National surveillance systems
Research, surveillance and information exchange increase evidence-based decision- and policy-making. Tobacco control monitoring among the Parties to the WHO FCTC is essential for strengthening and ensuring the full implementation of the treaty.
Surveillance of tobacco use in the population is the foundation of tobacco control monitoring. Age-standardized prevalence of current tobacco use among persons aged 15 years and older is also a progress indicator under the Sustainable Development Goals (SDGs) target 3.a – strengthen the implementation of the WHO FCTC.
Regular monitoring should address not only surveillance of tobacco use patterns and trends and exposure to tobacco smoke, but also their health impact, and the scope and implementation of tobacco control policies. Further, Parties benefit from monitoring different types of tobacco and nicotine products, and social and economic impact of tobacco and nicotine use.
Effective monitoring system can comprise of several different mechanisms and tools, such as censuses, surveys, longitudinal studies, civil registration and vital statistics (e.g. records of cause of death), health information systems (e.g. patient records) and administrative systems (e.g. excise tax collection records).
The characteristics of effective tobacco control monitoring systems include:
SIMPLE – Reduces the need for intensive training
VALID – Protocols to ensure consistency and minimize errors
TIMELY – Availability of results as quick as possible
FLEXIBLE – Able to adapt to new products and policies
SUSTAINABLE – Investment to human and financial resources
STANDARDIZED – Data comparability over time
REPRESENTATIVE – Of the general population
USABLE – Plans for data dissemination, publication and promotion in place
PERIODIC – Captures changes over time
Steps in building a national tobacco monitoring system
Assessing existing data sources and surveillance methods is the first step in building a coordinated national system. Non-communicable
disease (NCD) surveillance often provides opportunities for integrating key tobacco indicators to existing health surveys in a cost-effective way.
The following steps can be beneficial for assessing and improving national monitoring systems, especially in low resource settings:
- Assess existing data sources;
- Assess what type of new data is needed;
- Identify re-occurring data collections in related fields, such as NCD or tuberculosis surveillance;
- Build relationships with the organizations collecting and possessing data;
- Sensitize the WHO FCTC focal point and other key stakeholders for seeking political engagement and allocation of sufficient resources;
- Partner with government agencies, academia or non-governmental organizations;
- Promote integration of key tobacco indicators to existing surveillance systems;
- Train staff already skilled in monitoring and surveillance to tobacco indicators;
- Share staff trained in surveillance or analysis between different sectors;
- Share and publicise data and results, and use those to advocate for and develop tobacco control policies.
WHO report on the global tobacco epidemic, 2017: Monitoring tobacco use and prevention policies. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. Note: The list of characteristics of effective monitoring systems is based on the summary on p. 39 of the report, which is adapted from: Glynn MK, Backer LC. Collecting public health surveillance data: creating a surveillance system. In: Lee LM, Teutsch DM, Thacker SB, St Louis ME, editors. Principles and practice of public health surveillance, third edition. New York: Oxford University Press; 2010:44–64.
WHO FCTC Secretariat’s Knowledge Hub on Surveillance. Implementation of Article 20 of the WHO FCTC in low- and middle-income countries (LMICs) in 2018. Fact sheet. Helsinki: National Institute for Health and Welfare (THL); 2018.