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Is tobacco bill really necessary?

Last week we learned that President Joko “Jokowi” Widodo verbally rejected a proposal from lawmakers for a new tobacco bill that would increase protection of the industry and production of cigarettes. However, he finally gave written agreement for discussion by government and the legislature about the proposed law.

http://www.thejakartapost.com/academia/2017/03/24/is-tobacco-bill-really-necessary.html

Smoking and the tobacco industry have long been big business here with well documented impacts on national, family and individual economies, health and welfare. Today I call on activists concerned for the people of Indonesia to reject the proposed tobacco law, which threatens the health and well-being of our people. It is in conflict with prevailing laws on health and other fields.

We must also raise our voices to point to positive action that the government can take to address some key concerns of the President — an increase in revenues and the welfare of tobacco farmers and workers in the cigarette industry.

A review of some basic facts about smoking and tobacco in Indonesia makes clear the importance of acting promptly.

Among the country’s 255 million people, an estimated 65 percent of adult males are regular smokers, making Indonesia the second-largest cigarette market in Asia after China. Furthermore, in Indonesia the rate of smoking among women has increased rapidly in recent years. This threatens not only the health of these women, but that of their babies and children. Smoking while pregnant increases the risk of miscarriage, low birth weight and respiratory problems in children after birth.

A child growing up with a mother or father or both smoking is at risk in multiple ways. Children’s health may be permanently affected by second-hand smoke in the house. Furthermore children may associate smoking with “being adult” and rush to start smoking themselves leading to early, long-term addiction.

Finally, the households of smokers, particularly low-income families, live with cruel competition for family funds between expenditure on cigarettes and expenditure on good nutrition, clothing, school books and basic medical care. Research shows that it is often the basic needs that lose out — a punishment for the whole family that falls particularly hard on children who are building bones, brains and muscles.

As a pediatrician I would like all parents to be disciplined, caring and active in promoting the best possible life chances for each of their children. Yet science and global experience make clear that the addictive nature of cigarette smoking, peer-group pressure among young people and alluring cigarette advertising makes it easy to start lighting up. Later, smokers find it difficult or impossible to shake the habit.

Therefore I argue not only against the proposed bill.

I also suggest four important actions that could eventually help reduce the threat of smoking to people’s health, thus reducing individual and health expenditure, increase revenue, improve the situation of tobacco farmers and help cigarette factory workers.

First, accede to the Framework Convention on Tobacco Control (FCTC). This global public health treaty aims to reduce tobacco-related causes of ill health and death through cutting legal and illegal supply and demand for tobacco, and protection of health and the environment from tobacco-related damage. Having been adopted by 180 of the 193 UN member states, Indonesia is one of only 13 which is not yet a party to the convention.

Second, increase revenues from tobacco and smoking. The expansion of cigarette production and sales in the proposed bill is presented in terms of expansion of employment opportunities and income for the government.

Yet this increase can be achieved without the bill by increasing the price of a pack of cigarettes (20 sticks), now at US$ 1.40, among the world’s lowest. A significant increase in price will automatically increase revenues from taxes and excises, which benefits the national and regional levels.

Increasing the price would both raise revenue and reduce smoking among the young and the poor -meaning lower treatment costs of tobacco-related diseases.

Third, protect and develop tobacco farmers. Since independence, Indonesia has worked to improve its citizens’ productivity, health services and welfare. There is already a law for the protection and empowerment of farmers (Law No. 19/ 2013). Presidential or other government regulations with special focus could fully meet the needs of tobacco farmers.

Also urgent are special efforts to support farmers wanting to transit out of tobacco farming but without the resources for the startup investment, including training, equipment, seeds etc.

Fourth, protect and attend to the welfare of cigarette factory workers. Similar to farmers, there are laws and regulations that could be used to address their special needs as the industry evolves. And it is clear that even if the cigarette industry expands production in line with the proposed law, it would not expand employment, given the industry’s preference for the speed, efficiency and simplicity of mechanized production.

Layoffs of workers and the shift from hand-rolled cigarettes to mostly mechanized production is already well advanced – 75 percent of kretek (clove-based) cigarettes is now machine rolled. Thus the new law would unlikely provide any significant new employment or support for workers displaced by mechanization.

