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Global Tobacco Control: Inching Forward but No End-Game Yet

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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.    

The tobacco epidemic continues to be one of the biggest global public health threats. Data from the new edition of The Tobacco Atlas, launched at the Conference, shows that 942 million men and 175 million women ages 15 or older are current smokers. 

The good news: efforts in the past decade have slowed down the spread of the tobacco epidemic.  Smoking rates among adults have decreased globally. The bad news: this positive result obscures the fact that in some countries declines among males have stalled, and in other countries has continued to rise.  Female smoking is still relatively lower than males, but has had a moderate increase in some countries.

What is ominous for the future is the relative rapid increase of smoking rates among youth, globally. Africa, the Eastern Mediterranean, and the Americas, with young population age structures, have experienced the fastest percentage changes in consumption over 1980-2016 (52%, 65% and 44%, respectively). 

While 181 countries are parties to the FCTC, many are lagging in implementing its provisions.  A good example that illustrates this point is the banning of smoking in public places. Currently, only 50 countries, up from 10 countries a decade ago, have adopted comprehensive smoke-free legislation, covering about one-fourth of the total population in the world. Also, the adoption of significantly large tax hikes to make cigarettes more costly and reduce tobacco use and prevent uptake by youth, is still a widely underused policy measure.

We think that any end-game strategy for the future would need to place added emphasis in supporting the adoption, by all FCTC signatory countries, of smoke-free environments, regulations and tax policies to significantly reduce the social acceptability of smoking in all its forms and make the price of cigarettes unaffordable.

The economic rationale for this course of action is compelling, given the negative externalities from smoking, ranging from annoyance that smokers can cause to individuals around them in public places, harm suffered by non-smokers who are both exposed to smoking by others and third hand smoke (the residues that contain many of the harmful substances found in tobacco smoke that solidify and form in surfaces at homes and public spaces where smoking occurred), and the direct and indirect social costs  of tobacco use that families, communities and governments have to pay. 

Seoul, Republic of Korea
Patricio Marquez / World Bank 2018

Accumulated evidence shows that if properly implemented, these policies work and are impactful.  In many cities around the world, smoking is not allowed in restaurants, bars, clubs, hotels, or even in public housing complexes as in New York City.  Presentations delivered at the Conference by World Bank Group participants provided evidence of country experiences where tobacco tax hikes have led to higher prices, reduced consumption, helped mobilize additional domestic resources to finance priority investments and programs, and are helping reduce inequities associated with the impoverishment impact of costly treatments for tobacco related diseases.  Indeed, the experience of a range of countries that that have adopted tobacco tax reform in recent years--from Azerbaijan, Armenia, Belarus, Botswana, Colombia, Gabon, Ghana, Indonesia, Moldova, Mongolia, Montenegro, Philippines, Sierra Leone, and Ukraine--attest to the win- win nature of this fiscal policy.

It was also gratifying to learn a couple days after the end of the Conference that President Buhari of Nigeria has approved significant changes in the tobacco tax structure by introducing specific excise duties on to top of ad valorem rates to be implemented over 2018-2020. The potential impact of this policy decision in the most populous country and larger economy in Africa sends a clear signal that political will and commitment at the highest level of government can overcome industry interference and the power of interest groups for the benefit of the population of a country. 

We left Cape Town with a clear understanding that the global epidemic of tobacco use is not a problem that will simply go away.  But we are optimistic that it is possible to move the needle faster and further since the broad anti-tobacco movement comprised of governments, civil society, international agencies, and philanthropies, is growing stronger and bolder. 

Besides supporting the implementation of the FCTC globally, we think it is time to move away from siloed approaches and closely connect tobacco control efforts to broader processes geared to the achievement of the sustainable development goals.

In practice, this would imply exploring, innovating and trying ambitious approaches from crafting public health exceptions for tobacco control under global, regional and bilateral trade agreements with the support of the World Trade Organization (WTO) or political fora such as the G77, to leveraging the power of international finance markets by promoting shareholder activism to pursue “tobacco-free investments” as proposed during the Conference by Tobacco Free Portfolios, a global not-for-profit organization based in Australia. Michael R. Bloomberg’s launching of STOP (Stopping Tobacco Organizations and Products), an initiative that creates a new global watchdog to closely monitor and highlight the tactics the tobacco industry uses across the globe to undermine public health, is another tool to advance the tobacco control agenda.

As we move forward, paraphrasing an African proverb, we should remember that if we walk alone we could go fast, but if we walk together as a broad collective learning from and supporting country, regional, and global efforts we will go far, in achieving the ambitious WHO target of a 30% reduction in the prevalence of tobacco use by 2025.

South Africa Broadcast Corporation (SABC) News Interview on World Bank Group Position on Tobacco Control
World Bank Group Tobacco Program  


Patricio V. Marquez

Former World Bank Group (WBG) Lead Public Health Specialist

Enis Barış

Senior Advisor-Consultant, Global Health

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