To succeed in tobacco control you have to pay attention, learn from each other, and be brave.
Those were some of the messages that Dra. Laura Roballo from the Center for Research on the tobacco epidemics, ciet Uruguay, brought with her on a recent visit to Scotland.
Uruguay may be a small country, but it has achieved big things and now has some of the world’s strongest laws to fight tobacco use, albeit some are currently subject to legal challenges. In recent years it has taken forward a strong programme of measures, including smoke-free public places, a ban on advertising and sponsorship, a requirement for 80 per cent picture and text warnings on cigarette packets, and it also limits each tobacco brand to a single form of presentation.
“Uruguay’s comprehensive tobacco-control campaign has been associated with a substantial, unprecedented decrease in tobacco use,” concluded a recent study published in The Lancet that assessed the effect of Uruguay’s anti-tobacco campaign.
“Decreases in tobacco use in other low-income and middle-income countries of the magnitude seen in Uruguay would have a substantial effect on the future global burden of tobacco-related diseases.” During her visit Roballo held meetings at the Glasgow Science Centre which, she says, is interested in adapting and bringing to Scotland the interactive ‘Uruguay breathes’ exhibition, which aims to help children become “critical thinkers” about tobacco.
However, she has also been passing on some of the tobacco-control lessons learned in Uruguay to fellow campaigners and policy-makers.
Uruguay has good experiences to share, she says.
The Who Framework Convention on Tobacco Control helped them move forward, then they worked harder still to get their message across to the individuals with the power to make a difference.
“I really believe that things happen because someone is in the right place to do something,” says Roballo.
Their message heard, presidential decrees on smoke-free public places, increased taxes on tobacco products and picture-warning messages on packs were signed in quick succession.
The effect was significant and quick. Smoking prevalence rates in Uruguay show an abrupt decline from 32 per cent in 2006, when they began implementing their tobacco-control policies, down to 25 per cent in 2009. The latest figures for 2011 show that smoking rates are now down to 22 per cent and Roballo says they have also seen “hugely important” reductions in myocardial infarction and hospital admissions.
In Scotland the decline in smoking rates has been steady but slow, with recent figures showing prevalence rates of 23 per cent. With the Scottish Government’s new draft tobacco strategy due to be published this month, what lessons are there for Scotland from Uruguay’s experiences.
“For me, it builds on some of the ideas we already had, which is that critical leadership is important and getting someone or some group who get that big picture and decide they really want to move with it is really important,” says John Watson, director of policy and communications, ASH Scotland.
“But also when you are dealing with tobacco there isn’t one solution. This is true of every country we’ve looked at – it is a whole package of things.
They all have a contribution to play, so if you have a government that brings in several strong measures at once, we can actually see an immediate difference in terms of smoking rates.
“So it is a message about being bold and that if you are, you can achieve a lot.”