So is the proposed tobacco bill needed to raise revenues and protect agricultural and factory workers in the industry? No. If we are concerned about the people, their health and well-being, the proposed tobacco bill is clearly unnecessary!

***

The writer is presently leaders’ envoy and board chair for the Asia Pacific Leaders’ Malaria Alliance (APLMA). She served as health minister (2012-2014) and chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria (2013–2015)

Calls to stub out tobacco deals

http://www.thestandard.com.hk/section-news.php?id=180992

Several legislators yesterday called on the government not to extend further concessions to the tobacco trade that is trying to further delay implementation of bigger graphic health warnings on cigarettes to the detriment of public health.

The government proposed in May 2015 to enlarge the size of health warnings to cover at least 85 percent of the packet or retail containers of cigarettes, saying the existing six graphic health warnings which cover half of packets or containers have been in use since 2007.

The Food and Health Bureau has made four concessions to meet the industry’s concerns, including using any background color to show nicotine and tar content and for the English version of the health warning to remain at 50 percent of the surface area of the lid of a drum-shaped container.

Undersecretary for Food and Health Sophia Chan Siu-chee told a Legislative Council health services panel yesterday that the government will also extend the adaptation period from six months to 12 months upon gazetting of the amendment order of the smoking ordinance.

Tourism-sector lawmaker Yiu Si- wing said: “The government is conceding, giving in to the tobacco sector’s pressure.”

The Labour Party’s Fernando Cheung Chiu-hung: “Public health should come first. Especially as I have had some personal health problems, I understand the value of health.

“I understand from the grassroots that smoking is a relief for them from stress but the government should not concede anymore. It has already conceded enough.”

Peter Shiu Ka-fai, of the wholesale and retail sector, questioned whether the government would have evidence to show that bigger warnings would mean “people will stop smoking?”

Wong Ting-kwong, of the import and export sector, said he is a smoker and that bigger warnings will still affect second- and third-hand smokers as “the smoke isn’t less.”

The panel also discussed the Hong Kong Code, a voluntary code aimed at protecting breastfeeding and to impose restrictions on formula milk marketing practices that give misconceptions about the nutritional value of products for children up to 36 months old.

Chan told the legislators: “We consulted the Department of Justice and the code is not breaching the competition law as this is voluntary.”

Recent Gains on Global Tobacco Taxation

http://blogs.worldbank.org/health/recent-gains-global-tobacco-taxation

The landmark Surgeon General’s Report on Smoking and Health, issued by U.S. Surgeon General Dr. Luther Terry in 1964, represented the first time that a government report linked smoking and ill health, including lung cancer and heart disease. The scientific evidence accumulated over the past five decades has helped us understand how tobacco use imposes a heavy health and economic burden across countries.

Action to curb tobacco use makes solid economic sense, given the high costs of tobacco-related illnesses and premature death and disability among adults in their most productive years. Smoking harms health, incomes, earning potential, and labor productivity. Smoking also undermines human capital development —a critical factor for inclusive economic and social development.

Raising tobacco taxation commensurate with affordability levels is proven to be the most effective measure to curve consumption. Tax increases are most effective in countries where the social acceptability of smoking is reduced by curtailing smoking in public places and educating the population about its negative health impact.

Contrary to the assumption that tobacco taxes are regressive, the results of recent studies done in Chile and the United States show that the benefits of this policy measured in terms of lower medical expenses and an increase in working years outweighs any relative increase in tobacco prices, largely benefitting the poor more than the rich.

Over the past decade, the World Bank Group (WBG), in partnership with the Bill & Melinda Gates Foundation and the Bloomberg Foundation, and in coordination other organizations, such as WHO, has expanded its tobacco taxation work globally to assist countries implement their public health and domestic resource mobilization efforts. Simultaneously, technical assistance is being provided to strengthen countries’ legal and regulatory capacity to control illicit tobacco trade. Support is also being provided to facilitate knowledge-sharing, building upon existing platforms such as the Joint Learning Network (JLN).

The experience of Philippines over 2012-2016 is one of the most compelling examples of ambitious national tobacco tax reform. It involved a fundamental restructuring of the country’s tobacco excise tax structure, including reduction in the number of tax tiers; indexation of tax rates to inflation; and substantial tax increases which expanded the fiscal space to fund the increase in the number of families enrolled in the health insurance scheme from 5.2 million primary members in 2012 to 15.3 million in 2015.

