The current study analyzes this decision-making process according to the different interests, positions, and stakeholders. In methodological terms, this is a qualitative study based on document research, drawing primarily on the shorthand notes from the public hearings. We analyze the interests and arguments for and against ratification. The article shows that although preceded by intense debates, the final decision in favor of ratification was made by a limited group of government stakeholders, characterizing a decision-making process similar to a funnel.

A Convenção-Quadro para o Controle do Tabaco da Organização mundial da Saúde na agenda política brasileira, 2003-2005 / El Convenio Marco para el Control del Tabaco en la Organización Mundial de la Salud em la agenda política brasileña, 2003-2005 / The World Health Organization Framework Convention on Tobacco Control in the Brazilian political agenda, 2003-2005

Resumo: Este estudo analisa a criação de uma agenda política de controle do tabaco no Brasil a partir da participação do país na Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde (CQCT-OMS). Tal processo se estendeu entre as negociações diplomáticas para a participação do Brasil nesse Tratado, em 2003, e a sua ratificação pelo Congresso Nacional, em 2005, e foi marcado por longas controvérsias que colocaram frente a frente atores da saúde pública, que são os responsáveis pelas atividades de controle do tabaco, o alto escalão da diplomacia brasileira, os emissários da indústria tabaqueira, os representantes dos pequenos plantadores de fumo da Região Sul do país, deputados, senadores e ministros. O estudo toma como base as contribuições de John W. Kingdon sobre o processo de configuração de agenda no âmbito da formulação de políticas públicas. Sua construção baseou-se em bibliografia secundária, fontes legislativas e institucionais no período de 1995 a 2005. Conclui-se que a convergência da capacidade técnica da burocracia da saúde e suas ações para o controle do tabaco, o envolvimento do alto escalão do Ministério das Relações Exteriores (fluxo de políticas), a iniciativa de criação do CQCT_oms (fluxo de problemas) e a existência de um ambiente favorável, tanto no Executivo quanto no Legislativo (fluxo político), possibilitaram a abertura de uma janela de oportunidade para a ratificação da CQCT-OMS e sua ascensão à agenda de decisão governamental.

Resumen: Este estudio analiza la creación de una agenda política de control al tabaco en Brasil, a partir de la participación del país en el Convenio Marco para el Control del Tabaco de la Organizaciòn Mundial de la Salud (CQCT-OMS por sus siglas en portugués). Tal proceso se extendió entre las negociaciones diplomáticas para la participación de Brasil en ese tratado, en 2003, y su ratificación por el Congreso Nacional, en 2005, que estuvo marcado por largas controversias que pusieron frente a frente a actores de la salud pública, quienes son responsables de las actividades de control al tabaco; el alto escalón de la diplomacia brasileña, los emisarios de la industria tabaquera, los representantes de los pequeños agricultores del tabaco de la región sur del país, diputados, senadores y ministros. El estudio toma como base las contribuciones de John W. Kingdon sobre el proceso de configuración de agenda en el ámbito de la formulación de políticas públicas. Su construcción se basó en bibliografía secundaria, fuentes legislativas e institucionales durante el período de 1995 a 2005. Se concluyó que la convergencia de la capacidad técnica de la burocracia de la salud y sus acciones para el control el tabaco, la participación del alto escalafón del Ministerio de Asuntos Exteriores (flujo de políticas), la iniciativa de creación del CQCT-OMS (flujo de problemas) y la existencia de un ambiente favorable, tanto en el Ejecutivo como en el Legislativo (flujo político), posibilitaron la apertura de una ventana de oportunidad para la ratificación del CQCT-OMS y su ascensión a la agenda de decisión gubernamental.

Abstract: This study analyses the development of a tobacco-control agenda in Brazil following the country's participation in the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC). This process started with the diplomatic negotiations for the participation of Brazil in the treaty, in 2003, and its ratification by the National Congress, in 2005, and was marked by substantial controversies between public health players, who are accountable for tobacco-control actions, and the high echelon of Brazilian diplomacy, emissaries of the tobacco industry, representatives of small tobacco farmers from the Southern region of the country, congress representatives, senators and ministers. The study is based on the contributions of John W. Kingdon on the development of an agenda for the formulation of public policies. It took into account secondary references, legislative and institutional sources from the 1995 to 2005 period. It concluded that the association of tobacco-related healthcare actions by technically skilled officials, the involvement of the high echelon of the Ministry of Foreign Affairs (policy flow), the initiative for the establishment of the WHO-FCTC (problem flow), and the existence of a favorable environment in both, executive and legislative (political flow), opened a window of opportunity for WHO-FCTC ratification and its inclusion in the government decision agenda.

