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.
First confession: I am a seasoned smoker.
Next confession: I have long dreamed of adding “former” to that status. From time to time, my inner struggle reaches a crescendo, but then the momentum vanishes until the next wave of self-examination.
Smoking is the worst, if not the most stupid habit I have. I definitely understand that the damage caused to my health from smoking cannot be undone. I suspect my habit is a bit generational: my father was a smoker – until the doctors came up with a verdict – and the smell of smoke has been at home since my childhood. My son picked it up too, unfortunately. The only change between the generations is that my dad smoked at the table; these days we lean on the balcony.
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.
The real cost of smoking is high, especially high on your health. According to the World Health Organization (WHO), tobacco kills around 6 million people each year, out of which 600,000 are the results of non-smokers being exposed to second-hand smoke. The cost of smoking is also high on the global economy, as smoking burdens global health systems, hinders economic development, and deprives families of financial resources that could have been spent on education, food, shelter, or other needs.
Tobacco use is the world’s leading underlying cause of preventable death. It contributes to a great number of non-communicable diseases (NCDs), which account for 63% of all deaths. Prevention of tobacco use can significantly decrease the number of preventable deaths worldwide, encourage economic development, reduce poverty, encourage healthy lifestyle choices and support Sustainable Development Goals.
In order to prevent and reduce youth tobacco use, in February 2014 the U.S. Food and Drug Administration (FDA) put forward a national public education campaign titled “The Real Cost.” The following video is a part of this campaign: