National tobacco control programmes and capacity
National programmes are required to lead tobacco control efforts Building national capacity to carry out effective and sustainable national tobacco control programmes is critical to reversing the tobacco epidemic, and countries are obligated to implement a national tobacco control programme as part of their WHO FCTC obligations (1). Nongovernmental organizations and other members of civil society not affiliated with the tobacco industry, including health professional bodies, women’s, youth, environmental and consumer groups, and academic and health-care institutions, have made great contributions to tobacco control efforts nationally and internationally.
Although involvement by many sectors of government and civil society is required to implement an effective national tobacco control programme, strategic planning and leadership should occur centrally within a country’s ministry of health (57).
In larger countries, the programme may be designed for flexible implementation by decentralizing authority to subnational jurisdictions (57).
A national tobacco control programme with full-time, dedicated staff at both central and (where appropriate) subnational levels, with support from senior levels throughout government as well as technical experts and persons with expertise in planning and implementation, can provide highly effective leadership and administration of all programme initiatives.
Additionally, a national coordinating committee for tobacco control convened at a high level of government (i.e. cabinet or presidency) should include representatives from all government and civil society groups directly involved with tobacco control activities.
It is critical that the government provide its tobacco control programme with a steady source of funding at both national and, where appropriate, subnational levels.
Because most governments currently collect hundreds or even thousands of times more in tobacco tax revenues than they spend on tobacco control, there is room to increase tobacco control spending substantially. This can be accomplished either through use of general government funds or specific earmarks from tobacco tax revenues. Other sources of funding include donations and grants from national and international nongovernmental or philanthropic organizations.
Data from 2007 and 2008 show that aggregate tobacco tax revenues in countries reporting data are more than 173 times higher than expenses for tobacco control activities. Governments collect annually more than US$ 167 billion in tobacco tax revenues, yet spend a total of only US$ 965 million on tobacco control – with 99% of this amount spent by 17 high-income countries. Per capita spending on tobacco control ranges from a tenth of a cent per capita per year in low-income countries to half a cent per capita per year in middle-income countries and about US$ 1.80 per capita per year in high-income countries.
Most countries have a national tobacco control programme, but many do not staff them adequately
■■Nearly 80% of countries report having a national agency with responsibility for tobacco control objectives, with low- and middle-income countries more likely to have such an agency than high-income countries.
■■ Less than 15% of high-income countries and 22% of middle-income countries also have an agency with at least five full-time equivalent staff members, while 24% of low-income countries have an agency staffed at that level.
Brazil has high capacity in tobacco control programmes Brazil has given high priority and commitment to combating the tobacco epidemic. The country’s comprehensive approach to tobacco control is based on a sector-wide national coordination mechanism, which is led by a national tobacco control programme under the ministry of health that serves as the secretariat of the tobacco control health sector commission and the national committee for implementation of the WHO FCTC. Surveillance agencies within the ministry of health perform tobacco control monitoring and regulatory, enforcement and evaluation functions. Due to the federal structure of the country (27 states and the Federal District, with 5592 municipalities) and the decentralized nature of the health system, implementation and enforcement of most tobacco control policies are at the state and local levels. Subnational health departments and enforcement agencies constitute a powerful governmental tobacco control network with specific tobacco control focal points and devoted staff. In 2005, all states and more than two thirds of municipalities had trained staff to implement tobacco control activities, and a third of municipalities, including all major Brazilian cities, had implemented specific tobacco control programmes and enforcement actions.
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