Rhetoric and the law, or the law of rhetoric: How countries oppose novel tobacco control measures at the World Trade Organization.

The tobacco industry has developed an extensive array of strategies and arguments to prevent or weaken government regulation. These strategies and arguments are well documented at the domestic level. However, there remains a need to examine how these arguments are reflected in the challenges waged by governments within the World Trade Organization (WTO). Decisions made at the WTO have the potential to shape how countries govern. Our analysis was conducted on two novel tobacco control measures: tobacco additives bans (Canada, United States and Brazil) and plain, standardized packaging of tobacco products (Australia, New Zealand, Ireland, EU and UK). We analyzed WTO documents (i.e. meeting minutes and submissions) (n = 62) in order to identify patterns of argumentation and compare these patterns with well-documented industry arguments. The pattern of these arguments reveal that despite the unique institutional structure of the WTO, country representatives opposing novel tobacco control measures use the same non-technical arguments as those that the tobacco industry continues to use to oppose these measures at the domestic level.

Avanços do Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas não Transmissíveis no Brasil, 2011-2015 / Avances del Plan de acciones estratégicas para el combate de Enfermedades Crónicas no Transmisibles en Brasil, 2011-2015 / Progress with the Strategic Action Plan for Tackling Chronic Non-Communicable Diseases in Brazil, 2011-2015

OBJETIVO: descrever as ações realizadas no âmbito do Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas não Transmissíveis (DCNT) no Brasil, de 2011 a 2015. MÉTODOS: as ações foram levantadas por meio de reuniões setoriais, interministeriais, fóruns anuais, além de revisão documental de publicações e legislações em sítios eletrônicos governamentais. RESULTADOS: foram realizadas pesquisas nacionais e monitoramento das metas de redução de mortalidade e fatores de risco, ações de estímulo à atividade física, alimentação adequada e promoção da saúde mediante a criação do Programa Academia da Saúde, publicação de legislação sobre ambientes livres do tabaco, distribuição gratuita de medicamentos para hipertensão, diabetes e asma, organização da rede de atendimento de urgências para doenças cardiovasculares e ampliação do acesso ao diagnóstico e tratamento do paciente oncológico. CONCLUSÃO: observaram-se avanços referentes à vigilância, promoção da saúde e cuidado integral; de modo geral, as metas do Plano vêm sendo alcançadas.

OBJETIVO: describir los avances del plan de acciones estratégicas para el combate de Enfermedades No Transmisibles (ENT) en Brasil (2011 y 2015). MÉTODOS: las acciones fueron levantas a través de reuniones sectoriales, interministeriales, foros anuales, además de una revisión de publicaciones y legislaciones en sitios electrónicos gubernamentales. RESULTADOS: fueron realizadas investigaciones nacionales y monitoreo de las metas de reducción de mortalidad por factores de riesgo, acciones de estimulación para actividad física, alimentación adecuada y promoción de la salud mediante la creación del Programa "Academia da Saúde", publicación de legislación sobre ambientes libres de tabaco, distribución gratuita de medicamentos para hipertensión, diabetes y asma, organización de una red de atención de emergencias para enfermedades cardiovasculares y ampliación del acceso al diagnóstico y tratamiento del paciente oncológico. CONCLUSIÓN: hubo avances con respecto a la vigilancia, promoción de la salud y la atención integral; en general, los objetivos del Plan están siendo alcanzados.

OBJECTIVE: to describe the actions undertaken by the Strategic Action Plan for Tackling Chronic Non-Communicable Diseases (NCDs) in Brazil, from 2011 to 2015. METHODS: the actions were identified through sectorial and interministerial meetings, annual forums, as well as document reviews of publications and laws on government websites. RESULTS: the actions found were: national surveys and monitoring of mortality and risk factor reduction targets; encouragement of physical activity, adequate nutrition and health promotion through the creation of the Health Gym Program (Programa Academia da Saúde); the publication of legislation on tobacco-free environments; free of charge drugs for hypertension, diabetes, and asthma; organization of the emergency service network for cardiovascular diseases; and expanding access to diagnosis and treatment of cancer patients. CONCLUSION: we found progress regarding surveillance, health promotion and comprehensive care; in general, the goals of the Plan are being met.

