A woman smokes a cigarette branded ‘Fortune’ at a campaign rally for Philippine President Benigno Aquino III, a smoker who has said he has no intention of quitting the habit. The Philippines has the second highest number of smokers in South-east Asia. Credit: Kara Santos/IPS

By Katie Dain
NEW YORK, May 26 2015 (IPS)

Governments are in the midst of tough talks in New York over the text of the Addis Ababa Accord, which is scheduled to be adopted at the end of the Third Conference on Financing for Development (FfD) , to be held in Ethiopia in July.

However at last report, negotiators continued to downplay a powerful mechanism that governments could use to help achieve and finance the Sustainable Development Goals (SDGs) that will replace the Millennium Development Goals (MDGs) in September: tobacco taxes.Tobacco use killed 100 million people in the 20th century and, if trends do not change, it will kill one billion people this century.

According to a recent estimate, increasing specific excise taxes on tobacco worldwide, in order to double prices, would raise about 100 billion dollars per year in revenues, in addition to the approximately 300 billion that the World Health Organization (WHO) estimates governments already collect on tobacco.

Tobacco use is the world’s leading preventable cause of death, and the one risk factor common to four major non-communicable diseases (NCDs): cancers, cardiovascular and lung disease, and diabetes.

Tobacco use killed 100 million people in the 20th century and, if trends do not change, it will kill one billion people this century. The proposed SDGs recognise the devastating impact of NCDs and the tobacco use risk factor, and set targets for reducing the deadly impacts of both.

Fear of trampling on governments’ right to decide on taxation is reportedly at the heart of the negotiators’ reluctance to recommend taxation in general as a way to generate funding for sustainable development.

Yet, 180 of the world’s governments have already agreed that tobacco taxation is an important tool to both generate revenue and save lives. Meeting as the Parties to the WHO Framework Convention on Tobacco Control (FCTC), these governments have even agreed on guidelines that set out how to tax tobacco as effectively as possible.

Notably, these guidelines, to the FCTC’s Article 6, represent the first time that governments have agreed on what makes – and what doesn’t make – good tobacco tax policy.

Raising tobacco taxes, and subsequently tobacco prices, is good for health because it reduces the amount of tobacco consumed in three ways:

• Some existing smokers quit entirely;
• Some people, mostly teenagers, are deterred from starting to use tobacco;
• Some people continue to use tobacco, but reduce how much they use each day.

As a result, tobacco sales decline; however the revenue generated by the higher taxes on the remaining products sold more than makes up for lower sales. That is why increasing tobacco taxes is a win-win for governments: good for health and good for the bottom line.

Most of the revenue would initially be generated in rich countries, as taxes and prices there are much higher to begin with, but developing countries could still raise substantial revenue.

For example, the Philippines hiked specific excise taxes in 2013, raising the average price per cigarette pack by 48 percent. Sales declined and the number of smokers dropped from 28.3 percent of adults in 2009 to 25.4 percent in 2013, while government revenue from tobacco taxes more than doubled from 702 million dollars in 2012 to 1.5 billion in 2013 .

To be effective, tobacco tax increases must be accompanied by other measures, as FCTC Article 6 guidelines point out. Governments should also:

• Implement the simplest, most efficient tax systems;
• Make regular adjustments so that tobacco products become less affordable over time;
• Tax all tobacco products consistently to avoid substitution;
• Phase out tax-free and duty-free products; and,
• Set long-term policies, which could include a tax target.

Parties to the FCTC are not alone in recognising the potential of tobacco taxation. In their recent paper on financing for sustainable development, Jeffrey Sachs and Guido Schmidt-Traub praise tobacco taxes:

“Consumption taxes on tobacco products have been shown to have a very positive impact on reducing tobacco use and improving health. Higher tobacco taxes are particularly effective at reducing consumption by vulnerable populations, particularly youth. In many countries, tobacco taxation is also an important source of government revenue and is dedicated to tobacco control activities, hospital services and other health prevention or promotion services.”

The authors also refer to a 2011 report that Bill Gates presented to a meeting of G20 leaders.

In the executive summary Gates wrote: “Among the revenue proposals I have examined, tobacco taxes are especially attractive because they encourage smokers to quit and discourage people from starting to smoke, as well as generate significant revenues. It’s a win-win for global health.”

Gates continued: “Tobacco taxes are already ubiquitous. Ninety percent of countries have some form of them. And they work. In Thailand, as cigarette taxes rose from 1994 to 2007, revenues doubled even though the number of smokers went down significantly.”

The Sustainable Development Goals provide the roadmap for creating a healthier, more equitable and prosperous world, and as such are extremely ambitious. Considerable resources will be needed for these goals to be realised in the next 15 years.

Already endorsed by a large majority of the world’s governments, and with a clear road map for implementation, tobacco taxation should be highlighted in the Addis Ababa Declaration as an effective domestic tool for financing sustainable development.

Edited by Kitty Stapp

Excerpt:

By 2030, 80 percent of deaths from tobacco will be in the poorest countries in Asia, Africa and South America. Credit: Bigstock

By Laurent Huber
GENEVA, Jul 7 2014 (IPS)

Undeniably, the Millennium Development Goals (MDGs) helped lift specific health concerns onto the global agenda.

