TOBACCO CONTROL TO GAIN SUSTAINABLE DEVELOPMENT GOALS OF VIETNAM

MINISTRY OF EDUCATION AND TRAINING FOREIGN TRADE UNIVERSITY *** MASTER THESIS TOBACCO CONTROL TO GAIN SUSTAINABLE DEVELOPMENT GOALS OF VIETNAM Major: International Economics Full name: Nguyen Thi Le Thuy Hanoi, 2020 MINISTRY OF EDUCATION AND TRAINING FOREIGN TRADE UNIVERSITY *** MASTER THESIS TOBACCO CONTROL TO GAIN SUSTAINABLE DEVELOPMENT GOALS OF VIETNAM Major: International Economics Master of Research in International Economics Code: 1806410002 Full name: Nguyen Thi Le Thuy Supervisor: Assoc. Prof. Dr. Tu Thuy Anh Hanoi, 2020 COMMITMENT I would like to guarantee the master's thesis with title: "Tobacco control to gain sustainable development goals of Vietnam" is my own scientific research. The research contents in this topic are completely honest and have not been used or published in any form. The data indicated in the thesis is clear, accurate and collected from the confident sources of information. Hanoi, 2020 Author of thesis Nguyen Thi Le Thuy ACKNOWLEDGEMENT First of all, my warm gratitude is for the lecturers and staff of Faculty of Graduate Studies, Foreign Trade University for their kindness and helpful support during my coursework and development of this study, specially, Assoc.Prof.D r .Tu Thuy Anh, whose thoughtful orientation and guidance was invaluable. Besides the efforts of myself, I have received the help, encouragement and guidance of my teachers, friends, colleagues and family throughout the course as well as in the period of the thesis research I am grateful to my family for their encouragement and supports during the course and the period of thesis research. In spite of the great efforts of the author, inevitable shortcomings and limitation still exist in the thesis. Therefore, I am looking forward to receiving precious sharings and comments for better improvement. Sincerely, The Author Nguyen Thi Le Thuy i TABLE OF CONTENTS COMMITMENT i ACKNOWLEDGEMENT ii LIST OF ABBREVIATIONS iii LIST OF FIGURE iv ABSTRACT INTRODUCTION CHAPTER I. THE BASIC CONCEPTS OF THE SUSTAINABLE DEVELOPMENT GOALS AND TOBACCO CONTROL 11 1.1 Concept of Sustainable Development goals 11 1.1.1 What is sustainable development ? .11 1.1.2. Sustainable development goals 12 1 Overview of tobacco use and tobacco control measures in Vietnam 16 1.2.1 Current situation of tobacco use in Vietnam 16 1.2.2. Some results of the implementation of Tobacco Control Law 17 1.3. Channels for tobacco control to gain the goals of sustainable development Vietnam 19 control Strategies of Vietnam follow up to Framework in 1.3.1 Tobacco Convention on global tobacco control 19 1.3.2. Tobacco control Strategies of Vietnam follow to appropriate goals of sustainable development. .21 CHAPTER II. TOBACCO CONTROL MEASURES TO GAIN SUSTAINABLE DEVELOPMENT GOALS IN VIETNAM. 24 2.1. Overview of disease caused by tobacco 24 2.1.1 Tobacco use statistics from Ministry of Health 24 2.1.2. Tobacco use statistics of World Health Organization (WHO) 25 2.2. Some assessment of channels for tobacco control measures to gain sustainable development in Vietnam 27 ii 2.2.1. Results of Vietnam's tobacco control measures follow to six components of Framework Convention on Tobacco Control .28 2.2.2. Impacts of tobacco control measures to gain sustainable development in Vietnam .56 CHAPTER III: PROPOSALS FOR STRENTHING TOBACCO CONTROL MEASURES TO GAIN THE SUSTAINABLE DEVELOPMENT GOALS IN VIETNAM. 69 3.1. Some evaluation on implementing of tobacco control measures in Vietnam 69 3.1.1. An assessment of implementing the smokefree environment at agencies and units in provinces and cities in Vietnam 69 3.1.2. An assessment in organizing the implementation of the Tobacco Control Law in Vietnam 70 3.2. Recommendation for Vietnam tobacco control measures to complete Framework Convention on global tobacco control 74 3.3. Recommendation for Vietnam tobacco control measures to achieve sustainable development goals 81 3.3.1 Some review on the advantages and disadvantages in organizing the implementation of the Tobacco Control Law in Vietnam. 81 3.3.2 Recommendation for Vietnam tobacco control measures to achieve sustainable development goals. .83 CONCLUSION 88 LIST OF REFERENCES .90 iii LIST OF ABBREVIATIONS ASEAN: Association of Southeast Asian Nations COPD: Chronic obstructive pulmonary disease FCTC: Framework Convention on Tobacco Control LMICs: Low and middleincome countries NCDs: Noncommunicable diseases SDG: Sustainable Development Goal WHO: World Health Organization iv LIST OF FIGURE Figure 1: Prevalence of current smoker compared to 2010 and 2015 .28 Figure 2: Average number of the most consumed smoking tobacco product used per day among daily smokers compared to 2010 and 2015 29 Figure 3: Percentage of adult exposed to tobacco smoke at home in 2010 and 2015 30 Figure 4: Percentage of adult exposed to tobacco smoke in the workplace in 2010 and 2015 31 Figure 5: Percentage of adult exposed to tobacco smoke in the public places in 2010 32 Figure 6: Percentage of adult exposed to tobacco smoke in the public places in 2015 33 Figure 7: Percentage of youth exposed to tobacco smoke at home in 2010 and 2015 35 Figure 8: Average cigarette expenditure per month 36 Figure 9: Percentage of tobacco retail points by region in 2010 and 2015 38 Figure 10: Percentage of tobacco retail points by residence in 2010 and 2015 .39 Figure 11: Number of tobacco retail stores within 100m around schools and hospitals in 2017 40 Figure 12: Percentage of smokers planning to quit within next month 41 Figure 13: Percentage of smokers thinking about quitting within next 12 month 42 Figure 14: Number of former smoker 43 Figure 15: Percentage of current smokers who visited a doctor or health care professional and were advised to quit smoking in 2010 and 2015 44 Figure 16: Percentage of people who noticing Health Warnings on Cigarette Packages in the Past 30 days 45 Figure 17: Current smokers who thought about quitting because of a health warning label on a cigarette package 46 v Figure 18: The proportion of smokers who received health warnings on their cigarette packs between 2010 and 2015 .47 Figure 19: Adults who noticed cigarette marketing in stores where cigarettes are sold in 2010 and 2015 48 Figure 20: Currrent smokers who noticed cigarette marketing in stores where cigarettes are sold in 2010 and 2015 49 Figure 21: Adults who noticed any cigarette advertisements, sponsorships, or promotions in 2010 and 2015 50 Figure 22: Current