PAHO Meeting on Alcohol Marketing Regulation. Final Report. / Reunión de la OPS sobre reglamentación de la comercialización del alcohol. Informe Final

Scope and Purpose An exploratory international meeting on regulation of marketing* of alcohol products** was held at the Pan American Health Organization (PAHO) headquarters in Washington, D.C., USA, 12–13 January 2015. The objectives of the meeting were to summarize the research on the effects of alcohol marketing on young people; review existing statutory and self-regulatory codes on marketing and examine their effectiveness; consider the implications of international trade agreements and other treaties for developing a global alcohol marketing code; and describe the experience of countries where alcohol marketing legislation has been recently enacted or proposed. Participants, including experts on tobacco control, food and nonalcoholic beverages, trade agreements, and health policy, as well as staff from nongovernmental organizations (NGOs), country offices, and World Health Organization (WHO) headquarters in Geneva, formulated key concepts on the way forward, based on the Global Strategy to Reduce the Harmful Use of Alcohol passed by the World Health Assembly in May 2010 (Resolution WHA63.13) and the Regional Plan of Action to Reduce the Harmful Use of Alcohol passed by PAHO’s 51st Directing Council in September 2011 (Resolution CD51.R14).

Reunión de la OPS sobre reglamentación de la comercialización del alcohol. Informe Final / PAHO Meeting on Alcohol Marketing Regulation. Final Report

[Alcance y propósitos]. Durante los días 12 y 13 de enero de 2015 se celebró una reunión exploratoria internacional en la sede de la Organización Panamericana de la Salud (OPS), en Washington, D.C. (EUA), con los siguientes objetivos: resumir los resultados de investigación sobre los efectos de la comercialización* del alcohol** en los jóvenes; revisar los códigos estatutarios y auto-reguladores en materia de comercialización y analizar su efectividad; considerar las implicaciones de los convenios de comercio internacionales así como de otros tratados a fin de desarrollar un código global de comercialización del alcohol, y describir las experiencias de aquellos países donde se ha promulgado o propuesto recientemente una legislación relativa a la comercialización del alcohol. Los participantes de la reunión, en que se incluyeron expertos en el control de tabaco, alimentos y bebidas no alcohólicas, acuerdos comerciales y políticas de salud, además de funcionarios de organizaciones no gubernamentales, la sede de la OMS en Ginebra y las representaciones de los Estados Miembros de la OPS, formularon puntos claves para seguir adelante, basados en la Estrategia mundial para reducir el uso nocivo del alcohol que fuera aprobada por la Organización Mundial de la Salud (OMS) en mayo de 2010 (Resolución WHA63.13) y en el Plan de Acción Regional para Reducir el Consumo Nocivo de Alcohol aprobado por el 51˚Consejo Directivo de la OPS celebrado en septiembre de 2011 (Resolución CD51.R14).

Tobacco control campaign in Uruguay: Impact on smoking cessation during pregnancy and birth weight.

We analyzed a nationwide registry of all pregnancies in Uruguay during 2007-2013 to assess the impact of three types of tobacco control policies: (1) provider-level interventions aimed at the treatment of nicotine dependence, (2) national-level increases in cigarette taxes, and (3) national-level non-price regulation of cigarette packaging and marketing. We estimated models of smoking cessation during pregnancy at the individual, provider and national levels. The rate of smoking cessation during pregnancy increased from 15.4% in 2007 to 42.7% in 2013. National-level non-price policies had the largest estimated impact on cessation. The price response of the tobacco industry attenuated the effects of tax increases. While provider-level interventions had a significant effect, they were adopted by relatively few health centers. Quitting during pregnancy increased birth weight by an estimated 188 g. Tobacco control measures had no effect on the birth weight of newborns of non-smoking women.

Patologização e penalização do uso de drogas: uma análise socioantropológica de proposições legislativas (2007-2010) / The pathologization and criminalization of drug use: a socio-anthropological analysis of legislative proposals (2007-2010)

Com base nas contribuições de N. Elias e H. Becker, buscamos identificar os processos de patologização e penalização do uso de drogas presentes em proposições legislativas apresentadas ao Congresso Nacional durante a 53ª Legislatura. As 147 proposições reunidas através do descritor "álcool, tabaco e outras drogas" no banco de dados do Observatório da Saúde no Legislativo também dizem respeito a diferentes temas, como "alimentação e nutrição" e "propaganda". No inteiro teor de alguns projetos de lei, há uma recorrente indistinção entre uso, abuso e dependência de substâncias psicoativas ilícitas e lícitas; inclusive na própria ementa dos mesmos é patente uma tendência no sentido do aumento da pena dirigida a usuários e também distribuidores de drogas. A atuação do Poder Legislativo no que tange à questão das drogas contribui para sua penalização e patologização, mais do que para sua politização.

