Role Of Ng Os In Tobacco Control

THE ROLE OF NGOs IN TOBACCO CONTROL Prof. Dr Lekhraj Rampal MBBS, MPH, DRPH, FRSH, FAMM Deputy Chairman Malaysian Health Promotian Board Chairman, Action on Smoking and Health Committee, MMA 1993, 1996 -2009 Chairman, International Quit smoking and Win – MALAYSIA 1998, 2000, 2002, 2004,2006 Chairman, National Organizing Committee- World No Tobacco Day – Malaysia1993, 2002, 2004,2006 9th August 2009 RAMPAL

CONTENTS ,[object Object],[object Object],[object Object],9th August 2009 RAMPAL

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THE GLOBAL IMPACT OF SMOKING ON HEALTH ,[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

The 5 million deaths per year from tobacco smoking are not the result of liberty and free choice by adult and responsible consumers (60 to 80% want to stop). 9th August 2009 RAMPAL

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Gender-Specific Smoking Prevalence Across the World 1. Mackay J, et al. The Tobacco Atlas . Second Ed. American Cancer Society Myriad Editions Limited, Atlanta, Georgia, 2006. Also available online at: http://www.myriadeditions.com/statmap/. US 24% 19% Men Women Australia 19% 16% Belarus 53% 7% Brazil 22% 14% Canada 22% 17% Chile 48% 37% China 67% 2% Egypt 45% 12% France 30% 21% Iceland 25% 20% Mexico 13% 5% Iran 22% 2% Kenya 21% 1% Sweden 17% 18% Philippines 41% 8% Portugal 33% 10% South Africa 23% 8% India 47% 17% Russian Fed 60% 16% Italy 33% 17% Spain 39% 25% Germany 37% 28%

Four Stages of the Tobacco Epidemic: Mortality Is Increasing in Many Countries 1 % female deaths 0 ,[object Object],If current smoking patterns continue, deaths from smoking in Asia—home to a third of the world’s population—are expected to increase by 2020 to 4.9 million annually. 2 Percentage of smokers among adults Percentage of deaths caused by smoking ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],STAGE 1 STAGE 2 STAGE 3 STAGE 4 70 60 50 40 30 20 10 0 70 60 50 40 30 20 10 0 80 90 100 40 30 20 10 % male deaths % male smokers % female smokers Years 1. Lopez AD, et al. Tobacco Control . 1994;3:242-247. 2. Shafey O, et al (eds). Tobacco Control Country Profiles 2003, American Cancer Society; 2003; Atlanta, Georgia. Available at: http://www.who.int/tobacco/global_data/country_profiles/en/. Accessed June 2006.

Developing Countries ,[object Object],[object Object],9th August 2009 RAMPAL

Every day , THOUSANDS of young people around the world are trying their first cigarette and 80,000 – 100,000 are becoming regular smokers often precipitating a lifetime of addiction and untimely death. 9th August 2009 RAMPAL

Annual Deaths Attributable to Tobacco: Worldwide Estimates Canada >25% Australia 20%-24% UK >25% Germany >25% China & Taiwan 10%-14% Brazil 15%-19% % of Total Deaths Attributable to Tobacco* *Regional estimates in 2000 in men aged >35 years. 1. Mackay J, Eriksen M. The Tobacco Atlas. Second Ed. World Health Organization; 2006. US >25% Mexico 15%-19% Argentina 15%-19% Spain >25% Russian Federation >25% Sweden >25% Turkey >25% 9th August 2009 RAMPAL

Fig 13:“Youth should be inculcated in a “ Calture without Tobacco”- Chairman ASH IQSW 2000 9th August 2009 RAMPAL

Tobacco must be seen as a drug, not as a more agricultural product. Tobacco is a dangerous product and hazardous to health and it is lethal. 9th August 2009 RAMPAL

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World No Tobacco Day Geneva, 30 May 2006 ,[object Object],9th August 2009 RAMPAL

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WORLD HEALTH DAY 2007 ,[object Object],9th August 2009 RAMPAL

[object Object],[object Object],WHO Director-General Dr Margaret Chan. 9th August 2009 RAMPAL

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ECONOMIC LOSS ,[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