smokers noticed any cigarette advertisement, sponsorship, or promotion in 2010 and 2015 52 Figure 23: Percentage of adult belief the health effects of tobacco smoking 53 Figure 24: Percentage of adults noticed anticigarette smoking information on the television or radio 54 1 ABSTRACT Tobacco harms to the health of people in the general and workingage people in particular, costs health care and carries a burden of disease for the whole health system In addition to the cost of medical examination and treatment caused by tobacco, the loss of productivity due to illness and premature death among working age people. As a macro perspective, tobacco use causes poverty worse at the national level by hampering economic growth. As a microscale, tobacco use impoverishes families of smokers. Investing in tobacco control to achieve poverty reduction, economic growth and prevention of noncommunicable diseases (NCDs) is vital. In fact,Vietnam is one of 193 member countries joined in the sustainable development goals (SDGs) were endorsed by the United Nation which have the aim to “end poverty, protect the planet, and ensure prosperity for all as part of a new sustainable development agenda” Meanwhile, tobacco use has devastating health, social, environmental and economic consequences It is a major barrier to sustainable development Tobacco use has negatively affects to many of the 17 SDGs. Therefore, tobacco control is essential for sustainable development in Vietnam . This thesis with topic:“Tobacco control to gain SDGs of Vietnam” will study the current measures of tobacco control in Vietnam, summary Vietnam's results in harm prevention of tobacco. Also, the thesis focuses on more detailed analyzing and comparing data from two Vietnam's surveys follow to Global Adult Tobacco Survey (GATS) in 2010 and 2015; then, point out the impacts of tobacco control in gaining sustainable development in Vietnam, particularly in gaining SDG 1 (End poverty) and SDG 3 (Ensure health for all at all age) and quality educational goals. The finding also have some review on implementing of tobacco control measures in Vietnam and give some recommendation for Vietnam to improve Framework Convention on Tobacco Control in the next period in order to gain suitable SDGs. First chapter of thesis will mention to the concept of “sustainable development” and 17 SDGs adopted by United Nation that identify health as central to development. By outlining the link between tobacco, poverty and economic development, it shows that tobacco is incompatible with sustainable development. Then, thesis will mention an overview of the current situation of tobacco use in Vietnam that point out Vietnam is one of the 15 countries with the 2 highest rates of adult male smoking in the world (47,4%, GATS 2010) and the passive smoking rate in Vietnam is also very high (67.6% at home, 49% at work, Ministry of Health, 2010), poor people tend to smoke more than highincome people. Tobacco consumption also has a significant economic impact as well. Then, thesis will have some review on legistation about the way Vietnam goverment facing the tobacco epidemic. Vietnam has been taking interventions, which are evident in its membership to the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC) and integrate the implementing this Convention in the Sustainable Development Goals (SDGs) and the United Nations Agenda for Sustainable Development This chapter also describes two channels for Vietnam’s tobacco control measures to gain sustainable development that are improving the WHOFCTC and following to appropriate and priority goals of sustainable development. The next chapter focused on some assessment of channels for tobacco control measures to gain sustainable development in Vietnam By description, review the results of Vietnam’s tobacco control measures follow to World Health Organization Framework Convention on Tobacco Control (WHOFCTC), the thesis will analyze some impacts of these measures to gain prioritize goals in sustainable development goals in Vietnam. This chapter point out tobacco use is a major risk factor for a non communicable disease, tobacco use damages health and socio economic development, also increases poverty Some review on cost of smoking in Vietnam that affects directly to economic, indirectly to productivity losscauses hunger and food insecurity. The direct costs of health care and treatment caused by tobacco used can be large outofpocket costs of users, especially in poor households. Also, tobacco control to ensure healthy lives and promote wellbeing, gain quality education goal, gender equality, etc. The last chapter is some proposals to strengthen tobacco control to gain the sustainable development goals in Vietnam. Chapter begin with some evaluation on implementing of tobacco control measures in Vietnam such as implementing the smokefree environment in Vietnam (included enforcing smokefree environments at work; at kindergartens and primary schools; at specified public places); review on organizing the implementation of the Tobacco Control Law in Vietnam (legal documents; responsibilities of heads of agencies, organizations and localities) and 3 handling violations, etc. Based on these evaluation, thesis give some recommendation for Vietnam’s tobacco control measures to complete Framework Convention on global tobacco control that support to improve MPOWER package in the coming time. And, this chapter willreview on the advantages and disadvantages in organizing the implementation of the Tobacco Control Law in Vietnam which point out new challenges in tobacco control That is emerging tobacco products such as heating tobacco products, electronic cigarettes and the another sophisticated tricks of the tobacco industry that are aimed to youth and have more lasting negatively effects Based on this, thesis will give recommendation to achieve sustainable development goals such as need to have more studying which showsevidence on the linkage between tobacco use and poverty to persude policy makers to rise taxes on manufactured tobacco products regularly and uniformly across all tobaccotypes, strengthen anti smuggling measures, integrate tobacco control in broader poverty reduction efforts, particularly in governing the emerging tobacco products 4 INTRODUCTION 1. Research rationales The sustainable development goals (SDGs) were endorsed by the United Nations and hence all of its 193 member countries which Vietnam is one of them. The Sustainable Development Goals are a United