The World Health Organization (WHO) and US National Cancer Institute (NCI) have jointly released a Monograph on tobacco. The 21st monograph in a series on tobacco, the present document is entitled ‘The Economics of Tobacco and Tobacco Control’.

The 688 page document is too large to detail in a single post, so I will write a series of articles on the same. This article will provide an overview of the monograph, and describe the key findings of the monograph.

Background Information:

Globally, there are 1.1 billion tobacco smokers aged 15 or older, with around 80% living in low- and middle-income countries (LMICs). Approximately 226 million smokers live in poverty.

Tobacco use is estimated to cause 12% of deaths among persons aged 30 and over worldwide; this represents about 14% of deaths from noncommunicable diseases (NCDs) (such as cancer, cardiovascular disease, and lung disease) and 5% of deaths from communicable diseases (such as tuberculosis and lower respiratory tract infections). Additionally, tobacco use contributes to and exacerbates poverty, which itself contributes to ill health.

Key Messages:

Tobacco control is a key component of WHO’s global response to the epidemic of NCDs, primarily cardiovascular disease, cancers, chronic obstructed pulmonary disease and diabetes.

Major Conclusions

1. The global health and economic burden of tobacco use is enormous and is increasingly borne by low- and middle-income countries.

Around 80% of the world’s smokers live in LMICs.

2. Failures in the markets for tobacco products provide an economic rationale for governments to intervene in these markets.

The external costs of tobacco use are greater in countries where public funds are used to pay for a greater share of health care costs, given public spending to treat the diseases caused by tobacco use.

3. Effective policy and programmatic interventions are available to reduce the demand for tobacco products and the death, disease, and economic costs that result from their use, but these interventions are underutilized.

The WHO Framework Convention on Tobacco Control (WHO FCTC) provides an evidence-based framework for government action to reduce tobacco use.

4. Policies and programs that work to reduce the demand for tobacco products are highly cost-effective.

Such interventions include

• significant tobacco tax and price increases;
• bans on tobacco industry marketing activities;
• prominent pictorial health warning labels;
• smoke-free policies and
• population-wide tobacco cessation programmes to help people stop smoking.

In 2013-2014, global tobacco excise taxes generated nearly US$ 269 billion in government revenues. Of this, less than US$ 1 billion was invested in tobacco control.

5. Control of illicit trade in tobacco products, now the subject of its own international treaty, is the key supply-side policy to reduce tobacco use and its health and economic consequences.

In many countries, high levels of corruption, lack of commitment to addressing illicit trade, and ineffective customs and tax administration, have an equal or greater role in driving tax evasion than do product tax and pricing.

The WHO FCTC Protocol to Eliminate Illicit Trade in Tobacco Products applies tools, like an international tracking and tracing system, to secure the tobacco supply chain.                       Experience from many countries shows illicit trade can be successfully addressed, even when tobacco taxes and prices are raised, resulting in increased tax revenues and reduced tobacco use.

6. The market power of tobacco companies has increased in recent years, creating new challenges for tobacco control efforts.

 As of 2014, 5 tobacco companies accounted for 85% of the global cigarette market. Policies aimed at limiting the market power of tobacco companies are largely untested but hold promise for reducing tobacco use.

7. Tobacco control does not harm economies.

The number of jobs dependent on tobacco has been falling in most countries, largely due to technological innovation and privatization of once state-owned manufacturing.

Tobacco control measures will, therefore, have a modest impact on related employment, and not cause net job losses in the vast majority of countries. Programmes substituting tobacco for other crops offer growers alternative farming options.

8. Tobacco control reduces the disproportionate burden that tobacco use imposes on the poor.

Tobacco use is increasingly concentrated among the poor and other vulnerable groups.

9. Progress is now being made in controlling the global tobacco epidemic, but concerted efforts will be required to ensure that progress is maintained or accelerated.

In most regions, tobacco use prevalence is stagnant or falling. But increasing tobacco use in some regions, and the potential for increase in others, threatens to undermine global progress in tobacco control.

Useful Links:

Link to the WHO news release:

http://who.int/mediacentre/news/releases/2017/tobacco-control-lives/en/

Link to the Executive Summary of the Monograph (English) [PDF]:

Click to access m21_exec_sum.pdf

Link to the Full Monograph (English) [PDF]:

Click to access m21_complete.pdf