RM 4.5 billion per year (US$1.3 BILLION/PER YEAR) 1 st JUNE 2007 9th August 2009 RAMPAL

Estimated Annual Costs Attributable to Tobacco Canada $12.9 Australia $14.2 France $16.4 Germany $24.4 China $4.3 US $184.5 Estimated Costs to the Economy Attributable to Tobacco (US $ Billions) UK $2.3 Norway $1.62 1. Mackay J, et al. The Tobacco Atlas. Second Ed. American Cancer Society Myriad Editions Limited. Atlanta, Georgia, 2006. Also available online at: http://www.myriadeditions.com/statmap/. Venezuela $.284 Total Costs Direct Healthcare Costs 9th August 2009 RAMPAL

What’s in a Cigarette? ,[object Object],[object Object],[object Object],1. National Toxicology Program. 11th Report on Carcinogens; 2005. Available at: http://ntp-server.niehs.nih.gov. 2. Mackay J, Eriksen M. The Tobacco Atlas . World Health Organization; 2006. 3. Harvard Health Letter . May 2005. 4. Surgeon General’s Report. The Health Consequences of Smoking ; 2004. Chemical in Tobacco Smoke 2 Also Found In… Acetone Paint stripper Butane Lighter fluid Arsenic Ant poison Cadmium Car batteries Carbon monoxide Car exhaust fumes Toluene Industrial solvent

Chemicals 9th August 2009 RAMPAL

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Tobacco is the only freely available product which, when used as intended by the manufacturer, kills half of its dedicated users. 9th August 2009 RAMPAL

Mechanisms of Action: How Smoking Causes Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Surgeon General’s Report. The Health Consequences of Smoking ; 2004.

Smoking: Leading Preventable Cause of Disease and Death 1 Top 3 Smoking-Attributable Causes of Death in US #1 Lung cancer #2 Ischemic heart disease #3 COPD Cancer Lung (#1)* Leukemia (AML, ALL, CLL) 2-4 Oral cavity/pharynx Laryngeal Esophageal Stomach Pancreatic Kidney Bladder Cervical Cardiovascular Ischemic heart disease (#2)* Stroke – Vascular dementia 5 Peripheral vascular disease 6 Abdominal aortic aneurysm Respiratory COPD (#3)* Pneumonia Poor asthma control Reproductive Low-birth weight Pregnancy complications Reduced fertility Sudden Infant Death Syndrome Other Adverse surgical outcomes/wound healing Hip fractures Low-bone density Cataract Peptic ulcer disease † *Top 3 smoking-attributable causes of death. † In patients who are Helicobacter pylori positive. AML = Acute myeloid leukemia; ALL = acute lymphocytic leukemia; CLL = chronic lymphocytic leukemia; COPD = chronic obstructive pulmonary disease; SIDS = sudden infant death syndrome. 1. Surgeon General’s Report. The Health Consequences of Smoking ; 2004. 2. Sandler DP, et al. J Natl Cancer Inst . 1993;85(24):1994-2003. 3. Crane MM, et al. Cancer Epidemiol Biomarkers Prev . 1996;5(8):639-644. 4. Miligi L, et al. Am J Ind Med . 1999;36(1):60-69. 5. Roman GC. Cerebrovasc Dis . 2005;20(Suppl 2):91-100. 6. Willigendael EM, et al. J Vasc Surg . 2004;40:1158-1165. 9th August 2009 RAMPAL

There are more than 25 tobacco related diseases known today including : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

Merokok menyebabakan 90% daripada kematian akibat kanser paru-paru, 9th August 2009 RAMPAL

Common cancer among Tobacco chewing are -Oral cavity carcinoma -Oral Sub mucous fibrosis 9th August 2009 RAMPAL

Carcinoma of buccal mucosa Carcinoma of Maxilla 9th August 2009 RAMPAL

RESPIRATORY DISEASES ,[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

CARDIOVASCULAR DISEASES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

Cardiovascular diseases are now responsible for 30% of all deaths worldwide. Smoking is a well-established risk factor for cardiovascular disease. 9th August 2009 RAMPAL

38 YEARS SMOKER WHO DIED DUE TO WITH CEREBRAL STROKE 9th August 2009 RAMPAL

PAEDIATRIC DISEASES ,[object Object],[object Object],[object Object],9th August 2009 RAMPAL