Nations initiative, formally adopted by the United Nations General Assembly on 25 September 2015 in a resolution entitled Transforming our world: the 2030 Agenda for Sustainable Development. The SDGs build on and succeed the Millennium Development Goals. They include 17 goals and 169 targets to be achieved over the next 15 years, with the aim to “end poverty, protect the planet, and ensure prosperity for all as part of a new sustainable development agenda”. The sustainable development goals apply to all countries, rich and poor, and recognize the crucial interrelationship of health, poverty, education, gender, and many other issues. Meanwhile, tobacco use has devastating health, social, environmental and economic consequences. It is a major barrier to sustainable development. Tobacco use impacts health, poverty, global hunger, education, economic growth, gender equality, the environment, finance and governance. Each year, more than 7 million people die from tobacco use that is expected to increase to 8 million by 2020 (Mathers et al., 2006). Vietnam is one of the top 15 countries which male adult smoking prevalence is highest in the world that account for about 40,000 people die from tobaccorelated diseases, each year (Levy et al. 2006) And, a fact that 70% of deaths will occur in developing countries (Mathers et al., 2006) which bear almost 40% of the global economic cost of smoking from health expenditures and lost productivity, estimated at over US$ 1.4 trillion. If tobacco control is not taken effective, in this century, tobacco will kill 1 billion people, more than the total number of deaths from HIV/AIDS, tuberculosis and traffic accidents, the road resurfaces. Based on the analyze above, tobacco negatively affects many of the 17 sustainable development goals. Thereof, tobacco control is essential for sustainable development. The inclusion of FCTC implementation as a key target for the health goal recognizes the magnitude of the smoking epidemic. The sustainable development goals cigarette manufacturing (joint venture with Philip Morris, formerly with Sampoerna) and accessory production (joint venture with New Toyo). Most cigarettes produced in Vietnam are made by the stateowned Vietnam Tobacco Corporation (Vinataba) and its subsidiaries, which currently own 11 of the country’s 17 factories and produce more than 200 brands nationwide. Other facilities are under local management. The largest member of the Vinataba group is the Saigon Cigarette Company, which produces 25 brands in its Saigon and Vinh Hoi cigarette factories, resulting in about 26 billion sticks yearly or 1.3 billion 20piece packs. Saigon Cigarette Company manufactures the most popular foreign brands produced under license by Vinataba, such as 555 State Express and Marlboro, which capture a significant share of the market. In 2005 more than 20% of cigarettes sold in Vietnam were linked to foreign brands (i.e. either produced by joint ventures or by the Vinataba group through business cooperation contracts). This is up from a 5% share in 1998, and occurs in spite of the 2001 government decree implementing tobacco control measures and banning operations by foreign tobacco companies, as well as the aforementioned renewed decree on cigarette production and trading. In 2000: Government of Vietnam furthers its commitment to tobacco control and adopts a national tobacco control policy, the overall objective of which is to reduce the male smoking rate from 50% to 20% and maintain the female smoking rate below 2%. In 2004: Vietnam commits to global tobacco control. The Framework Convention on Tobacco Control (FCTC) is ratified in December. In 2006: Vietnam’s special consumption tax (SCT) on cigarettes is made uniform across cigarette and cigar types and set at 55% of the pretax exfactory price. SCT is increased to 65% of the pretax ex factory price in January 2008 56 In 2007: The Ministry of Health fails to adopt strong health warning measures Health warnings remain but without strong wording or pictorials (warnings to be 30% of the principal display areas). In 2012: ASEAN Free Trade Area (AFTA) tariff reductions to be fully implemented. In 2016: The proportion of the retail price of the most popular price category of tobacco product consists of taxes and value added tax/goods and services tax (VAT/GST) is 75% that Combination of specific and ad valorem taxes. Cigarettes and other tobacco products can be taxed in a variety of ways, including excise taxes, other valueadded taxes, and import duties. Excise taxes can be either specific (based on quantity or weight) or ad valorem (based on value). In some cases, both specific and ad valorem elements are combined in a single excise duty. The MPOWER program concluded: "Tobacco taxes are generally well received by the community in a positive manner and increase the government budget. There is a need to raise taxes regularly to regulate inflation and consumer purchasing power." 2.2.2. Impacts of tobacco control measures to gain sustainable development in Vietnam Noncommunicable diseases , usually chronic diseases, include those that are not communicable, have a long duration and generally slow progression. The disease creates a heavy burden of illness due to the high rate of disability and premature death The risk of disease is mainly due to unhealthy lifestyle and unfavorable environmental factors. However, many risks of NCDs can be prevented. There are four main types of NCDs currently of concern: cardiovascular diseases (such as heart attack and stroke), cancers, and chronic respiratory diseases (such as chronic obstructive pulmonary disease. and bronchial asthma) and diabetes. According to a report by the WHO, of about 57 million deaths in 2008, 36 million, accounting for 63% of the cases were due to noncommunicable disease. The leading cause of death from NCDs globally in 2008 was cardiovascular disease (17 million people, or 48% of all deaths due to NCDs) 57 According to the organization's global report on NCDs in 2014, cardiovascular still accounts for a high rate of 46%, cancer 22%, chronic obstructive pulmonary disease (COPD) accounts for 10% of the cause of death due to disease. The Southeast Asia and Western Pacific regions are the regions with high mortality rates from NCDs compared to other regions of the world. It is estimated that the economic loss caused by the 4 main groups of NCDs is about 30 trillion USD over the next 20 years. In Vietnam, according to the official report of the Ministry of Health, NCDs are the leading cause of death. 