For example, maternal mortality, which is addressed in MDG 5, declined 45 percent from 1990 to 2013, while deaths of children under five (MDG 4) dropped from 12.4 million to 6.6 million worldwide from 1990 to 2012, (both statistics from the World Health Organisation).If trends do not change, by 2030 NCDs will be the leading global cause of disability.

Despite those impressive advances, the world is facing new development challenges. For this reason, the Sustainable Development Goals (SDGs) that will replace the MDGs in 2015 must expand the list of health goals to include non-communicable diseases (NCDs) – the world’s #1 killer.

NCDs account for 60 percent (35 million) of all deaths. They include cancers, cardiovascular and lung disease, and diabetes, but they are not – as many people believe – ‘lifestyle’ diseases afflicting old people in rich countries. The largest burden – 80 percent, or 28 million deaths – occurs in low-middle-income countries (LMICs), making NCDs a major cause of poverty and an urgent development issue.

If trends do not change, by 2030 NCDs will be the leading global cause of disability. In addition, between 2011 and 2031 the diseases would have cost the world economy 30 trillion dollars, the equivalent of 98,400 dollars for every person in the United States.

Tobacco is the leading risk factor for NCDs. One hundred million people died from tobacco-related disease in the 20th century, and unless the global community acts decisively, one billion people will die in the 21st century. By 2030, 80 percent of deaths from tobacco will be in the poorest countries in Asia, Africa and South America.

In 2011, world leaders assembled for the first time at the United Nations to discuss the growing NCDs epidemic. The Political Declaration they issued concluded that the burden of NCDs “undermines social and economic development throughout the world”.

It noted that NCDs strike people in LMICs during their prime working years, and that close to half of all NCD deaths in these countries occur below the age of 70, and nearly 30 percent under age 60. As well, most NCDs deaths are preceded by long periods of ill health.

These illnesses, and early deaths of families’ main income earners, result in loss of productivity, which drags down economic growth and development.

Social determinants, such as education and income, influence people’s vulnerability to NCDs and exposure to risk factors. Individuals of lower education and economic status are increasingly exposed to NCDs risks and are disproportionately affected by them. For example, in countries such as Bangladesh, India and the Philippines, tobacco use is highest among the least educated and poorest segments of the populations.

At the same time, having an NCD may also contribute to social inequalities. The financial burden associated with these diseases increases the risk that families will be unable to send children to school and, under-educated, the risk grows that those children will live in poverty for the rest of their lives.

What can be done? There are four modifiable risk factors for the main NCDs: unhealthy diets, physical inactivity, harmful use of alcohol and tobacco use. While work continues to adopt global tools to tackle the first three factors, there is consensus on how to fight the tobacco epidemic.

In 2003, the world’s governments adopted the WHO Framework Convention on Tobacco Control, the first modern-day public health treaty. It contains a number of measures that Parties commit to implement, including: smoke-free public spaces, pictorial health warnings on packages, price and tax measures to increase the price of tobacco – which discourages consumption – and complete bans on tobacco advertising.

Today the FCTC has 178 Parties, representing nearly 90 percent of the world’s population. In the battle against NCDs, “There is no other ‘best buy’ for the money on offer”, said WHO Director-General Margaret Chan in 2011.

Recognising the potential of global tobacco control, the Political Declaration of the 2011 NCD Summit:

• Urged greater efforts from countries to implement the FCTC;
• Called on countries that are not Parties to the FCTC to accede to the Convention;
• Noted the importance of tobacco taxation as a strategy at the national level;
• Recognised the irreconcilable differences between the tobacco industry and public health policy.

Building on the Declaration, in May 2013 the World Health Assembly endorsed the Global Action Plan for the Prevention and Control of NCDs, 2013-2020. It includes a target for cutting tobacco use: a 30 percent relative reduction in smoking prevalence by the year 2025.

A stand-alone goal, Attain healthy lives for all, has been proposed for the SDGs. Its sub-goals include: “By 2030 reduce substantially morbidity and mortality from non-communicable diseases (NCDs) through prevention and treatment…” and “Strengthen implementation of the Framework Convention on Tobacco Control in all countries who have ratified the Convention and urge countries that have not ratified it to ratify and implement it”.

Including NCDs and the FCTC in the development goals that will be announced by the UN General Assembly in 2015 will also ensure that battling the tobacco epidemic becomes a national priority, and prevent millions of premature deaths.

Laurent Huber is Director of the Framework Convention Alliance.

Cigarettes are a popular buy from vendors selling imported goods here in Port Moresby in Papua New Guinea. Credit: Catherine Wilson/IPS

By Catherine Wilson
SYDNEY, Aug 19 2013 (IPS)

Governments in the Western Pacific Islands, believed to be home to a third of the world’s smokers, have begun a long battle with the growing crisis of non-communicable diseases. Such diseases currently account for 75 percent of the region’s fatalities.