More recently, national governments in several countries have adopted significant tobacco tax reforms to improve public health and mobilize domestic resources, covering a total population of 200 million people. In the Ukraine, the 2017 budget includes a 40% excise tax increase on tobacco products, above the 2016 level, while maintaining a 12% ad valorem tax. It is estimated that that this measure will increase on average the excise tax burden as a share of the retail price of a pack of cigarettes from 41% in 2016 to 46% in 2017, while consumption is expected to decrease by 10%. To get a sense of the magnitude of health gains likely to result from the adoption of these tax increases, modeling work estimated that, by 2035, Ukraine’s recent tobacco tax increases will prevent 126,730 new cases of smoking-related disease; 29,172 premature deaths; and 267,098 potential years of life lost, relative to no change in tax. These reductions in disease and death are estimated to result in significant healthcare costs avoided.

As part of broad fiscal reforms approved by Colombia’s Congress, new taxes on tobacco products will nearly triple prices over 2017-2018, with annual adjustments for inflation and a mandated specific increase in subsequent years. Likewise, in Moldova, the average excise tax burden on a pack of cigarettes will increase from 39% in 2016 to 45% in 2017.

Following the introduction of the new tax regime in 2017, Armenia’s tobacco excise tax burden will double, increasing to 62% of the average retail price by 2020. In the case of Armenia and Colombia, tobacco taxation increases are part of larger tax system reforms that were included under fiscal consolidation programs.

In moving forward this agenda, we have to be clear that to be effective and sustainable, the design of tobacco tax reforms has to be grounded on a good understanding of how public policy is created and implemented in a country, including the social forces which could support or hinder the passage of strong anti-tobacco measures. We also have to be mindful that the adoption of tobacco tax reforms could be greatly facilitated if they are included as part of broad fiscal consolidation programs as shown by the recent experience in Armenia and Colombia, or as part of the formulation of annual government budgets as shown by the experience in Moldova and Ukraine.

Workers urged to ask smokers to stop smoking in their homes during visits as part of East Cambs District Council’s new anti-smoking policy

Tough new anti smoking rules within East Cambridgeshire Council – including a ban on electronic cigarettes and making workers get their manager’s permission for a smoking break- are ready to be implemented.

http://www.elystandard.co.uk/news/workers_urged_to_ask_smokers_to_stop_smoking_in_their_homes_during_visits_as_part_of_east_cambs_district_council_s_new_anti_smoking_policy_1_4932524

With two people a week in the district dying from smoking related diseases, the council is determined it will lead by example with its compulsory ‘smoking at work’ policy.

Spencer Clark, open spaces and facilities manager, will tell the regulatory and support services committee the refreshed policy supports the council’s duty of care.

“This smoking policy will apply to all staff, elected members, visitors, contractors and others who enter any premises or vehicles used as workplaces by the council,” he says.

“The legislation applies to all council enclosed buildings, related areas and council owned vehicles”.

Mr Clark said the smoke free workplace policy is to “guarantee a healthy working environment” and protect the current and future health of staff members and the public.

Any council employee found breaching the new guidelines will face disciplinary action.

It also asks employees who visit smokers in their homes as part of their duties to ask them to consider refraining from smoking. Managers may also be asked to complete risk assessments before visits to protect employees from exposure to second-hand smoke.

Smoking in workers’ private vehicles is also strongly discouraged and those workers who do smoke must do so off-site and must get their line manager’s permission,

All visitors, contractors and deliverers must also abide by the new policy.

All premises owned and occupied by the council – including staff car parks – will be covered by the smoking ban. Those buildings owned by the council – such as E-Space North and South – which have multi tenanted offices will also be brought into the non smoking in the grounds policy.

The policy is in line with the council’s aim to reduce the number of smoke-related deaths in the district and “guarantee the right of everyone to breathe in air free of tobacco smoke.”

Statistics from Public Health England have revealed that there were 97 smoke-related deaths in East Cambridgeshire in 2016.

* Portley Hill depot, Littleport, is the only council owned property that will be allowed to retain a designated smoking area.