7 out of 10 deaths are due to NCDs diseases. The WHO estimated that in 2012, Vietnam had 520,000 deaths, of which 73% of deaths from NCDs (about 379,600 cases). Every year, there are 75,000 cases of cancer deaths, and around 125,000 new cancer cases are discovered. The proportion of the population suffering from high blood pressure is 25%, diabetes (in the age group 2079) is 5.8%, and chronic obstructive pulmonary disease in the community aged 15 and over is 2.2% Meanwhile, smoking is a leading risk factor for NCDs Noncommunicable diseases are the direct cause of hospital overcrowding, increasing poverty, and pressures on socioeconomic development. Thus in the world as well as in Vietnam, NCDs threaten progress towards the Sustainable Development Goals including reducing premature mortality due to NCDs by onethird by 2030.WHO says inter poverty closely related to NCDs, it is expected that the rapid rise of NCDs will hamper poverty reduction initiatives in lowincome countries, especially increasing the expenditure on healthrelated households; vulnerable and marginalized subjects have NCDs and die earlier than those with stable lives due to increased risk of exposure to harmful products such as tobacco, unhealthy diet and lack of intake In lowresourced settings, the cost of health care for NCDs quickly depletes the family economy, the cost of NCDs due to costly longterm treatment and loss of labor resources. Millions of people live in poverty and hold back the potential for national development 58 2.2.2.1. Tobacco control to gaining: End poverty in all its forms everywhere and Zero hunger goals. Tobacco use leads to chronic diseases that are costly to treat and premature deaths that cause financial burdens on families Tobacco addiction depletes meager family income of the poorest households. Tobacco companies set a low price for poor farmers and their contract growing deals keep farmers in a debt cycle Tobacco impoverishes governments due to the enormous financial burden it incurs with respect to health care costs, lost productivity, and environmental damage, among others. There are a number of links between tobacco and poverty: The poor have higher smoking rates than the rest of the population, but can afford tobacco least. All expenditures on tobacco represent lost funds that could have been spent on basic needs such as food, education, and health care. Many tobacco farmers find that rather than generating real income on the crop, they simply fall further into debt. This is in part because tobacco is a very chemically intensive and labour intensive crop, requiring not only high fertilizer and pesticide inputs but also much labour. Many of those employed in tobacco production earn very low wages and work in inhumane working conditions. In addition, farmers have no control over the grading of their product or of the price that they receive for it; this can mean that they earn less than it cost to grow the crop. However, since they normally obtain loans from the company for seed and fertilizer, tobacco farmers cannot stop growing tobacco until they repay the loan—a system that benefits the industry. The high labour costs can also mean that parents do not send their children to school, thereby virtually ensuring the generational continuation of poverty. Tobacco consumption can affect the family economy in several important ways First, it reduces the total amount of money available for basic needs, as mentioned above. It also potentially increases health costs and reduces productivity as a result of illness. Poverty and the opportunity costs of tobacco: 59 When very poor men are addicted to tobacco and purchase cigarettes rather than food and other important goods and services, women and children, in particular, suffer There are a number of reasons for this. First, money spent on tobacco means less security for the family with regard to food. Adequate nutrition for mothers and children improves pregnancy outcomes and reduces susceptibility to infectious diseases, including HIV/AIDS and tuberculosis Poor nutrition increases infant mortality and makes older children less likely to succeed at school. Second, less money in the family limits other important purchasing possibilities There is a correlation between disposable income and likelihood of seeking medical attention for a sick mother or child If more money is spent on tobacco than on education, there is less chance that children, especially girls, will be sent to school. If money is scarce, children are more likely to be required to work to contribute to family income. These decisions can entrench families in an ongoing cycle of poverty, as the very investments necessary to lift family members out of poverty are foregone in favour of an addictive drug. In addition, when a household member smokes, he or she exposes all members of the family to the hazards of passively inhaled tobacco smoke. Of course, even if comprehensive quit programmes existed in developing countries, people may not automatically spend the money saved from tobacco on food and other beneficial goods Nevertheless, the concern is that for people with tiny incomes, any money spent on tobacco is money that could keep women and children (and men) alive and healthy in the short term. Although the tobacco industry contributes to the national budget, the contribution of the tobacco industry is not enough to offset the economic and health losses caused by tobacco use to personal, family and social These losses include spending on smoking, spending on medical examination and treatment related to smoking, due to disability due to illness and premature death, losses due to fire and explosion, environmental pollution, etc. In 2012, Vietnamese people spent 22 trillion VND on buying cigarettes 60 Spending on tobacco reduces other household essentials, especially low income households. Poor households in Vietnam have to spend about 5% of their family income on tobacco. In these households, the money to buy cigarettes is even higher than the money spent on health or education. If poor smokers quit, they would have more money to buy food or to pay for their children's education. In addition to the cost of smoking, total treatment costs and disability due to illness and premature death for 5 diseases (lung cancer, upper respiratory tract cancer, lung disease chronic obstructive, myocardial infarction, stroke) caused by smoking. The total economic cost of smoking