Today we mark World No Tobacco Day and this year the focus is on “Tobacco and Heart Disease.” The goal is to highlight the important and often overlooked role of smoking cigarettes as a leading cardiovascular disease (CVD) risk factor.
Earlier this month, we attended the 17th World Conference on Tobacco or Health , held in Cape Town, South Africa--the first time on the African continent. While we celebrated the effort made by the global community to implement the Framework Convention on Tobacco Control (FCTC) over the past decade, it was sobering to realize that a greatly intensified and sustained effort is required in the future. Business as usual will not suffice.
This blog first appeared on Joint Learning Network for Universal Health Coverage
Adam Smith, the 18th century social philosopher and political economist, renowned as the father of modern economics, observed in his seminal work “The Wealth of Nations” that “sugar, rum, and tobacco are commodities which are nowhere necessaries of life, [but] which are ... objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.”
Regulating tobacco use using excise taxation, restrictions on smoking in public places, and restrictions on youth access and sale of tobacco products is now a widely-accepted policy action to prevent its harmful health effects. The ruling by the United States Federal District Court that ordered the country’s four largest cigarette makers to make “corrective statements” to inform the public about the harms of cigarettes, including light and low-tar cigarettes, which began on November 26, 2017 for one year, using prime-time television commercials and full-page ads in newspapers, only confirms what is already known on the basis of accumulated evidence over the past half century: the manipulation of cigarette design and composition to ensure optimum nicotine delivery have led to addiction, ill health, and premature mortality and disability among smokers and among those exposed to secondhand smoke. And the recent decision by the Vatican to ban duty-free cigarette sales is a good example of how societal attitude towards tobacco use has changed: a sovereign state is willing to forego revenue from products that clearly harm people's health.
Few people today doubt that smoking is bad. But many, including seasoned policy makers, do not realize just how bad it is. Bad for people, bad for economies, and bad for poverty reduction. In fact, tobacco use not only kills millions of people each year but places a staggering poverty and economic burden on low-income families and less-developed countries that is deepening inequalities between and within countries.
A new report by the World Health Organization (WHO) shares some good news: Six in 10 people worldwide are now protected by at least one of the WHO Framework Convention on Tobacco Control (FCTC)-recommended demand reduction measures, including taxation. The report, launched on the sidelines of the UN high-level political forum on sustainable development, also makes clear that raising taxes to increase tobacco product prices is the most cost-effective means to reduce tobacco use and prevent initiation among the youth. But it is still one of the least used tobacco control measures.
The accumulated evidence over the past half century on the causal relationship between smoking and harm to health provides us with a robust scientific foundation to inform policy design and action.
Tobacco use poses an unparalleled health and economic burden worldwide. A new study found that the diseases caused by smoking account for US$ 422 billion in health care expenditures annually, representing almost 6% of global spending on health. Smoking causes close to 6 million deaths per year - more than the deaths from HIV/AIDs, TB and Malaria combined. And the total economic cost of smoking after including productivity losses from death and disability amounts to more than US$ 1.4 trillion per year- equivalent in magnitude to 1.8% of the world’s annual GDP.
Since the World Health Organization (WHO) adopted the Framework Convention on Tobacco Control (FCTC) a decade ago, over 180 countries have signed the treaty. Progress has been made in expanding the coverage of effective interventions--more than half of the world’s countries, with 40% of the world’s population have implemented at least one tobacco control measure, and despite increasing global population, smoking prevalence has decreased slightly worldwide from 23% of adults in 2007 to 21% of adults in 2013. How can greater reductions in smoking be achieved in the next decade and contribute to reaching the health and social targets of the UN Sustainable Development Goals (SDGs) by 2030? We review some key issues in the epidemiology and economics of global tobacco control.