Smoking During Pregnancy Harms Infants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*1990s. 1. Fagerström K. Drugs . 2002;62(Suppl 2):1–9. 2. Le Souef PN. Thorax . 2000;55:1063–1067. 3. Mackay J, et al. The Tobacco Atlas. World Health Organization; 2002. 4. Hellstrom-Lindahl E, et al. Respiration. 2002;69:289-293. 9th August 2009 RAMPAL

For every person who dies from tobacco use, another 20 suffer with at least one serious tobacco-related illness. Half of all long-term smokers die prematurely from smoking-related causes. Until recently this epidemic of chronic disease and premature deaths mainly affected the rich countries. It is now rapidly shifting to the developing world. 9th August 2009 RAMPAL

IMPACT OF SMOKING ON MALE SEXUAL HEALTH ,[object Object],[object Object],9th August 2009 RAMPAL

What Does Secondhand Smoke Do? ,[object Object],[object Object],[object Object],[object Object],1. News release, June 27, 2006; US Department of Health & Human Services. Available at: http://www.hhs.gov/news/press/2006pres/20060627.html. 2. Mackay J, et al. The Tobacco Atlas. World Health Organization; 2002. 3. Teo KK, et al. Lancet. 2006;368:647-658. 9th August 2009 RAMPAL

PREVALEVE OF SMOKING IN MALAYSIA 9th August 2009 RAMPAL

Prevalence of Smoking among Malaysians Estimated: ~ 3 million smokers in Malaysia (2006) 9th August 2009 RAMPAL 1996 2004 2006 NHMS2 UPM NHMS3 ( > 18 yrs) ( > 18 yrs) ( > 18 yrs) Overall 24.8% 23.2% 21.5% Male 49.2% 47.2 46.4% Female 3.5% 2.7% 1.6% Malay 27.9% 28.9 % 24% Chinese 19.2% 18.7% 16.2% Indian 16.2% 16.8% 13.7% Others 32.4% 22.5% 23.8%

Table III: Prevalence of ever and current smokers by sex and ethnicity 2004 9th August 2009 RAMPAL Ethnicity Sex Prevalence of Ever Smokers % (SE %) Prevalence of Current Smokers % (SE %) All Races Male Female Both 59.3 (0.7) 4.8 (0.3) 32.0 (0.5 ) 47.2 (0.7) 2.7 (0.2) 24.9 (0.4) Malay Male Female Both 69.8 (0.8) 4.6 (0.3) 37.0 (0.6) 55.6 (0.9) 2.6 (0.2) 28.9 (0.6 ) Chinese Male Female Both 45.2 (1.6) 5.0 (0.6) 25.3 (1.0) 34.1 (1.5) 3.0 (0.4) 18.7 (0.9) Indian Male Female Both 41.1 (2.2) 1.1 (0.3) 21.1 (1.3 ) 33.4 (2.1) 0.5 (0.2) 16.8 (1.2) Others Male Female Both 55.4 (10.4) 5.1 (2.0) 27.5 (4.7 ) 46.1 (9.4) 3.5 (1.6) 22.5 (4.4) Bumiputra Sarawak Male Female Both 61.2 (3.6) 10.7 (1.9) 35.8 (2.3 ) 50.9 (3.2) 5.2 (1.4) 27.9 (2.0) Bumiputra Sabah Male Female Both 57.5 (2.4) 5.5 (1.0) 32.0 (1.6 ) 50.2 (2.2) 2.6 (0.6) 26.8 (1.6)

NHMS3 - Adult Smoking Prevalence 9th August 2009 RAMPAL Ever Smoker Current Smoker Ex-Smoker Overall 27.0% 21.5% (2.73M) 5.4% Male 57.6% 46.4% (2.61M) 11.0% Female 2.5% 1.6% (0.12M) 0.9% Urban 24.1% 18.9% (1.56 M) 5.0% Rural 32.3% 26.2% (1.17 M) 6.0%