in 2011 was estimated at 24 679.9 billion Vietnamese dong (VND), equivalent to US$1173.2 million or approximately 0.97% of the 2011 gross domestic product The direct costs of inpatient and outpatient care reached 9896.2 billion VND (US$470.4 million) and 2567.2 billion VND (US$122.0 million), respectively. The government’s contribution to these costs was 4534.3 billion VND (US $215.5 million), which was equivalent to 5.76% of its 2011 healthcare budget The indirect costs (productivity loss) due to morbidity and mortality were 2652.9 billion VND (US$126.1 million) and 9563.5 billion VND (US $454.6 million), respectively. These indirect costs represent about 49.5% of the total costs of smoking. At the national level, in Viet Nam, it has been found that the money spent on tobacco each year, if redirected, would purchase enough rice to feed 10.6 million people for one year. The poorest Vietnamese also spend more money on tobacco than on education. Smokers in Vietnam spent 5,834 billion VND ($US416.7 million) on cigarettes in 1998. This amount could buy 1.6 1.8 million tons of rice, which is sufficient to feed 10.6‐ 11.9 million people per year. Therefore, tobacco control contributes to poverty alleviation efforts. Tobacco control measures (ban on advertising, smoke free places, higher tobacco taxes, etc.) will reduce tobacco use and spending on the vice and healthcare; and instead, allow income to be redirected towards necessities like food, education, and other investments that could lift the poor out of poverty 61 Also, tobacco use causes hunger and food insecurity, as spending on food is diverted to tobacco products Studies have shown that in lowincome households, spending on tobacco products often represent more than 10% of household expenditure, taking away income for necessities like food. On the other hand, food insecurity has also been found to be a risk factor for smoking, as people cope with financial stress. On the production side, tobacco cultivation eats up large areas of land which could otherwise be used for food production. Tobacco is one of the major causes of soil and land degradation, stripping the soil of nutrients faster than other crops, contributing further to food insecurity as the land becomes unsuitable or less productive for purposes of growing food crops. A decrease in tobacco consumption could improve immediate health outcomes, such as the incidence of cardiovascular and respiratory diseases, as well as intermediate health outcomes that are mediated by poverty, such as child malnutrition. Parental tobacco use in households is associated with an increased risk of stunting, underweight, wasting and severe malnutrition in children under the age of 5 years. Furthermore, the public health impact of children’s exposure to secondhand smoke is substantial. Young children are especially vulnerable to environmental tobacco smoke exposure, which causes a variety of illnesses in children, including lower respiratory tract infections, fluid in the middle ear and a reduction in lung function. Household expenditures on tobacco are especially problematic in countries with low socioeconomic status such as Vietnam, where households with smokers spend approximately VND 627 000 (US$ 40) per year on tobacco. Tobacco expenditures can lead to poverty and exacerbate its effects by diverting household income away from essential needs. For the “poor” and “poorest” Vietnamese households (i.e. lowest two income quintiles), annual spending on tobacco often constitutes a substantial share of annual spending on essential items such as food, clothing and education. If a portion of the money spent on tobacco by poor households in Vietnam were reallocated toward food purchases, approximately 11.2% of all foodpoor smoking households could potentially be 62 raised above the food poverty line. While not all savings gained from eliminating tobacco purchases would necessarily be invested in food and other. Reducing tobacco use can redirect spending to ease hunger (food and nutrition), from tobacco products and health costs for tobaccorelated illnesses. Food assistance and tobacco reduction programs are mutually beneficial. Further, land used for tobacco production can be shifted to the growing of food crops with support from the government as mandated under the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). 2.2.2.2. Tobacco control to ensure healthy lives and promote wellbeing for all at all ages According to the World Health Organization, tobacco use in the world is a major cause of lung diseases, typically lung cancer and chronic obstructive lung disease. 90% of the world's over 600,000 lung cancer sufferers every year are smokers (WHO). Smoking is also responsible for 75% of chronic obstructive pulmonary cases In Vietnam, according to figures of the Central Cancer Hospital, the proportion of lung cancer patients who smoke is 96.8%. The number of deaths due to noncommunicable diseases accounts for 73% of all deaths due to illness and injury in Vietnam, one of the main reasons is the high prevalence of tobacco use. Vietnam is among the 15 countries with the highest number of smokers world According to the Global Adults Tobacco use survey in 2010, the male smoking prevalence was 47.4% (on average two men in one person smoking), in women it was 1.4%. Twothirds of women and children often breathe have to smoke at home. 33 million people do not smoke but often breathe have to smoke in the house. 5 million nonsmokers regularly breathe in secondhand smoke at work. High smoking rates have caused enormous health and economic harm in Vietnam. According to a survey at K Hospital in 2000, the proportion of lung cancer patients had smoke up to 96.8%. And, smoking is the main cause of lung cancer. 