A cigarette vendor in Manila sells a pack of 20 sticks for less than a dollar. Credit: Kara Santos/IPS

By Lyndal Rowlands
UNITED NATIONS, Jan 13 2017 (IPS)

Low and middle-income countries have far fewer tobacco regulations than high-income countries and are paying the price – with bigger health and economic impacts.

Yet, according to new wide-ranging research published by the World Health Organization (WHO), tobacco companies are misleading governments, telling them that tobacco regulations will potentially harm their economies.

The research was compiled in a new monograph titled The Eonomics of Tobacco and Tobacco Control, published jointly by the WHO and the National Cancer Institute of the US-based National Institutes of Health.

Frank Chaloupka, who edited the monograph, told IPS that when low and middle income countries do implement regulations, there is usually a much bigger pay off.

“We present some new evidence in the monograph on tobacco advertising bans that shows they have a bigger effect in low- and middle-income countries than they do in high-income countries,” said Chaloupka who is also Distinguished Professor of Economics & Public Health at the University of Illinois.

“I think it’s partly because of the fact that in a lot of low- and middle-income countries they haven’t been exposed to the same information about the health consequences of tobacco use, people are more susceptible to the industry(’s positive) portrayals of tobacco,” noted Chaloupka.

For example, says Chaloupka, graphic warning labels have proven more effective in low- and middle-income countries.

“People can really see the damage caused by tobacco through the graphic warnings.” For those who have had less exposure to these warnings from other sources of information, the warnings have an even bigger impact.

Taxes on tobacco sales in low and middle countries also have a bigger impact than in high-income countries, Chaloupka added.

“Given people’s lower incomes, people are more responsive to changes in the price,” he said.

There are several reasons why low- and middle-income countries have less tobacco regulations than high-income countries, said Chaloupka, but one problematic cause is misleading arguments made by the industry:

“The industry’s arguments around things like illicit trade, impact on jobs and the broader economic impact, the impact on the poor, the impact on their tax revenues, really the economic arguments that the industry uses against tobacco control are really misleading, and for the most part, false.”

This has contributed to a widening gap between regulations in low and middle-income versus high-income countries. The gap has also widened because of how quickly high-income countries moved to implement control measures:

“We’ve seen governments get serious and really take action, and adopt strong tobacco control measures, push up taxes, ban smoking in public places, ban tobacco marketing as a result we’ve seen tobacco use falling for at least a few decades in most high-income countries.”

While some low and middle-income countries may lack the capacity to implement complex regulations, Chaloupka noted that often simpler policies can be more effective.

“The Philippines (had) a complicated tax system where we had different rates on different brands,” he said. “Over time they moved toward a significant reform in their system and they’re in the process of moving to a single uniform tax which is a lot easier to administer and much better at deterring tax avoidance and tax evasion.”

However although so-called excise taxes on tobacco products can act as a deterrent worldwide they are far from helping governments recoup the costs of tobacco use to economies and society.

“The estimate we have for the global cost is about $1.4 trillion, and less than $300 billion being generated in tax revenues,” said Chaloupka, adding that less than $1 billion of tobacco-related tax revenues is being used for tobacco control.

Chaloupka also pointed to Turkey as an example of a middle-income country that has successfully regulated tobacco use.

“If you go back a few decades the Turkish government used to be the tobacco industry in Turkey. They used to be one of the biggest growers of tobacco leaf in the world, and over time they’ve completely moved in the other direction.”

“They privatised their tobacco industry (and) they didn’t make any promises to the tobacco companies that moved into their markets, and really then did move forward with strong tobacco control policies.”

Correction: An earlier version of this article referred to “$300 million being generated in tax revenues” and “$1 million of tobacco-related tax revenues…” it should have read billion(s) not million(s).

By Laurent Huber
GENEVA, Feb 18 2015 (IPS)

February 27 will mark the 10th anniversary of the World Health Organisation Framework Convention on Tobacco Control (FCTC), the first global public health treaty.

Today the FCTC has 180 Parties, making it among the most widely-adopted international instruments. About 90 percent of the world’s population falls under the FCTC’s protections.

The creators of the Convention were bold in their intentions – “to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption.”

An anniversary is an opportunity to look back and reflect, and to look forward and plan. Has the FCTC lived up to its lofty goals? Are we on track to end the tobacco epidemic? Is it too soon to judge?

1 billion deaths ahead?

It is no accident that the first global, legally-binding public health effort targeted tobacco. In the absence of action, the world gloomily looked ahead to one billion deaths from tobacco consumption in the 21st century.

In addition to that depressing figure, tobacco has profoundly negative consequences for the wealth of nations and individuals, for human rights, for development and for the environment. In 10 years, have we made a dent?

Yes. The FCTC came into being at a critical time in the history of the tobacco epidemic. Consumption was moving swiftly from the developed to the developing world, and growing overall.

Everywhere, tobacco addiction was becoming a burden on the poorest, most marginalised populations.

Tobacco industry profits were staggering, dwarfing the gross domestic products of most of the countries in which they operated.

This wealth was poured back into marketing, litigation and public influence to ensure the addiction of future generations.

In 2005, when the FCTC came into force, the tobacco industry was put on notice that the world had united against it.

Numerous victories

The public health community can point to specific victories. In 2004, Ireland became the first country to ban smoking in all public and work places. They have been followed by dozens more.

Several countries have struck at the core of the industry’s business model by banning marketing – including the display of products in stores – and corporate social responsibility schemes (Mauritius), and by requiring plain packaging (Australia).

Scores of countries have introduced graphic warning labels on packaging, and there have been large tobacco tax increases in countries not previously known for their strong tobacco control policies, such as Chile and the Philippines, to name just two.

There is a protocol to address the massive problem (often perpetrated by the industry itself) of illicit trade. An increasing number of governments are using litigation to hold the industry accountable for the consequences of its products.

Mainly health ministries

But – and you knew there was going to be a “but” – sober reflection is also called for. The number of tobacco users and deaths continues to rise. The tobacco industry, the vector of the epidemic, is not on its heels: the profit of the four biggest firms was over US$36 billion in 2013.

While we have succeeded in convincing health ministries of the importance of tobacco, other government sectors lag far behind.

The implementation of the all-important FCTC Article 5.3, calling for governments to refuse to cooperate with the tobacco industry in formulating health policy, is failing miserably in all but a few countries.

And when governments bravely move forward with cutting-edge tobacco control measures, they can expect an avalanche of tobacco industry lawsuits, both domestically and through international trade agreements, chilling the political will of other governments.

Mixed results, to be certain. Should we celebrate? Absolutely! No one expected the FCTC to be an instant cure. At the outset, the curve of the epidemic was simply too steep to believe that, in 10 years’ time, it could be reversed.

We’ve made great strides.

On 27 Feb, if you have been involved in this historic endeavour, take a moment to congratulate yourself and a colleague. And then on the 28th, let’s move forward with purpose to fill in the gaps. The FCTC is the beginning, not the end, of a long and purposeful journey.

Edited by Roger Hamilton-Martin

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