NHMS3 - Adolescent Smoking Prevalence ( 13 to <18 years) 9th August 2009 RAMPAL Overall Boys Girls Ever smokers - Young people who have ever smoked a cigarette (even 1puff) 14.7% (180,328) 26.2% (162,438) 3.0% (17,891) Current smokers - Young people who smoke on at least one day in the last 30 days preceding the survey 8.7% (107,154) 16.6% (103,240) 0.7% (3,914) Frequent/ established smokers Young people who have smoked on at least 20 of the 30days preceding survey 3.3% (40,172) 6.4% (39,083) 0.18% (1,089) Experimental smokers - Young people who have smoked < 20days for the past 30 days & not smoked for last 7 days 1.1% 1.9% 0.2% Triers - Young people who ever tried to smoke but stopped after only one (1) cigarette or after a few puffs 5.2% 8.3% 2%

10 Principal Causes of Deaths in MOH Hospitals, 2006 9th August 2009 RAMPAL Septicaemia 16.87% Heart Diseases & Diseases of Pulmonary Circulation 15.70% Malignant Neoplasm 10.59% Cerebrovascular Diseases 8.49% Pneumonia 5.81% Accidents 5.59% Diseases of the Digestive Systems 4.47% Certain Conditions Originating in the Perinatal Period 4.20% Nephritis, Nephrotic Syndrome & Nephrosis 3.83% Ill-defined conditions 3.03%

Total Treatment Cost for 3 Smoking Related Diseases/ Year (RM - million ) Syed Aljunid, 2005 9th August 2009 RAMPAL Mean Min Max Patient 949.8 682.3 1730.6 Provider 1975.0 925.0 3257.7 Total 2924.8 1607.3 4988.3 % of GDP 0.74 0.41 1.27 % of NHE 16.49 9.06 28.12 % MOH budget 26.14 12.24 43.11

Factors Influencing Tobacco Use 9th August 2009 RAMPAL

1. Tobacco industry marketing and advertising 2. Profit margin/ Sales are legal even though it kills half of its user 3. Nicotine Addiction 4. Low Tobacco Tax 5. Peer smoking status and influence 6. Parental smoking status 7. Smoking environment in Workplace and house 8. Greed and Corruption 9. Smuggling of tobacco products 9th August 2009 RAMPAL

TOBACCO INDUSTRY TARGETTED YOUNG PEOPLE ( DYER C. BMJ 1998;316:1923 ,[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

TOBACCO INDUSTRY – ADVERTISMENT?? 9th August 2009 RAMPAL

ON THE SIDE OF A SHOP TOBACCO INDUSTRY – ADVERTISMENT?? 9th August 2009 RAMPAL

RESTAURANT TOBACCO INDUSTRY – ADVERTISMENT?? 9th August 2009 RAMPAL

2. NICOTINE ADDICTION 9th August 2009 RAMPAL

Section 2: Tobacco Dependence Mechanisms ,[object Object],[object Object],[object Object],[object Object]

Mechanism of Action of Nicotine in the Central Nervous System ,[object Object],[object Object], 4  2  2  2  4  4  2 Nicotinic Receptor

Nicotine Stimulates Dopamine Release ,[object Object],D Ventral Tegmental Area Nucleus Accumbens Adapted from Picciotto MR, et al. Nicotine and Tob Res . 1999: Suppl 2:S121-S125. D  4  2 Nicotinic Receptor  Nicotine  Dopamine Reward D D D Axon

Nicotine May Cause Up-Regulation and Desensitization of Receptors Resulting in Tolerance ,[object Object],[object Object],[object Object],[object Object],[object Object],1. Schroeder SA. JAMA. 2005;294:482-487. 2. Jarvis MJ. BMJ. 2004; 328:277-279.

The Cycle of Nicotine Addiction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Jarvis MJ. BMJ. 2004; 328:277-279. 2. Picciotto MR, et al. Nicotine and Tob Res . 1999: Suppl 2:S121-S125. Dopamine Nicotine

Tobacco Industry ,[object Object],[object Object],[object Object],9th August 2009 RAMPAL

SMOKING IN UTERO INCREASES RISK OF LATER ADDICTION ARNOLD MANN NIDA, 2004: 19 (4) 9th August 2009 RAMPAL

Patrick Zickler NIDA 2004; 19 (2) SMOKING MAY BE MORE ADDICTIVE IF IT IS INITIATED DURING ADOLESCENCE, AND EARLY EXPOSURE MAY HEIGHTEN RESPONSE TO OTHER ADDICTIVE DRUGS. MALES AND FEMALES MAY DIFFER IN THEIR SUSCEPTIBILITY TO THESE EFFECTS 9th August 2009 RAMPAL