Fewer Scots are choosing to smoke – but the costs of the habit remain high

National No Smoking Day passed last week with the now routine announcements from health chiefs welcoming the fact that fewer adults are choosing to light up.

http://www.scotsman.com/news/health/fewer-scots-are-choosing-to-smoke-but-the-costs-of-the-habit-remain-high-1-4392433

But the costs of the habit remain high and ensure that neither the Westminster or Holyrood governments will be declaring victory in their battle to stub it out.

Smoking remains the primary ­preventable cause of ill-health, disability and premature death in Scotland.

Each year tobacco use is associated with around 128,000 hospital admissions and more than 10,000 smoking-attributable deaths north of the border.

The average smoker in Scotland spends £1,500 each year on tobacco – and significantly more people in our poorest communities spend at this level compared to our most affluent.

Prevalence rates in Scotland have fallen from around 28 per cent in 2003 to just under 21 per cent in 2015. Among 13-year-olds and 15-year-olds, smoking rates have fallen steadily to their lowest ever levels – two per cent and seven per cent respectively.

“We’ve had ten years of decisive action which has undoubtedly improved our nation’s health – but there is still more to be done,” said public health minister Aileen Campbell. “As a result of our Take it Right Outside campaigns, reported exposure to second-hand smoke in the home among children under 16 has halved between 2013 and 2015 from over 11 per cent to six per cent.

“In December 2016 it became ­illegal to smoke in cars where children are present – and later this year, we will restrict the sale and availability of e-cigarettes to under-18s and introduce an offence for smoking near hospital buildings.

“We believe that by working together, and with the public’s ­support, we can achieve our goal of creating a tobacco-free generation by 2034.”

Data published this month by the Office for National Statistics (ONS) revealed that 17.2 per cent of adults across the UK smoked in 2015 – the lowest level since records began in 1974.

Figures from 2015 also showed the highest level of so-called quitters in more than four decades.

Can we trust Big Tobacco to promote public health?

There’s a new catchcry in public health: people working in tobacco control should join with Big Tobacco to promote “safer” tobacco products.

http://www.econotimes.com/Can-we-trust-Big-Tobacco-to-promote-public-health-588041

It runs like this: before starting work each morning, tobacco company employees sing with gusto the company song “Thank you, thank you, addictive nicotine”. But they really hate the small problem that smoking kills around two in three of its long-term users early. Just think of all the lost revenue from those collective millions of smokers who die an early death.

So for decades tobacco companies have been busy trying to get their chemists and engineers to develop “safer” (ie less dangerous) products, e-cigarettes being the latest kid on the block.

The public health community has always seen the tobacco industry as the largest vector for lung cancer and all the other diseases caused and exacerbated by smoking. This is why the World Health Organization’s Framework Convention on Tobacco Control – now ratified by every country in the world except Cuba, Haiti, Argentina, Mozambique, Switzerland (headquarters to Philip Morris International) and the US – has a whole section (Article 5.3) detailing how governments should work to combat tobacco industry interference in tobacco control. I contributed a background document on the many ways the tobacco industry tries to gut tobacco control at every turn.

Shifting the focus

The new catchcry proposes Big Tobacco really, really wants to stop selling its deadly products and have all its smokers, in time, switch over to its we-are-not-yet-sure-how-much-but-probably-less-deadly products.

It emphasises the only real goal tobacco control should have is to reduce disease caused by using tobacco products. And guess what? This now turns out to be a shared goal: Big Tobacco and public health both want the same thing so they should forget all the mistrust and animosity of the past, welcome the industry to the table, invite them to conferences, share data and embrace them as partners.

Unfortunately, the catchcry is profoundly myopic. No, let’s not muck around. It displays weapons-grade naivety and ignorance in those promoting it, as this opinion piece shows.

Has Big Tobacco really changed?

Here is why the “they’ve changed” argument about Big Tobacco hits the rocks.

Can anyone name a single example of any Big Tobacco company taking its foot off the accelerator of aggressive opposition to any policy that promises to effectively reduce its core mission: selling more cigarettes?

Philip Morris tried and failed recently in a legal case to gut Uruguay’s tough, comprehensive tobacco control program. The company was doubtless attempting to bully a minnow nation into submission, to send a loud message to any other small nation silly enough to get ahead of itself with such policies.

