Ms. Bharathi Viswanathan Focal Point, Tobacco Control Public Health Department Ministry of Health Victoria Seychelles

Presentation prepared for the Regional Workshop on FCTC preparatory meeting,9-12 October 2012, Dakar, Senegal

Development of Tobacco control Act in Seychelles

• High profile activities for tobacco control since 1990s– National surveys (1989, 1994, 2004; GYTS 2002); WHDs, media programs, etc

• Active participation of Seychelles in all INB FCTC meetings

• Seychelles ratified the FCTC in 2003 (first in AFRO region)

• National Committee for Tobacco Control appointed by minister in 2000 and legislation developed since 2000; previous attempts since 1996

• Broad local input with broad consortium of stakeholders; and international assistance from TFK (R Nathan), WHO and World Bank

• Tobacco Control Act enacted in August 2009

• Act includes, among various provisions: total ban on smoking in all enclosed public/work places, total ban on advertising, promotion and sponsorship, 50% area display of health warnings on packages, etc.

• WHO classifies Act amongst the most comprehensive in the world

Total ban on smoking in all enclosed work/public places and on public transport and in selected

outdoor public places

• Any place covered by a permanent or transient roof or ceiling (e.g. rooms, verandas, shelters, tent)

• Enclosed by one or more walls or sides (e.g. stadium)

Workplace, public places & public transport

• Enclosed work places include:– rooms, verandas, toilets, eating areas, elevators, foyers stair case and

any other common area

• Enclosed public places include:– restaurants, bar, discotheques, hotels, theatres, church halls, shopping

centers, gymnasiums, stadiums and others

• Out door public places including premises of: – schools, hospitals and children day care centers

• All vehicles transporting public including:– taxis, buses and all other public transports if hired or for payment

• Exceptions are not allowed

Enforcement plan

• Ban on smoking publicized repeatedly through the media

• Spots on ban on smoking aired extensively on national TV

• Several media programs (adverts/programs on TV, radio, leaflets)

• Several information sessions organized in work and other places

• More than 5000 letters sent to all work/public places

• Training for enforcement officers (police, PHC, health, etc)

• Continuous media and other sensitization programs (schools, work places, media, minister’s message)

Enforcement

• Employers, managers and their representatives must ensure that no client or worker smokes in any enclosed work place, public place or public transport

• Owner of a public place or enclosed work place must display “no smoking” sign notices as prescribed in a visible manner at all times

• Public vehicles must also display the no smoking sign

No smoking sign

Adoption of FCTC at WHA, Geneva, 2003

In 2000, students of all schools handed over pledge signed by 14’385 to VP at State House.

WHO award given to MOH, 2004

Policy for tobacco control in Seychelles: a success story

Display of no smoking sign in public places

banners promoting smoke free Jeux des Iles in 2011

Information leaflet

Penalties

• Smokers: SR 1,000 (~100US$) on first conviction and up to SR. 8,000 or imprisonment not exceeding 3 years on subsequent convictions.

• Owner/manager of hospitality/transport premise: SR 5,000 on first conviction and up to SR. 20,000 or imprisonment up to 3 years on subsequent convictions

• Failing to display “No Smoking” signs where smoking is prohibited SR 5,000 on first conviction and up to SR. 20,000 or imprisonment up to 3 years on subsequent convictions can be prosecuted.

Evaluation of the ban smoking in enclosed places

• Survey in May 2010 to evaluate enforcement of ban on smoking in restaurants, bars and discos in the country

• Two thirds of restaurants, bars and discotheques participated

• Questionnaire to 3 patrons, 2 workers, one manager

Results:

• Ban on smoking well implemented (90%)

• ‘No smoking signs’ displayed in 60% of places

• Only 50% of the workers reported having received training

• 40% of workers felt uncomfortable to ask a smoker to stop

Viswanathan B et al. Good compliance with a smoking ban in public places: a rapid assessment in the Seychelles. Tobacco Control 2011;20:427-430.

Prevalence of main risk factors in the population aged 35-64 in 1989 and 2004: tobacco use decreased largely

51

33

52

16

6

32

57

38

36

11

0 20 40 60 80

Smoking

BMI > 25 kg/m2

BP >140/90 mmHg

Cholesterol >6.5 mmol/l

Diabetes (FBG >7 oraw are)

Prevalence (%)

2004

1989

Men, age 35-64

12

60

43

22

6

4

74

33

23

8

0 20 40 60 80

Prevalence (%)

2004

1989

Women, age 35-64

Bovet P et al. Divergent 15-year trends in traditional and metabolic risk factors of cardiovascular diseases in the Seychelles. Cardiovascular Diabetology 2009;8:34

Marked decrease in age-adjusted stroke and MI mortality between 1989 and 2010: role of decreasing tobacco prevalence

01

00

200

300

1990 1995 2000 2005 2010 1990 1995 2000 2005 2010

Men Women

Stroke

Myocardial infarction

Mo

rta

lity

pe

r 10

00

00

Stringhini S et al. Declining stroke and myocardial infarction mortality between 1989 and 2010 in a country of the African region. Stroke 2012;43:2283-88.

Priority next tasks (regulations )

• Regulation of display of health warnings – Health warnings to cover ≥50% of main display areas

– Regulation completed, awaiting publication in official gazette (October)

– To be enforced by mid 2013

• Prepare regulations to empower special enforcement officers– who can inspect

– how to conduct inspections

• Prepare instruments for business reporting– Formant and content related to amount, selling price, brands of tobacco

manufactured/imported/export

– country imported, transshipped or exported

– statements on display on packets

– date of import/export

Challenges & lessons learnt

• Good surveillance since 20 years: link surveillance data and policy development; generated broad interest, and helped build no smoking norms and consensus on interventions

• Tobacco control led by a same single CVD unit: clear focus and long term coherent strategy to advance policy

• FCTC brought political support and provided guidelines on how the legislation needed to be developed

• Mobilizing leadership and commitment at all levels

• Involving local and international experts

• Seeking integrated, multidisciplinary and multi-sector approaches

Conclusions

Seychelles Tobacco Control Act came in to force in 2009

Act is comprehensive and largely complies with FCTC

Ban on smoking well implemented but needs further strengthening

– Need to formalize inspections and enforce penalities– Need for ongoing training to workers– Need for continued education on ban and other policy in mass media

Regulations on health warnings is being finalized

Seychelles has advanced policies for TC but further strengthening is needed

Large decrease in age adjusted rates of CVD mortality is likely related to a large part to decreasing smoking prevalence

Thank you