REAL PRICE OF TOBACCO TO CONSUMER – PRICE WAR 9th August 2009 RAMPAL

TOBACCO PRICE WAR - Decline in tobacco price ???Answer: Increase Taxes to such an extent that tobacco companies don’t think of reducing their price again. Use the money for Tobacco control activities and for Victims of Tobacco Use 9th August 2009 RAMPAL

PEERS SMOKING 9th August 2009 RAMPAL

PARENTAL SMOKING 9th August 2009 RAMPAL

9th August 2009 RAMPAL Risk factors Crude Odds Ratio P value Adjusted Odds Ratio P value Highest education achieved University/ College Secondary Primary No formal Education 1.00 1.61 (1.40, 1.86) 1.41 (1.2, 1.65) 0.98 (0.81, 1.19) <0.001 <0.001 0.846 1.00 2.22 (1.87, 2.64) 2.68 (2.18, 3.30) 6.61 (4.91, 8.89) <0.001 <0.001 <0.001 Friends who smoke No Yes 1.00 17.95 (15.25, 21.13) <0.001 1.00 4.9 (4.03, 5.96) <0.001 Family who smoke No Yes 1.00 1.58 (1.44, 1.74) <0.0001 1.00 2.20 (1.97, 4.47) <0.001 Self Esteem High Moderate Low 1.00 0.97 (0.88, 1.07) 1.29 (1.16, 1.45) 0.565 <0.001 1.00 0.92 (0.81, 1.04) 1.31 (1.13, 1.51) 0.185 <0.001

GREED AND CORRUPTION 9th August 2009 RAMPAL

A letter from James F. Ripslinger to Sylvester Stallone dated June 14 1983 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

It is sad that very few is calling for its BAN 9th August 2009 RAMPAL

Quitting at Any Age May Increase Life Expectancy 1. Doll R, et al. BMJ . 2004;328:1519–1527. ,[object Object],Survival At Each Age Point (%) 40 35-44 Stopped Age Results From a Study of Male Physician Smokers in the United Kingdom Nonsmokers Cigarette Smokers Age (Years)

Risk of Cardiovascular Disease (CVD) Reduced By Quitting Smoking ,[object Object],[object Object],[object Object],*Defined as self-reported smokers who were cotinine negative. 1. Critchley JA, Capewell S. JAMA . 2003;290:86-97. 2. Twardella D et al. Eur Heart J . 2004;25:2101–2108. 0.71 0.64 0.44 1.00 0.00 0.20 0.40 0.60 0.80 1.00 1.20 Currently Smokes Recently Quit* Formerly Smoked Never Smoked Odds Ratio

COMBATTING THE PROBLEM 9th August 2009 RAMPAL

1. CORE DEMAND REDUCTION 2. CORE SUPPLY REDUCTION 9th August 2009 RAMPAL

NGOs Role in tobacco control efforts should be focused on several fronts: ,[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

WHO classifies interventions into two major groups, those aimed at reducing the demand for tobacco: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

and those aimed at reducing the supply of tobacco: ,[object Object],9th August 2009 RAMPAL

ROLE OF NGOs IN TOBACCO CONTROL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

MALAYSIAN EXPERIENCE ,[object Object],[object Object],9th August 2009 RAMPAL

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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

MMA SUBMITS MEMORENDAM TO GOVERNMENT TO BAN SMOKING IN PUBLIC PLACES 9th August 2009 RAMPAL

IMPACT: CABINET RULING BANS SMOKING IN GOVERNMENT MEETINGS AND PLACES 9th August 2009 RAMPAL

LEAD ROLE :CATALYST ASH,MMA ORGANISES WORKSHOP ON SMOKING OR HEALTH 1983 9th August 2009 RAMPAL

SLIDE SHOWING WORKSHOP AND EXHIBITION “ON SMOKING OR HEALTH 9.10.1983 Dr RAMPAL 9th August 2009 RAMPAL

NATIONAL NO SMOKING DAY 6 TH NOV 1986 ORGANISED BY ASH, MMA WITH COLLABORATION WITH MOH AND OTHER NGO’S 9th August 2009 RAMPAL