All tobacco companies fight with all they have to stop tax rises. Just go to British American Tobacco (BAT) Australia’s twitter feed, where tweets about illicit tobacco feature heavily. Here’s an example:

Capture

But why is BAT so obsessed with illicit tobacco? The company is trying to get public brownie points by showing it’s concerned about tax lost to illicit trade. Its main agenda is it wants the government to stop raising tobacco tax. It knows that a tax-reduced lower prices will increase tobacco sales like nothing else, particularly to low income groups like the poor and kids. Tax is the single most effective policy in reducing use, which is why Big Tobacco gives such priority in its lobbying to trying to defeat tax rises.

All the main transnationals poured millions into trying (and failing) to stop Australia’s pioneering plain packaging legislation. Go figure why they tried that.

And as recently as December 2016, BAT wrote this appalling letter to the Hong Kong administration trying to stop graphic health warnings going ahead. This was from a company which, published in its 2016 financial results statement a call to “champion informed consumer choice”.

Informed, yes, but please we don’t want smokers to see pictures of what smoking does to you and be THAT informed.

Big Tobacco would love its new generation products to sell well. But down the corridor from its harm reduction division are its cigarettes, financial and executive divisions that know which side the corporate butter is spread thickest. The only possible conclusion is Big Tobacco’s goal with reduced risk products is not to cannibalise its own core product, but to try and promote dual use (cigarettes and e-cigarettes): “smoke when you can, and vape when you can’t”.

Cigarettes still core business

Three of the world’s biggest tobacco transnational companies have very recently affirmed that cigarettes will remain their “core” business.

Philip Morris says:

…cigarettes, our core product.

Imperial says:

Our core business is built around a tobacco portfolio…

BAT says:

Tobacco will be a core part of our business for many years.

BAT chief executive officer, Nicandro Durante said recently the company expects to continue to boost sales of traditional cigarettes in several key markets, pointing to (paywall) the fastest growing areas:

Places like Vietnam, the Philippines, and Indonesia — there are many opportunities out there.

He added that BAT derives more than half of its total revenues from emerging markets.

No firewall between ‘good’ and ‘bad’

The Royal College of Physicians of London wrote recently (p188):

There is no firewall between a “good” tobacco industry that is marketing harm-reduction products in the UK and a “bad” one that promotes smoking, or undermines tobacco control activities, in low- and middle-income countries.

It’s report continued:

Tobacco companies make their money by selling tobacco, and the industry’s recent programme of investment and acquisitions in e-cigarettes perhaps indicates recognition that these products represent a disruptive technology that should be harnessed to protect the core business of selling tobacco, exploited to expand tobacco markets or developed as an opportunity to make nicotine products attractive to non-smokers. There is little likelihood that the industry sees e-cigarettes as a route out of the tobacco business, but it is highly likely that e-cigarettes will be exploited to enhance claims of corporate social responsibility, and to undermine implementation of Article 5.3 of the World Health Organization Framework Convention on Tobacco Control.

Those who believe the tobacco companies are born-again public health angels with the advent of e-cigarettes have little to say about Big Tobacco’s business as usual with cigarettes. It’s a bit like arguing that we should pat a mafia boss on the back for donating a few hundred thousand dollars to a drug rehabilitation clinic while it’s business as usual during the rest of his week.

Study explores alarming threat of emerging Asian tobacco companies to global health

There are already one billion tobacco smokers worldwide, and this number is likely to rise further with Asian tobacco companies poised to enter the global market, according to SFU health sciences professor Kelley Lee.

http://www.sfu.ca/sfunews/stories/2017/03/theloomingthreatofasiantobaccocompaniestoglobalhealth.html

“While companies like British American Tobacco and Philip Morris, traditionally known as ‘Big Tobacco’, have been rightfully targeted by tobacco control efforts to date, on the horizon are several companies based in Asia ‘going global’ with their business strategies,” says Lee, a Tier I Canada Research Chair in Global Health Governance.

“Their aim is to grow their share of the world market through increased marketing, new products and lower prices. This is likely to mean more smokers worldwide.”

Lee and her team are the first to study the global business strategies of Asian tobacco companies, recently published in a special issue of Global Public Health entitled, “The Emergence of Asian Tobacco Companies: Implications for Global Health Governance.”