90% of patients with lung cancer due to smoking. In cigarette smoke, there are about 4000 active substances that are toxic to the body, especially 34 benzopyzen substances are clearly carcinogenic in experiments. So there are patients who are diagnosed with lung cancer but they do not smoke, they may have been exposed to 63 a significant amount of tobacco smoke (passive smoking, inhalation of cigarette smoke during the time). long) At K Hospital, many patients with lung cancer have been smoking more than 10 cigarettes per day for many years. Along with that, waterpipe smoking is also one of the main causes of lung cancer. Research by the Health Strategy and Policy Institute in 2011 shows disease and early death from tobacco lost 1.5 million years to health for Vietnamese, accounting for 12% of the total burden of disease. At present the burden of disease is not contagious. The main cause is tobacco increasing rapidly. In 1986, the disease Noncommunicable patients only account for 39% of the hospitalization cases. In 2011, this ratio was 62.7%. According to the World Health Organization, the number of cases deaths from noncommunicable diseases account for 75% of all deaths due to diseases and injuries in Vietnam. Diseases caused by tobacco use such as stroke, pulse coronary heart disease, chronic obstructive pulmonary disease (COPD), lung cancer The leading cause of death in both men and women. Every year in Vietnam, about 40,000 people die from diseases tobacco related If no stronger tobacco control measues is taken, by 2033 at least 67,000 Vietnamese will die annually due to smoking. When lung cancer was used to measure cumulative smoking exposure, 28% of all adult male deaths (>35 years) in Vietnam in 2008 were attributable to smoking According to the estimates in "Burden of cancer attributable to tobacco smoking in member countries of the Association of Southeast Asian Nations (ASEAN), 2012" study, tobacco smoking accounted for 131,502 of new cancer cases in ASEAN member countries in 2012 (114,775 in male and 16,727 in female). In male, the total number of smoking attributable cancer incidence was the highest in Indonesia (38,341), followed by Vietnam (24,261). In male, the number of patients with lung cancer attributable to smoking was the highest followed by liver cancer while, in female, the number of patients with lung cancer attributable to smoking was the highest followed by cervix uterine cancer. Tobacco use causes death, disability and disease. Tobacco kills over 8 64 million people every year, costs the world economy nearly 2% of its gross domestic product, and strips land and soil of their viability How tobacco control helps Sustainable Development Goal: One of the SDG targets is strengthening the implementation of WHO FCTC, a treaty which sets forth measures proven to be effective in reducing tobacco consumption. If nothing is done, one billion people could die from tobaccorelated diseases in this century The Who Health Organization estimates that the burden of these chronic diseases has increased in Vietnam and now exceeds the burden caused by infectious diseases. Poor people are more vulnerable to chronic diseases; they are also more exposed to some of the risk factors. 2.2.2.3. Tobacco control to gain quality education goal. Tobacco products are addictive. More is spent on tobacco than on education in low and middleincome countries (LMICs) Tobacco use results in children being forced to drop out of school to take care of a sick relative or to find work to make up for lost wages. Many children about 1.3 million children (under 14 years old) are out of school as they work in tobacco fields. Studies have also shown that smoking among adolescents and exposure to secondhand smoke leads to learning problems/cognitive impairment Tobacco control keeps children in school. Money can be used for the education of children, rather than on tobacco addiction or tobaccorelated diseases Without tobacco, families can better afford to keep kids in school. Reduced tobacco production means that more children are not kept from school to work in tobacco fields. Reducing adolescent smoking reduces the risks of learning disabilities and of cognitive impairment later in life 2.2.2.4. Tobacco control to gain Gender equality and Reduced inequalities goal. Tobacco use has been rising among women, as women have been specifically targeted by the tobacco industry. In certain countries, there are already more women or girls smoking than boys or men Women face genderspecific health risks from tobacco, such as the disproportionate burden in exposure to secondhand smoke and use during pregnancy. Globally, secondhand smoke accounted for 886,000 deaths in 2015 65 As analyze above, in terms of gender, in Vietnam the current prevalence of smoking among women decreased from 1.4%, from 1.3% in 2010 to 1.1% in 2015 Also, the proportion of secondhand smoke exposure in women dropped by 14.2% more than men during the period. In terms of age group, home smoke exposure rate dropped the most in this period, aged 2544 (15.5%), followed by 1524 years (11.4%), followed by 45 64 years old (11.2%) and the lowest is over 65 years old (10.9%). The proportion of secondhand smoke exposure in homes in urban areas is much lower than in rural areas. Specifically, the urban tobacco smoke exposure rate decreased by 16.3% during this period while that of the rural area decreased by 10.9%. Tobacco control measures can stop the rise in tobacco use among women and girls, and reduce problems associated with secondhand smoke exposure. The WHO FCTC requires parties to undertake measures which address genderspecific risks under Article 4.2. At national level, tobacco wastes scarce financial resources and widens social inequality. There is evidence that tobacco use widens social inequality. The prevalence of tobacco use is higher among the poor, and the poor spent a larger portion of their household expenditures on tobacco. Tobacco use widens inequality. In most countries, tobacco use is highest among the poor, those with low literacy rates and those with a mental health condition. LMICs bear 87% of the world’s premature mortality from non communicable diseases, “with the poorest and most marginalized disproportionately affected.” Those already facing social disadvantage, living in neighborhoods that are unsafe or with limited recreation or with limited access to health services and information for example, are more vulnerable to smoking, which leads back to inequitable conditions. Tobacco control can close gaps in inequality Tobacco taxes are proven to reduce consumption, most among the poor, thereby reducing inequities in smoking and its impacts, especially when revenues from taxes are reinvested into disadvantaged communities Reducing tobacco use through effective tobacco control measures as provided in the WHO FCTC will improve health and increase 66 opportunities in education and labor, among others, which can further reduce inequalities 2.2.2.5. Tobacco control to gain responsible consumption & production Vietnam ranks among the countries with the highest prevalence of smoking, and the poor smoke more and quit less than do those with higher incomes. Both cigarette production and consumption