ROLE: EDUCATIONAL ASH, MMA HIGHLIGHTS HAZARDS OF PASSIVE SMOKING 9th August 2009 RAMPAL

ROLE : EDUCATIONAL ASH, MMA HIGHLIGHTS ROLE OF HEALTH PROFESSIONALS IN TOBACCO CONTROL 9th August 2009 RAMPAL

WORLD NO TOBACCO DAY 1993 9th August 2009 RAMPAL

ROLE :ADVOCATIVE ASH MMA WRITES TO MALAYSIAN AIRLINES TO BAN SMOKING ON LOCAL FLIGHTS 9th August 2009 RAMPAL

Impact Of Health Promotion And Advocacy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

Impact Of Health Promotion And Advocacy ,[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

ASH, MMA SUBMITS MEMORENDAM TO GOVERNMENT TO BAN SMOKING IN PUBLIC PLACES 9th August 2009 RAMPAL

IMPACT ,[object Object],9th August 2009 RAMPAL

IMPACT ,[object Object],[object Object],[object Object],9th August 2009 RAMPAL

ROLES: LEAD AND CATALYST 9th August 2009 RAMPAL

INTERNATIONAL QUIT SMOKING AND WIN CAMPAIGN – MALAYSIA 1998, 2000, 2002 , 2004 9th August 2009 RAMPAL

Rules and Regulations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],PRIZES 9th August 2009 RAMPAL

PANEL OF JUDGES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

The International Quit Smoking and Win is an Global Joint event involving 75 countries and we expect 500,000 to one million participants to give up smoking for at least one month it also helps to inform the general public about harmful effects on health by tobacco consumption. 9th August 2009 RAMPAL

Assisted by: ,[object Object],[object Object],[object Object],9th August 2009 RAMPAL

The IQSW application forms were published in the English, Malay, Chinese and Tamil Language Newspapers which had Nation-wide circulation. 9th August 2009 RAMPAL

IQSW 1998 POSTER 9th August 2009 RAMPAL

Fig 10: International Quit Smoking And Win Campaign 1998-Malaysia 9th August 2009 RAMPAL

ROLE - ADVOCATIVE Tobacco Advertisment Issue brought up by Dr Lekhraj Rampal, Chairman, ASH ,MMA’ and Minister Agrees to bring up the Issue of Tobacco Advertisment to Cabinet 9th August 2009 RAMPAL

ROLE : ADVOCATIVE ,[object Object],9th August 2009 RAMPAL

IMPACT Malaysia enacted the control of Tobacco Product Regulations 1993 under the Food Act 1983 to discourage smoking in the country. A number of provisions are made in the Regulations to curb smoking. This includes areas such as cigarette accessibility to children, health warning messages and cigarette advertising. One of the programs intended to discourage smoking is the anti-tobacco media campaign. 9th August 2009 RAMPAL

Fig 14: President Malaysian Medical Association and Chairman ASH Slam Tobacco Firms Over Warning Labels 9th August 2009 RAMPAL

DR RAMPAL 9th August 2009 RAMPAL

Launched by Deputy Minister of Health, Malaysia 9th August 2009 RAMPAL

ROLE :ADVOCATIVE ASH MMA WRITES TO THE GOVERNMENT TO INCREASE TAX ON TOBACCO AND HAVE A SPECIAL FUND FOR TOBACCO CONTROL ACTIVITIES 9th August 2009 RAMPAL

Message form Prof Dr Lekhraj Rampal Chairman, ASH, MMA on World No Tobacco Day 31 st May 2007 Major TV stations and Newspapers and again on 2 July 2007 TV 2 ,[object Object],[object Object],9th August 2009 RAMPAL

WE CAN QUIT SMOKING Fig 11: Bank Staff Quit As A Group During IQSW 1998 9th August 2009 RAMPAL

DEPUTY MINISTER OF HEALTH QUITS SMOKING 9th August 2009 RAMPAL

Fig. 5: Launching of the No Smoking Week 1987 . Deputy Minister of Health. Kicks The Habit Himself (30 Years As a Smoker) 9th August 2009 RAMPAL