Their aim in analysing companies in Japan, South Korea, China, Taiwan and Thailand was to document how these companies are shifting from a domestic focus to become aspiring transnational companies.

“Several of these companies have already started to export their brands to rapidly growing markets in Asia, Europe, the Middle East and Africa,” says Lee.

“Their success will mean a further increase to the already six million deaths caused by tobacco use each year.”

These new research findings suggest that globalization of the tobacco industry may be entering a new phase.

Rather than supporting the expansion of these companies as sources of profit, Asian governments need to recognize that far greater economic, environmental and social costs are being caused by this deadly industry.

The authors conclude that collective action by all countries, focused on the World Health Organization’s Framework Convention on Tobacco Control, is needed more than ever.

Lee sat down with SFU News to go over the five case studies that were examined in the special issue, and answered three questions about the findings:

What are the key factors behind the global business strategies of the five Asian tobacco companies?

Trade liberalization and tobacco industry lobbying pressured Asian countries to open their markets to transnational tobacco companies (TTCs) from the late 1980s. British American Tobacco, Philip Morris, R.J. Reynolds and other companies introduced new brands, marketing methods and undermined tobacco control measures to gain a major share of the market in Asia.

The loss of domestic market share also prompted Asian tobacco companies, in turn, to look abroad to grow their own foreign markets. Their global business strategies have borrowed many of the practices used by existing transnational tobacco companies.

Which global business strategies have Asian companies pursued?

Government supported consolidation, restructuring and rationalizing of domestic operations. This included shutting down facilities deemed inefficient, merging smaller concerns into larger ones and upgrading production capacity.

The companies also increased manufacturing, specifically for export to foreign markets, and engaged in new product development to create brands that have global appeal.

Moreover, there has been product innovation, including specially designed filters, flavourings, super slim cigarettes and electronic cigarettes, as well as foreign direct investment in the form of joint ventures, overseas manufacturing and leaf growing operations.

How globalized are Asian tobacco companies to date?

Japan Tobacco International was the first Asian tobacco company to successfully globalize, beginning in the late 1990s, supported by the Japanese government as part owners. Today, Japan Tobacco International is the third largest transnational tobacco company in the world.

Korea Tobacco & Ginseng is well positioned to become the world’s next transnational tobacco company given its active and successful pursuit of foreign markets since privatisation in 2001. The company is achieving rapid growth in eastern Europe, the Middle East and South Asia countries.

The China National Tobacco Company is by far the world’s largest tobacco company but to date has been largely domestically focused. Consolidation has been followed by a strong commitment by the state owned monopoly to “go global” over the next decade through exports, overseas manufacturing and leaf production.

Taiwan Tobacco and Liquor Corporation and Thailand Tobacco Monopoly have both expressed ambitions to globalize, but remain domestically focused and are more likely to become regional players in the foreseeable future.

Tobacco Smoke Ups Rhinitis Rates in Asian Children

Tobacco smoke is associated with pediatric rhinitis among Asian children, according to cohort study findings presented at the 2017 AAAAI Annual Meeting

http://www.empr.com/aaaai-2017/pediatric-rhinitis-asian-non-allergic-immunoglobulin-e/article/642022/

“This Asian cohort demonstrates supportive evidence for positive association of tobacco smoke exposure with rhinitis, while the effect is mainly confirmed to non-allergic rhinitis and more pronounced in adolescents than in young children, highlighting the need for raising public health awareness about the detremental effects of tobacco smoke exposure on children’s respiratory health,” reported lead study author Hui-Ju Tsai, MPH, PhD, of the National Health Research Institutes in Miaoli, Taiwan, and coauthors.

Prior research demonstrated that tobacco smoke exposure harms respiratory health but few population studies have employed cotinine as an exposure biomarker, Dr. Tsai said. And so, the research team set out to examine tobacco smoke exposure and allergic disease among Asian children.

This population based study included a total of 1,315 children aged 5–18 years, who were assessed using questionnaire instruments, and allergen-specific immunoglobulin E, and serum cotinine concentrations as biomarkers of tobacco smoke exposure.