in Vietnam have risen sharply over recent decades. Tobacco consumption generates tons of waste and releases thousands of chemicals into the planet’s air, water and soil. Cigarette butts are the most discarded waste item worldwide, amounting to 1.69 billion pounds of toxic trash each year Smokers are at higher risk of dying from cardiovascular disease and lung cancer, because air pollution combines synergistically with cigarette smoking for mortality. Tobacco control can enhance responsible consumption and production by reducing tobacco use and its resultant waste. Tobacco control “encourages countries and individual farmers to shift from tobacco production toward activities that are friendlier to people and planet, while supporting tobacco users to quit or reduce consumption and nonusers to never begin. There are many studies shows that questionable economic gain but evident health risks in tobacco farming in rural Vietnam. For years, in search of even more profits, the tobacco industry has encouraged countries and farmers to grow more tobacco. Tobacco companies have promoted tobacco growing as a panacea, claiming that it will bring unparalleled prosperity to farmers, their communities, and their countries. Viet Nam is a prime target for the tobacco industry: a developing country with a tropical climate appropriate for tobacco cultivation, and hard working laborers. The total area devoted to tobacco cultivation in Vietnam in 2002 was about 18,000 hectares (accounting for 0.28% of total agricultural land) which gave an output of about 27,400 tones of tobacco per year. The number of fulltime equivalent tobacco cultivators was about 136,000. The tobacco industry has established a plan to gradually increase domestic tobacco leaf production toward the year 2010 through increased production areas and improved yields. While the cigarette industry argues that tobacco farming is a major contributor to the country's 67 economy, the seriously damaging health and environmental impacts caused by tobacco farming have been well documented. From the moment the tobacco seed is planted to the time the tobacco plant is harvested and cured, the health of those who cultivate the crop is constantly at risk. The hazards posed by tobacco cultivation place tobacco workers at increased risk of injury and illness. Children and adults (mainly women) working with tobacco frequently suffer from green tobacco sickness (GTS), which is caused by dermal absorption of nicotine from contact with wet tobacco leaves. GTS is characterized by symptoms that may include nausea, vomiting, weakness, headache, dizziness, abdominal cramps, and difficulty in breathing, as well as fluctuations in blood pressure and heart rate. Large and frequent applications of pesticides to protect the plant from insects and diseases can cause poisoning, skin and eye irritation and other disorders of the nervous, respiratory systems, as well as kidney damage. Tobacco growing also causes a lot of damage to the environment In many developing countries wood is used as fuel to cure tobacco leaves and to construct curing barns. An internationally estimated 200 000 hectares of forests and woodlands are cut down each year because of tobacco farming. Environmental degradation is also caused by the tobacco plant, which leaches nutrients from the soil, as well as pollution from pesticides and fertilizers applied to tobacco fields. In Vietnam, tobacco control has recently received greater attention The Vietnamese Government's readiness to curb the epidemic of tobacco related disease was reflected in the Prime Minister's Decision No 77/2002/QDTTg on the Ratification of the Programme of Prevention and Control of Certain Non communicable Diseases for the Period 2002–2010 and the Government Resolution No 12/2000/NQCP on National Tobacco Control Policy 2000 – 2010. Vietnam signed the Framework Convention on Tobacco Control on August 8, 2003 and ratified it on 17 December 2004. In order to enforce the policies on tobacco control in Vietnam, especially the enactment of the tobacco control law, reliable information on the economic and health effects of tobacco farming is urgently needed by health advocates, as well as for society in general. 68 On the other hand, the tobacco industry seeks partnerships with governments and institutions in order to promote its commercial interests Tobacco industry partnerships with government and other institutions form part of its public relations strategy, designed to enhance their image, by lending them credibility and legitimacy, and thereby sending a deceptive message that their products are safe and benign. The tobacco industry uses partnerships with government and other institutions, including through socalled corporate social responsibility (CSR) contributions and activities, to gain access to highlevel officials, which allows them to help in crafting policies that are in line with their commercial interests, including the provision of tax exemptions and delaying enforcement of tobacco control policies, among others Article 5.3 of the WHO FCTC provides that parties must protect public health policies from the commercial and vested interests of the tobacco industry The guidelines for implementation of Article 5.3 lay down specific measures to ensure compliance with the foregoing obligation, including the rejection of partnerships and other agreements with the tobacco industry. Full compliance with Article 5.3 of the WHO FCTC ensures transparency and that policies adopted and implemented are in line with the standards provided in the treaty 69 CHAPTER III: PROPOSALS FOR STRENTHING TOBACCO CONTROL MEASURES TO GAIN THE SUSTAINABLE DEVELOPMENT GOALS IN VIETNAM. 