Abstract
Brazil has reduced its smoking rate by about 50% in the last 20 y. During that time period, strong tobacco control policies were implemented. This paper estimates the effect of these stricter policies on smoking prevalence and associated premature mortality, and the effect that additional policies may have. The model was developed using the SimSmoke tobacco control policy model. Using policy, population, and smoking data for Brazil, the model assesses the effect on premature deaths of cigarette taxes, smoke-free air laws, mass media campaigns, marketing restrictions, packaging requirements, cessation treatment programs, and youth access restrictions. We estimate the effect of past policies relative to a counterfactual of policies kept to 1989 levels, and the effect of stricter future policies. Male and female smoking prevalence in Brazil have fallen by about half since 1989, which represents a 46% (lower and upper bounds: 28%-66%) relative reduction compared to the 2010 prevalence under the counterfactual scenario of policies held to 1989 levels. Almost half of that 46% reduction is explained by price increases, 14% by smoke-free air laws, 14% by marketing restrictions, 8% by health warnings, 6% by mass media campaigns, and 10% by cessation treatment programs. As a result of the past policies, a total of almost 420,000 (260,000-715,000) deaths had been averted by 2010, increasing to almost 7 million (4.5 million-10.3 million) deaths projected by 2050. Comparing future implementation of a set of stricter policies to a scenario with 2010 policies held constant, smoking prevalence by 2050 could be reduced by another 39% (29%-54%), and 1.3 million (0.9 million-2.0 million) out of 9 million future premature deaths could be averted. Brazil provides one of the outstanding public health success stories in reducing deaths due to smoking, and serves as a model for other low and middle income nations. However, a set of stricter policies could further reduce smoking and save many additional lives. Please see later in the article for the Editors' Summary.
Highlights
Since 1989, Brazil has implemented policies to increase cigarette taxes, require bold warnings on cigarette packages, ban many tobacco marketing practices, and generally expand tobacco control programs [1,2,3]
In 1996, Brazil was made a World Health Organization Collaborating Center for the Tobacco or Health Program, strengthening its international importance and pioneering role in providing support for preventive actions related to tobacco control to low and middle income nations
Between 1989 and 2008, SimSmoke predicts that the male smoking rate decreases from 43.3% to 22.9%, approximately a 47% decline in relative terms, and that the female smoking rate falls from 27.0% to 13.9%, approximately a 48% relative decline
Summary
Since 1989, Brazil has implemented policies to increase cigarette taxes, require bold warnings on cigarette packages, ban many tobacco marketing practices, and generally expand tobacco control programs [1,2,3]. More recent data [3] indicate that smoking rates have fallen by almost half since 1989, to a level of 18.5% in 2008 The reasons for this steep decline have not been documented. Annual tobacco-related deaths could increase to more than 8 million by 2030 In response to this global tobacco epidemic, the World Health Organization has developed an international instrument for tobacco control called the Framework Convention on Tobacco Control (FCTC). Since it came into force in February 2005, 176 countries have become parties to the FCTC. They agree to implement comprehensive bans on tobacco advertizing, promotion, and sponsorship; to ban misleading and deceptive terms on tobacco packaging; to protect people from exposure to cigarette smoke in public spaces and indoor workplaces; to implement tax policies aimed at reducing tobacco consumption; and to combat illicit trade in tobacco products
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