“Serum cotinine levels were positively associated with rhinitis ever (adjusted odds ratio [AOR] 2.95, 95% CI: 1.15–7.60) and current rhinitis (AOR 2.71, 95% CI: 1.07–6.89), while the association for physician-diagnosed rhinitis approached significance (AOR 2.26, 95% CI: 0.88–5.83 [not significant]),” they reported.

No association was found for asthma or eczema, they noted. When data were stratified by patient age groups, these associations were significant only for children at least 10 years old (rhinitis ever AOR 3.34; 95% CI: 1.05–10.61; current rhinitis AOR 4.23; 95% CI: 1.28–13.97). For patient less than 10 years old, no significant association was detected.

“Stratified analyses demonstrated significant association of serum cotinine levels with current rhinitis among children without allergic sensitization (AOR 6.76, 95% CI: 1.21–37.74), but not among those with allergic sensitization,” they noted.

Tobacco control: saving lives and driving development

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.

https://blogs.worldbank.org/health/tobacco-control-saving-lives-and-driving-development

Globally, the public health and economic burden of tobacco is increasingly carried by low and middle income countries rather than high income ones. Within low and middle countries, the burden falls hardest onto the poor and vulnerable populations who can least afford the care. While tobacco use has been declining in most high income countries, it has been stable or rising in many low and middle income countries. Currently, over 80% of global deaths from cancer, diabetes, heart and lung disease occur in low and middle income countries, and this disparity is likely to grow based on current tobacco use patterns. Additionally, coping with tobacco related disease takes attention and resources away from other urgent health priorities, limiting capacity to respond to epidemic diseases, build sustainable health systems, and provide people with basic health services. A community that reduces its tobacco use is a healthier and more prosperous one.

These themes are the focus of a new monograph by the National Cancer Institute of the United States Department of Health and Human Services, in collaboration with the World Health Organization: The Economics of Tobacco and Tobacco Control. The monograph finds that tobacco control measures are highly cost-effective and do not harm economies. Though progress is being made in controlling the global tobacco epidemic, existing measures have not yet been used to their full potential. ‎Applying evidence-based interventions, such as significant tobacco tax and price increases, comprehensive smoke-free policies, and bans on all tobacco product advertising, promotion, and sponsorship would reduce the demand for tobacco products and significantly reduce the prevalence of tobacco use and the resulting death, disease, and economic costs.

Frank Chaloupka, Ph.D., Distinguished Professor of Economics at the University of Illinois at Chicago and the lead scientific editor for the monograph concludes, “the evidence is clear – effective tobacco control interventions make sense from an economic as well as a public health standpoint.”

The monograph also highlights the economic opportunities to be found in controlling tobacco. In addition to paying significant dividends for health, tobacco taxes have the potential for domestic resource mobilization. A recent study has shown that if all countries were to raise their cigarette excise taxes by the equivalent of US$ 0.80 per pack, an additional US$ 141 billion in excise revenue from cigarettes would be generated globally. In developing countries, this increase in revenue could help create the fiscal space needed to help achieve their development priorities. Examples from countries such as Egypt, Thailand, the Philippines, and Vietnam demonstrate how these revenues can be channeled into health initiatives, thereby alleviating some of the funding needs for the health sector. The so-called ‘sin tax’ reforms of the Philippines, for example, provided additional tobacco tax revenues to help finance a significant scale-up of subsidized health insurance for poor families.

The Addis Ababa Action Agenda on Financing for Development recognizes that “price and tax measures on tobacco can be an effective and important means to reduce tobacco consumption and healthcare costs, and represent a revenue stream for financing for development in many countries”. The implementation of the WHO Framework Convention on Tobacco Control is one of the targets under Sustainable Development Goal Three: to promote healthy lives and wellbeing for all people at all ages. These processes under the 2030 Agenda, along with the commitments made at the UN High Level Meetings on Noncommunicable Diseases in 2011 and 2014, provide a governance framework for action on tobacco control in relation to development.

In order for the targets of the 2030 Agenda to be met, consideration of tobacco economics needs to be integrated into broader policy, and tackled with a whole of government approach that recognizes the cross-sectoral impact of tobacco. The economics of tobacco control affects our daily lives, our communities and our economies.

Tobacco control makes good sense not only from economic and public health viewpoints but from a sustainable development perspective as well.