3.1. Some evaluation on implementing of tobacco control measures in Vietnam. The first comprehensive legal framework for tobacco control in Vietnam is the National Tobacco Control Policy 2000 2010, approved by Resolution No 12/2000/NQCP which was signed by the Prime Minister (Vietnamese Government, 2000). Some reviews on the implementation of the Tobacco Control Law as below: 3.1.1. An assessment of implementing the smokefree environment at agencies and units in provinces and cities in Vietnam 3.1.1.1. Enforcing smokefree environments at work The implementation of the smokefree environment has been implemented at ministries, agencies and social organizations. More than 90% of Ministries, agencies and organizations have regulations on banning smoking in the workplace by higher authorities and there is a regulation to ban workplace smoking in the workplace cultural regulations In addition, the agencies that strictly implement the regulations on no smoking in the office, but the percentage of good implementing agencies that ban smoking in the hallway/stairs has not reached the target of 65%. Thus, it can be seen that, in terms of policy, the ministries, branches and social organizations all agreed and implemented the ban on smoking in houses in the guidelines and official documents This also provides a positive result of the implementation of the law and the implementation of the law on smokefree environment at agencies, at least on guidelines. In the coming time, it is advisable to continue promoting the thorough implementation of the smokefree environment in the home, even in the corridor. 3.1.1.2. Enforcing smokefree environment in kindergartens and primary schools Overall, at least 70% of preschool and elementary schools nationwide have strictly enforced the no smoking policy on campus. According to the tobacco control plan, the implementation plan in 2016 is that 70% of kindergartens and primary schools strictly forbid smoking on campus. By the time of evaluation, this 70 plan has been achieved and exceeded the target. The good news is that no school sells cigarettes on its campus and no school accepts tobacco sponsorships. However, there were still less than 15% of schools still having cigarette butts, tobacco smells and smoking behaviors during the observation period. By law, schools are one of the places where smoking is strictly enforced, even on school property. Therefore, in the coming time, it is necessary to continue supporting to implement thoroughly at the school. 3.1.1.3. Enforcing smokefree environment at specified public places (from people's observation). Thus, it can be said that the implementation of a smokefree environment has been implemented in provinces and cities nationwide and has initially achieved certain goals This result from the observation channel of the local people is completely consistent with the results that the research team reported on interviews with leaders in state agencies and on the basis of the research group conducting the observation implementation. at the school. It can be seen that the implementation of smokefree environment regulations in accordance with the law is quite good at the above locations However, implementing a smokefree environment is still difficult and difficult to implement at locations such as tea shops, cafes, restaurants and bars. This is a major challenge in implementing the smokefree environment. In the coming time, the Fund should continue researching to be able to implement at least piloting some models at some restaurants, cafes, tea shops and coffee shops. 3.1.2. An assessment in organizing the implementation of the Tobacco Control Law in Vietnam 3.1.2.1 Assessment of the situation of tobacco use in Vietnam Results of the 2015 national survey (GATS) show that the smoking rate among men is 45.3%, the passive exposure rate to secondhand smoke at work is 30.9%, at school. 16.1% at health facilities 18.4%. Initial survey results in some provinces in 2018 showed that 12 provinces had a lower and lower male smoking rate than the national survey in 2015, such as Quang Ninh, Bac Giang, Lao Cai and Son. La, Thai Binh, Yen Bai, Lang Son, Ninh Binh, Nghe An, Phu Tho, Hoa Binh and Quang Tri. However, there are still some 71 provinces with higher male smoking rates than the national survey such as Ho Chi Minh City (46.7%), Hau Giang (46.8%) The proportion of secondhand smoke exposure at workplaces, health facilities, and schools decreased significantly compared to 2015. However, the survey results also showed that the exposure rate to secondhand smoke in restaurants and bars eating, coffee shops have not decreased compared to 2015 (over 80%). 3.1.2.2. Assessment in implementation of responsibility for state management of tobacco control Carry out the state management of tobacco control according to Clause 2, Article 5 of the Tobacco Control Law, in the period of 20172018, the Ministry of Health has developed or cooperated with other ministries and construction sectors to submit The Government and the Prime Minister issue and promulgate according to their competence a number of legal documents, such as: The revised Law on Special Consumption Tax on Tobacco Goods; Comments on the draft Law amending and supplementing a number of articles of the Planning Law with regulations related to tobacco business planning. Draft Decree amending and supplementing a number of articles of Decree No.176/2013/NDCP stipulating sanctions against administrative violations in the field of health, including tobacco control. Decision No.20/2018/QDTTg dated April 26 th, 2018 of the Prime Minister stipulating the destruction of confiscated illegally imported cigarettes which are confiscated fake cigarettes and confiscated imported cigarettes and quality assurance for export abroad. Coordinate with the Ministry of Culture, Sports and Tourism to formulate the Circular No.25/2018/TTBVHTTDL dated August 30, 2018 of the Ministry of Culture, Sports and Tourism on restricting images of actors. tobacco use in cinematographic works; Comments on the draft Decision to replace Decision No.15/2017/QD TTg on the list of imported goods subject to customs procedures at the import gate (tobacco goods) ... 2.2.1. Results? ?of? ?Vietnam'' s? ?tobacco? ?control? ?measures follow? ?to? ?six components? ?of? ? Framework Convention on? ?Tobacco? ?Control .28 2.2.2. Impacts? ?of? ? tobacco? ?control? ?measures? ?to? ?gain? ?sustainable? ?development? ? in ... control? ?Strategies? ?of? ?Vietnam? ?follow up? ?to? ?Framework in 1.3.1 Tobacco Convention on global? ?tobacco? ?control? ? 19 1.3.2.? ?Tobacco? ?control? ?Strategies? ?of? ?Vietnam? ?follow? ?to? ?appropriate? ?goals? ?of? ? sustainable? ?development. ... Vietnam 16 1.2.2. Some results? ?of? ?the implementation? ?of? ?Tobacco Control? ?Law 17 1.3. Channels for? ?tobacco? ?control? ?to? ?gain? ?the? ?goals? ?of sustainable development Vietnam 19 control? ?Strategies? ?of? ?Vietnam? ?follow up? ?to? ?Framework

Tiêu đề	Tobacco Control To Gain Sustainable Development Goals Of Vietnam
Tác giả	Nguyen Thi Le Thuy
Người hướng dẫn	Assoc. Prof. Dr. Tu Thuy Anh
Trường học	Foreign Trade University
Chuyên ngành	International Economics
Thể loại	master thesis
Năm xuất bản	2020
Thành phố	Hanoi

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