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Tobacco is a deadly threat to global development

May 30th, 2017
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Dr Margaret Chan, Director-General of WHO

http://who.int/mediacentre/commentaries/2017/tobacco-threat-development/en/

When I reflect on my tenure as Director-General of the World Health Organization, there are many areas where the agency played its unique role as the guardian of health for all people.

But I am especially proud of our work to fight tobacco use, something that I have personally championed since 2007.

Tobacco is a deadly product that kills more than 7 million people every year, and costs the global economy more than US$ 1.4 trillion annually in healthcare expenditure and lost productivity.

Tobacco control will play a major part in meeting the Sustainable Development Goal target of reducing premature deaths from noncommunicable diseases by one-third by 2030.

But tobacco control is about more than preventing deadly cancers, heart diseases and respiratory diseases. In addition to posing a serious threat to health, tobacco use also threatens development in every country on every level and across many sectors — economic growth, health, education, poverty and the environment — with women and children bearing the brunt of the consequences.

The theme for this year’s World No Tobacco Day, on 31 May, is “Tobacco – a threat to development”. This year, WHO will launch a new report that highlights the great harm to the environment inflicted by tobacco growing, manufacturing, trade and consumption. For example, growing and producing tobacco uses 4.3 million hectares of land resulting in deforestation of 2-4%, and the pesticides and fertilizers used in tobacco growing can be toxic and pollute water supplies. Tobacco manufacturing produces over 2 million tonnes of solid waste each year. Up to 10 billion cigarettes are disposed in the environment every day. Cigarette butts account for 30-40% of all litter collected in coastal and urban clean-ups.

Tobacco farming also stops children from attending school and exposes them to hazardous chemicals. Children in tobacco-growing families often miss class because they are needed to work in the tobacco fields. Women are also disproportionately at risk of chemical exposure, as they make up 60-70% of the tobacco farming workforce.

Tobacco use hits the poorest people the hardest and exacerbates poverty. Spending on tobacco products often represents more than 10% of total household income – meaning less money for food, education and health care. Some 80% of the premature deaths attributable to tobacco use occur in low- or middle-income countries. These countries bear almost 40% of the global US$ 1.4 trillion cost of smoking from health expenditures and lost productivity.

Fortunately, we have powerful tools to fight the tobacco epidemic. The WHO Framework Convention on Tobacco Control (WHO FCTC), the first international treaty negotiated under the auspices of WHO, provides governments with clear, legally binding measures that they can introduce to reduce the harm caused by tobacco use. These include banning advertising, promotion and sponsorship of tobacco, effectively warning about the harmful effects of tobacco use, implementing tax or price policies and protecting people from exposure to second-hand tobacco smoke.

In line with WHO’s FCTC, WHO’s MPOWER measures support countries to reduce demand for tobacco, using methods that are practical, low-cost and high-impact. Tobacco taxation is a powerful tool for saving lives. Taxes reduce smoking rates and help government raise revenues to improve health and promote development. Increasing tobacco taxes and prices is one of the most effective, yet least utilized control measures globally. By increasing cigarette taxes worldwide by US$1, an extra US$ 190 billion could be raised for development.

We need to make sure that countries know that this tool exists and how to use it. Ministers of health are convinced by the evidence, and I ask them to be vocal in persuading ministers of finance, trade, foreign affairs and others not to be swayed by the unsubstantiated arguments of the tobacco industry.

Many countries have already shown tremendous progress in reducing tobacco use. Our challenge now is to help more countries follow suit, and to fight the efforts of the tobacco companies to hinder or counter progress that has been made by countries implementing strong measures.

Everyone can help play a role in stamping out tobacco and promoting development at the same time. People can commit to never take up tobacco products or to seek help to quit the habit. Governments can strengthen implementation of the WHO FCTC.

The tobacco industry is a vector of one of the greatest threats our society faces. It takes courage to antagonize powerful economic operators. If we fail to accept this responsibility, we will never make sufficient progress in health and development.

WHO stands ready to help governments introduce innovative approaches to tackle tobacco use. We have taken off our gloves and entered the ring on the side of the countries working to advance tobacco control, and we are going to fight tobacco tooth and nail.

If we rise to the challenge of beating tobacco by adopting measures that reduce demand for this deadly product, we can promote a healthier, more sustainable world.

Stopping production and marketing of tobacco can be the only way to uphold basic human rights

May 29th, 2017
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Action on Smoking and Health and Unfairtobacco agree with the Danish Institute of Human Rights (DIHR) that Philip Morris International (PMI) should cease “the production and marketing of tobacco.”

http://www.news-medical.net/news/20170529/Stopping-production-and-marketing-of-tobacco-can-be-the-only-way-to-uphold-basic-human-rights.aspx

After completing a collaboration with Philip Morris International (PMI) to develop a “human rights implementation plan,” the Danish Institute for Human Rights (DIHR) concluded that immediately stopping the sale and marketing of tobacco is the only way for tobacco companies to uphold basic human rights.

ASH and Unfairtobacco are fully aligned with the DIHR conclusion that tobacco production and marketing is deeply harmful and irreconcilable with the human right to health, meaning that PMI and other tobacco companies must stop selling harmful products immediately.

