The World Health Report 2003 While the health sector is in large measure supportive of tobacco control, it cannot on its own bring the resources, expertise and political will needed to advance change. This requires sup- port and commitment from all the relevant sectors in the national government. Tobacco control efforts are more likely to be sustained when incorporated into existing national,state and district-level health structures The expected outcome of building national capacity is a comprehensive, effective and sus- tainable strategy for multisectoral national tobacco control programmes and policies. Here, the role of WHo is to coordinate global expertise, enhance leadership, facilitate assistance to front-line efforts, and promote partnerships with governments and civil society to foster the implementation of more effective tobacco control strategies. Many success stories are avail able to guide countries; two are summarized lin bo tegrating tobacco control into health systems Treatment of tobacco dependence is another possible policy measure in low-income and mid le-income countries(17). As the projections in Figure 6.2 demonstrate, a mix of effective prevention and treatment measures will avert significantly more tobacco-caused deaths within the coming decades compared with prevention alone(18). Cessation programmes for adult smokers are essential for rapid population health improvements over the next 20-30 years, since the benefits of preventing young people from taking up smoking will become apparent only after several decades. The Global Youth Tobacco Survey showed that most young smok ers in the Western Pacific Region wished to stop smoking(see Box 6.3) The delivery of cost-effective treatment of tobacco dependence in most countries is ham- pered by many factors, including: the lack of integration of tobacco dependence treatment into health care systems; lack of skills of health care providers; high price of nicotine replace- ment therapy products and cessation services; and the strict regulation of such products Support and greater access to treatment provided through the health care systems will help the poor populations who are most likely to smoke(19). All health providers must be in- volved, including oral health professionals who, in many countries, reach a large proportion of the healthy population. A supportive environment is essential to support smoking cessa- tion programmes and this requires strong government action, for example, in the promotion of smoke-free environments and communication and awareness measures to reduce the so- cial acceptability of tobacco use(20) Box 6.2 Examples of successful tobacco control strategies Tobacco excise taxation in South africa Health warnings in Thailand The past 10 years have witnessed a major shift in government policy on The first health warnings on cigarette packets in Thailand were intro- tobacco control in South Africa, which rests on two important pillars: duced in 1974. Since 1989, many changes have been made to the mes. cise tax incr announced an increase in tax on tobacco products to 50% of the retail The health warnings were improved in stages, with a greater variety of price (at that point, excise taxes amounted to 21% of the retail price texts and stronger language. The number of rotating warnings has in- and the total tax burden was 32% of the retail price). In 1997, the creased from one to twelve. The size of the warning area on cigarette Minister of Finance announced that the 50% target had been achieved. packages and cartons has increased to one-third of the principal sur. Subsequent tax increases were aimed at keeping the tax percentage at faces. A new set of pictorial health messages, occupying half of the front the same level. Over the past decade the real retail price has more than and back display areas, was prepared and submitted to the Ministry of doubled: cigarettes, compared with a basket of other goods and sery. Health in 2003 and is currently awaiting the approval of the Govern. ices, have become very expensive. Along with other tobacco control ment of Thailand. Per capita cigarette consumption has been decreasing interventions, tax increases have contributed to a 33%reduction since the mid-1990s as a result of Thailands comprehensive control in tobacco consumption. In addition, real government revenue from to. policies (16) bacco taxes has more than doubled (15)94 The World Health Report 2003 While the health sector is in large measure supportive of tobacco control, it cannot on its own bring the resources, expertise and political will needed to advance change. This requires sup￾port and commitment from all the relevant sectors in the national government. Tobacco control efforts are more likely to be sustained when incorporated into existing national, state and district-level health structures. The expected outcome of building national capacity is a comprehensive, effective and sus￾tainable strategy for multisectoral national tobacco control programmes and policies. Here, the role of WHO is to coordinate global expertise, enhance leadership, facilitate assistance to front-line efforts, and promote partnerships with governments and civil society to foster the implementation of more effective tobacco control strategies. Many success stories are avail￾able to guide countries; two are summarized in Box 6.2. Integrating tobacco control into health systems Treatment of tobacco dependence is another possible policy measure in low-income and mid￾dle-income countries (17). As the projections in Figure 6.2 demonstrate, a mix of effective prevention and treatment measures will avert significantly more tobacco-caused deaths within the coming decades compared with prevention alone (18). Cessation programmes for adult smokers are essential for rapid population health improvements over the next 20–30 years, since the benefits of preventing young people from taking up smoking will become apparent only after several decades. The Global Youth Tobacco Survey showed that most young smok￾ers in the Western Pacific Region wished to stop smoking (see Box 6.3). The delivery of cost-effective treatment of tobacco dependence in most countries is ham￾pered by many factors, including: the lack of integration of tobacco dependence treatment into health care systems; lack of skills of health care providers; high price of nicotine replace￾ment therapy products and cessation services; and the strict regulation of such products. Support and greater access to treatment provided through the health care systems will help the poor populations who are most likely to smoke (19). All health providers must be in￾volved, including oral health professionals who, in many countries, reach a large proportion of the healthy population. A supportive environment is essential to support smoking cessa￾tion programmes and this requires strong government action, for example, in the promotion of smoke-free environments and communication and awareness measures to reduce the so￾cial acceptability of tobacco use (20). Box 6.2 Examples of successful tobacco control strategies Tobacco excise taxation in South Africa The past 10 years have witnessed a major shift in government policy on tobacco control in South Africa, which rests on two important pillars: legislation and excise tax increases. The government elected in 1994 announced an increase in tax on tobacco products to 50% of the retail price (at that point, excise taxes amounted to 21% of the retail price and the total tax burden was 32% of the retail price). In 1997, the Minister of Finance announced that the 50% target had been achieved. Subsequent tax increases were aimed at keeping the tax percentage at the same level. Over the past decade the real retail price has more than doubled: cigarettes, compared with a basket of other goods and serv￾ices, have become very expensive. Along with other tobacco control interventions, tax increases have contributed to a 33% reduction in tobacco consumption. In addition, real government revenue from to￾bacco taxes has more than doubled (15). Health warnings in Thailand The first health warnings on cigarette packets in Thailand were intro￾duced in 1974. Since 1989, many changes have been made to the mes￾sages, as an important component of a comprehensive control policy. The health warnings were improved in stages, with a greater variety of texts and stronger language. The number of rotating warnings has in￾creased from one to twelve. The size of the warning area on cigarette packages and cartons has increased to one-third of the principal sur￾faces. A new set of pictorial health messages, occupying half of the front and back display areas, was prepared and submitted to the Ministry of Health in 2003 and is currently awaiting the approval of the Govern￾ment of Thailand. Per capita cigarette consumption has been decreasing since the mid-1990s as a result of Thailand’s comprehensive control policies (16)