Using concepts by N. Elias and H. Becker, we identified processes of pathologization and penalization of drug use in legislative proposals submitted to the National Congress during the 53th Legislature in Brazil. The 147 proposals gathered using "alcohol, tobacco, and other drugs" as descriptor on the database of the Congress Health Watch address other topics as well, such as "food and nutrition" and "advertising". At the core of some legal reform projects lays a recurrent lack of distinction between use, abuse, and dependence with regard to illicit psycho-active substances. A tendency to increase jail time for both distributors and users also evident. The role of the Legislature is key to the issue of drug use, contributing to its criminalizing and pathologization, rather than to its politicization.

Conference report on tobacco taxes in Central America: current situation and opportunities to reduce prevalence and increase fiscal revenues.

INTRODUCTION: As stated in Article 6 of Framework Convention on Tobacco Control (FCTC), increasing tobacco prices through higher taxes is one of the most effective interventions to reduce tobacco use and to encourage smokers to quit. The potential for tax increases on tobacco products in Central America is ample. We aim to synthesize the current tobacco taxes situation and highlight research needs to strengthen taxation. BACKGROUND: In May 2012, a workshop was carried out with representatives from each Central American country to analyze the tobacco tax situation in each country and to identify key research gaps with experts in the field. DISCUSSION: Tobacco taxes in Central America fall far short of the levels recommended by FCTC. Moreover, the legal framework is complex and creates barriers for higher taxes that require further research and political will. Top research priorities are an in-depth analysis of tobacco tax legislation, impact of tax and price policies, analysis of costs associated to health care of tobacco-related diseases and lost productivity, and the feasibility of approaches to increasing tobacco taxes in certain contexts. An additional area of research is the interrelationship between human rights and tobacco control. CONCLUSION: Central American countries would benefit from increasing excise taxes on tobacco products. The lack of available data and research to counteract tobacco industry arguments are significant obstacles. Active leadership of civil society in support of the partnership of chronic disease interventions is vital in order to obtain tax increases on tobacco products.

Complete home smoking bans and antitobacco contingencies: a natural experiment.

INTRODUCTION: The California antitobacco culture may have influenced home smoking bans in Mexico. Based on the Behavioral Ecological Model, exposure to socially reinforcing contingencies or criticism may explain adoption of home smoking bans in Tijuana, Mexico, approximating rates relative to San Diego, California, and higher than those in Guadalajara, Mexico. METHODS: A representative cross-sectional population survey of Latinos (N = 1,901) was conducted in San Diego, Tijuana, and Guadalajara between June 2003 and September 2004. Cities were selected to represent high-, medium-, and low-level exposure to antitobacco social contingencies of reinforcement in a quasiexperimental analysis of possible cultural influences across borders. RESULTS: Complete home smoking ban prevalence was 91% in San Diego, 66% in Tijuana, and 38% in Guadalajara (p < .001). Sample cluster-adjusted logistic regression showed significantly lower odds of complete home smoking bans in Guadalajara (odds ratio [OR] = .048) and in Tijuana (OR = .138) compared to San Diego after control for demographics. Odds of complete home smoking bans in both Guadalajara and Tijuana in comparison with San Diego were weakened when mediators for bans were controlled in predictive models. Direction of association was consistent with theory. When theoretical mediators were explored as possible moderators, weak and nonsignificant associations were obtained for all interaction terms. Bootstrap analyses demonstrated that our multivariable logistic regression results were reliable. CONCLUSIONS: Results suggest that California antismoking social contingencies mediate complete home smoking bans in all 3 cities and may account for the greater effects in Tijuana contrasted with Guadalajara.

Evolution of tobacco labeling and packaging: international legal considerations and health governance.

Numerous national governments have recently adopted packaging and labeling legislation to curb global tobacco uptake. This coincides with the World Health Organization's 2011 World No Tobacco Day, which recognized the extraordinary progress of the Framework Convention on Tobacco Control (FCTC). The tobacco industry has presented legal challenges to countries, including Australia, Uruguay, and the United States, for enacting legislation meeting or exceeding FCTC obligations. We argue that national governments attempting to meet the obligations set forth in public health treaties such as the FCTC should be afforded flexibilities and protection in developing tobacco control laws and regulations, because these measures are necessary to protect public health and should be explicitly recognized in international trade and legal agreements.