The Economics of Tobacco and Tobacco Control provides the first comprehensive review of the economics of global tobacco control efforts since the 2003 adoption and 2005 entry into the World Health Organization Framework Convention on Tobacco Control

Expert warns on dangers of tobacco farming

An expert on tobacco-induced diseases, Akin Adebiyi, has warned tobacco farmers of the harmful effects of cultivating the crop.

Mr. Adebiyi, a medical doctor at the University College Hospital, Ibadan, said tobacco farmers should form a co-operative and engage the government for alternative means of sustenance in farming.

Tobacco cultivation is an intensive process that involves several stages and exposes farmers to tobacco dust.

For example there is the Green Leaf syndrome that is well documented that the tobacco farmer is prone to have, said Mr. Adebiyi.

“But more importantly is when they harvest the tobacco product and they are trying to make it suitable for the tobacco industry to buy from them. During the Curing process, they have to do a lot of work which is highly intensive, and they have to use firewood so they are exposed also to smoke, they are exposed to the tobacco dust that is generated when you are trying to put the products together.

“And they are not the only ones that are exposed, they also bring in their children to make sure that these are packed well. Sometimes it gets mouldy and they are exposed to mould.

“So all these are situations where the farmer can actually be exposed to deleterious effects of tobacco, so it’s not only about smoking,” he said.

Mr. Adebiyi spoke with journalists during a tour of tobacco farms in Iwere-Ile, Oyo State, on Wednesday.

He said the efforts tobacco farmers put into the cultivation of the plant is not commensurate with the financial gains they receive through sales of the finished products.

“I would say is that if you look at the efforts that tobacco farmers put into the farming, in terms of when the product is at the nursery stage and they have to wet morning and night, spend a lot of time in the farm and you look at what they eventually get at the end of the process, you realise that it’s not that profitable,” he said.

“And then along the line they are exposed to some deleterious effects of tobacco dust and of the firewood they use during the curing process.

“Government needs to engage the farmers. They need to know that tobacco farmers have to earn a living. And because they have to earn a living, we must as a matter of necessity look for alternative to tobacco farming.

“Animals shy away from tobacco, they don’t eat tobacco. But man is…it’s so funny that animals that are supposed to be at the lower level than man understand the dangerous effects of tobacco, but man is the one that is cultivating it and eating it. And man is supposed to be at a higher level than animals.

The farmers need to be educated and they need to group themselves into a cooperative to approach the government.”

A tobacco farmer in the community, Michael Falana, said they grow the plant twice a year – between March and June and then July and August.

“I stay at the farm from 7 a.m. to 7 p.m. during the planting season,” said Mr. Falana, the head of tobacco growers in the community.

Mr. Falana said they receive loans from tobacco companies at the start of every planting season – about N400,000 – and make a profit of about N150,000 after repaying the loan.

“I plant cassava in between the planting seasons to support my income,” he added.

Akinbode Oluwafemi, an environmental activist, said tobacco farmers do not receive adequate protection from government in terms if policy formulation.

“If my memory serves me right, this is my fifth tour of tobacco farms and, sadly, nothing has changed,” said Mr. Oluwafemi, Director of Corporate Accountability at Environemntal Rights Action/Friends of the Earth Nigeria.

“The farms remain a territory for modern slavery. The tobacco farmers are in a cycle of debt with the tobacco companies who treat them like slaves. They farm the crop, they take it to the collection centre and they come and dictate the price. The farmers are still exposed to all manner of risks as a result of chemicals that are used in tobacco farming. There is not enough protection in terms of policy on the side of government.

“Most importantly, you all saw what it took to even locate one tobacco farm. So you begin to ask yourself ‘where are the tobacco farms?’

“The reality on ground is the same question we have been asking the government to unravel. How many acreage of tobacco farms are in Nigeria? How many tobacco farmers are in Nigeria? How much of tobacco leaves do Philip Morris, BAT import into their factories in Ibadan or Ilorin to produce the volumes that we have?

“Because from what you’ve seen today, certainly those leaves are not coming from these farms. What we basically have in Nigeria are farmers that the tobacco companies are using for public relations and for their political agenda. And we are saying that narrative must change. Government must take interest in this, work with civil society, stakeholders, and the farmers to find a way out of this problem.”