GETTING THE HEALTH PROFESSIONALS IN THE ARMED FORCES INVOLVED 9th August 2009 RAMPAL

NGOs Roles include: ,[object Object],[object Object],[object Object],9th August 2009 RAMPAL

As Scientist ,[object Object],[object Object],[object Object],9th August 2009 RAMPAL

As a Leader ,[object Object],[object Object],[object Object],9th August 2009 RAMPAL

Opinion-builder ,[object Object],9th August 2009 RAMPAL

Alliance-builder ,[object Object],9th August 2009 RAMPAL

Watch out for tobacco industry activities ,[object Object],[object Object],9th August 2009 RAMPAL

BARRIERS TO NGOs INVOLVEMENT IN TOBACCO CONTROL ,[object Object],[object Object],[object Object],9th August 2009 RAMPAL

ROLE:TRAINING HEALTH PROFESSIONALS IN SMOKING CESSATION TECHNIQUES 9th August 2009 RAMPAL

PARTICIPATION IN LOCAL AND INTERNATIONAL CONFERENCES AND FORUMS 9th August 2009 RAMPAL

DR PETO AT WORLD CONFERENCE IN FINLAND 9th August 2009 RAMPAL

Dr Judith Mackay at APACT Conference in Taiwan 9th August 2009 RAMPAL

MALAYSIAN HEALTH PROMOTION BOARD 9th August 2009 RAMPAL

YOUTH INVOLVEMENT 9th August 2009 RAMPAL

DEPUTY MINISTER OF YOUTH AND SPORTS LAUCHES TOBACCO CONTROL ACTIVITIES AMONGST THE YOUTH USING INTERACT AND ROTERACT CLUBS 9th August 2009 RAMPAL

TOBACCO FREE SPORTS NATIONAL ART POSTER & SLOGAN COMPETITION INTERNATIONAL QUIT SMOKING AND WIN 2002 THEME: TOBACCO FREE SPORTS 9th August 2009 RAMPAL

Organized by MMA AND COMMONWEALTH MEDICAL ASSOCIATION 9th August 2009 RAMPAL

IMPACT ON THE MEMORENDUM GIVEN BY ASH, MMA TO THE GOVERNMENT TO INCREASE TAXES AND USE THE MONEY FOR TOBACCO CONTROL ACTIVITIES- SIN TAX 9th August 2009 RAMPAL

2005 WORLD NO TOBACCO DAY Launched by MINISTER OF WILAYAH PERSEKTUAN 31.5.2005 AT UNIVRSITY MALAYA 9th August 2009 RAMPAL

WINNERS OF COMPETITION BEING GIVEN PRIZES 9th August 2009 RAMPAL

USING ART AND CULTURE IN TOBACCO CONTROL 9th August 2009 RAMPAL

NATIONAL ART COMPETITION 2005 ASH, MMA THEME: HARMFUL EFFECTS OF TOBACCO AND TOBACCO PRODUCTS – START A HEALTHY LIFESTYLE WITHOUT TOBACCO ORGANIZED BY MMA WITH THE ASSISTANCE OF MINISTRY OF EDUCATION, HEALTH AND PRIVATE SECTOR 9th August 2009 RAMPAL

NATIONAL ART POSTER COMPETITION - 2005 ORGANIZED BY ASH, MMA ,[object Object],9th August 2009 RAMPAL

JUDGES SELECTING THE WINNERS MR VICTOR CHIN (PROFESSIONAL ARTIST ) 9th August 2009 RAMPAL

PROF DR KRISHNA GOPAL TRUSTEE NATIONAL ART MUSEUM 9th August 2009 RAMPAL

CHAIRMAN ASH,MMA DR RAMPAL WITH THE WINNERS 9th August 2009 RAMPAL

PLEASE ADVOCATE TO EXTEND THE EXISTING BAN TO INCLUDE 9th August 2009 RAMPAL

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IN CONCLUSION: YOU AND YOUR NGOs CAN PLAY THE FOLLOWING ROLES IN TOBACCO CONTROL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],9th August 2009 RAMPAL

IN CONCLUSION: Malaysia has taken several steps forward in tobacco control. We need to work together locally and globally to achieve – “ A Tobacco Free World”. 9th August 2009 RAMPAL

Role Of Ng Os In Tobacco Control

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