Kiribati and the Marshall Islands have the highest rates of diabetes in the world at 25.7 percent and 22.2 percent respectively. Fiji carries the greatest burden of non-communicable diseases (NCD)-related deaths in the region at 501 per 100,000 in the population.

Major factors include heavy tobacco and alcohol consumption, physical inactivity, and poor nutrition. These are exacerbated by rapid urbanisation, and spreading consumerism.
In 2011 Pacific Island leaders declared NCDs to be at the centre of a health and development exigency with long-term impacts including lower economic productivity, loss of household income and unsustainable health costs.

The limited capacity of health services to cope with escalating financial and service delivery demands is of growing concern. Most national health expenditure, up to 90 percent in Vanuatu and 87 percent in Samoa, is already met by governments, and there is limited potential to increase budgets further.

“I don’t think any country can cope with the burden of NCDs, not even high-income countries,” Dr Wendy Snowdon of the Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases at the Fiji School of Medicine told IPS.

“NCDs are expensive to treat, and while countries in the region are increasing their investment in treating NCDs, the only viable solution is effective promotion [of prevention] which could reduce the burden.”

Challenging entrenched lifestyle habits and controlling access to tobacco are imperative to reducing the prevalence of hypertension, diabetes and cancer, and addressing cardiovascular disease, which is the greatest killer of all.

The World Health Organisation (WHO) cites tobacco as the second highest risk factor in NCD-related deaths, 80 percent of which occur in low- and middle-income countries.

The prevalence of smoking in men ranges from 74 percent in Kiribati and 60 percent in Papua New Guinea to 55 percent in Tuvalu and 47 percent in the Cook Islands. Female smoking rates, while on the increase, are lower at 43 percent in Kiribati, 41 percent in the Cook Islands and 27 percent in Papua New Guinea.

Stephanie Erick of Tala Pasifika, a New Zealand heart service aimed at empowering Pacific peoples in tobacco control, told IPS: “Smoking practices over the years have embedded themselves in [Pacific] cultural practices, for example, with kava drinking. Socially it has become a part of gift giving [of duty free cigarette packs] from overseas travellers coming into Pacific Island countries.”

A report last year by the United States-based health foundation Legacy and the Pacific Partnership for Tobacco Free Islands (PPFTI) highlighted the very young age at which dependence starts. Twenty-five percent of high school students in the Northern Mariana Islands are smokers. In the Marshall Islands, almost 90 percent of smokers start in adolescence, and two-thirds are daily consumers by18 years.

The socio-economic repercussions for this generation as it ages will be serious in a region striving, with mixed progress, to achieve the Millennium Development Goals.

The connection between NCDs and disability, such as stroke paralysis, amputations and blindness, is already taking its toll. In Fiji, diabetes is the main cause of amputations and the second main factor in adult blindness.

A report by the University of Sydney, Australia, blames smoking for the burden of lung cancer in 39-47 percent of men in the Pacific Islands and predicts this will increase to 70-84 percent within the next two decades.

Pacific Island leaders, fully cognizant of the implications for the region’s future, developed crisis response strategies during an NCD Forum last year focussed on tobacco control and building capacity in primary health care services. Their goal is 25 percent reduction in NCD-related fatalities in people aged 30-70 years by 2025.

However, there are significant challenges to implementation, with many health service providers constrained by low funding and resources.

Prevention through ‘whole of society’ and ‘whole of government’ approaches is being advocated by health ministers as the most likely to reverse the present scenario.

A critical step has been ratification of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) by all Pacific Island member states and territories. The framework is supported by the MPOWER strategy which promotes tobacco price and tax increases, tobacco advertising bans, regulation of tobacco use in public spaces and cessation services.

Jeanie McKenzie, NCD adviser on tobacco and alcohol at the Secretariat of the Pacific Community (SPC) in Noumea, New Caledonia, told IPS that the FCTC was an important catalyst to the emergence of tobacco policies in the region.

“SPC has been undertaking tobacco enforcement workshops in Vanuatu, Solomon Islands, Cook Islands and Palau, and these reflect the fact that there is legislation in place in these countries,” she said. “Countries in the Pacific are also increasing the tax on tobacco, with many increases at or above 20 percent.”

This year the sale of single cigarettes and smoking in public places became illegal in the Solomon Islands. Fiji also introduced new requirements that graphic health warnings cover 60 percent of cigarette packages.

“Increasing the price of tobacco affects price-sensitive [social groups], usually youth and women, and acts as a disincentive,” McKenzie explained. “Laws that prevent the sale of small cigarette packs and the illegal breaking open of a pack and selling of single cigarettes also assist in dealing with the problem of young people being able to access cigarettes for a smaller financial outlay.”

WHO claims that every 10 percent increase in the retail price of tobacco induces a drop in consumption in low- and medium-income countries by up to 8 percent.

The coral atoll nation of Niue, located northeast of New Zealand, with a population of 1,611, has emerged as an early success story. Last month it announced that sustained tobacco control and health support measures had led to a massive drop in the smoking rate in men from approximately 58 percent in recent decades to 15.8 percent, and in women from 17 percent to 7.6 percent. This places the island state well ahead of its 2021 objective of less than 25 percent for men and 13 percent for women.