Tobacco giant Philip Morris International (PMI) approached the Danish Institute for Human Rights (DIHR), a quasistate body, last year to collaborate on a “human rights implementation plan” for PMI. The DIHR was given access to the corporation to assess PMI’s value chain. Following DIHR’s completion of their work, they concluded:

Tobacco is deeply harmful to human health, and there can be no doubt that the production and marketing of tobacco is irreconcilable with the human right to health. For the tobacco industry, the [United Nations Guiding Principles on Business and Human Rights] therefore require the cessation of the production and marketing of tobacco.

Allan Lerberg Jørgensen, Department Director, Human Rights and Development with the DIHR, stated they hoped their “input will enable PMI to better understand how the corporate responsibility to respect human rights applies to their business and take the necessary action.”

“ASH and our allies strongly agree with DIHR that the sale of cigarettes is irreconcilable with human rights. The necessary action that DIHR references is clear: if PMI is serious about human rights, it should stop producing, marketing and selling products that kill their consumers.”

Laurent Huber, Action on Smoking and Health (USA)

“As early as 1954, then PMI Vice President George Weissman said that ‘If we had any thought or knowledge that in any way we were selling a product harmful to consumers, we would stop business tomorrow’. The DIHR assessment is just the most recent reminder of their promise. We expect PMI to finally stop selling cigarettes immediately.”

Laura Graen, Unfairtobacco

For PMI to continue producing and marketing cigarettes directly conflicts with development and human rights objectives. Tobacco corporations not only sell a defective product that kills half of its consumers, but they also have a long history of pressuring governments to block and delay lifesaving regulations, thus costing the world millions of lives and billions of dollars every year.

Global Public Health Policies Against Tobacco Partnerships

One strategy the tobacco industry utilizes is the use of third party collaborations to interfere with tobacco control policy making, or to gain legitimacy as a “stakeholder,” and to white wash their reputation.

For this reason, the global tobacco treaty, the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) includes a process designed to protect public health policies from the interests of the tobacco industry, requiring that all public or semipublic institutions “should interact with the tobacco industry only when and to the extent strictly necessary to enable them to effectively regulate the tobacco industry and tobacco products.” With that in mind, the global public health community was united in asking DIHR to break their PMI relationship, in line with the Institute’s international human rights obligations. The DIHR responded promptly, ending the relationship before its originally published end date (August 2017).

Stopping the sale of tobacco products is also consistent with the United Nations

Sustainable Development Goals (SDGs), which call on countries to reduce the number of smokers through implementation of the tobacco treaty, the WHO FCTC.

Philip Morris has publicly welcomed the adoption of the Sustainable Development Goals, while their products are simultaneously recognized by the United Nations, Human Rights agencies, and the public health community as a barrier to development and human rights. Philip Morris states on its website, “How long will the world’s leading cigarette company be in the cigarette business?” The answer is clear: not a day longer.

Smokers Undeterred as Bills Keep Rising

May 28th, 2017
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Since the beginning of the past fiscal year (ended in March) the taxes collected on tobacco products are paid to the Health Ministry (50%), Education Ministry (25%) and Ministry of Sports and Youth Affairs (25%) for anti-smoking campaigns

https://financialtribune.com/articles/people/65335/smokers-undeterred-as-bills-keep-rising

Iranians spend $1-1.5 million (40 to 50 billion rials) on tobacco products each day and the cost of treating tobacco-related disease is almost three times more than the amount spent on tobacco consumption.

During the past five years, the rate of tobacco consumption has only slightly decreased, studies conducted by the Health Ministry indicate. The rate is still high among adolescents and young people (the peak age for first trying of smoking has decreased from 13 to 10). The figure has also increased dramatically compared to the past decade, the Persian language weekly ‘Salamat’ reported.

“In 2006, Iranians smoked 50 billion cigarettes (worth $33.3 million). The figure reached 60-70 billion cigarettes in 2016,” said Dr Mohammadreza Madani, head of the Iranian Anti-Tobacco Association (IATA).

Another concern is the high prevalence of hookah (water pipe) for smoking flavored tobacco among young people. One hour of smoking hookah exposes a smoker 100-fold to the amount of smoke inhaled from a single cigarette. Even those people around a hookah smoker inhale smoke equal to 10 cigarettes.

Every year on May 31, the WHO marks World No Tobacco Day (WNTD), highlighting the health and additional risks associated with tobacco use, and advocating effective policies to reduce tobacco consumption.

The theme for World No Tobacco Day 2017 is ‘Tobacco – a threat to development.’

But irrespective of the programs to create awareness on the harmful effects of smoking, statistics show that 14-15% of Iranians from the 80 million population are regular cigarette smokers (more than 3% are women, and 20% men).

“Though most of the cigarette smokers are men, hookah smoking doesn’t vary by gender; 21.3% of women and 21.7% of men are hookah smokers,” Madani said.

Dodging Taxes

Iran is one of the nations that has signed the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), by which a country is committed to reduce the rate of tobacco consumption every year (by implementation of both price and tax measures as well as non-price measures to reduce demand for tobacco).

Pointing to Article 8 of the National Comprehensive Law on Tobacco Control, Madani said, “According to the law passed in 2006, every year taxes on cigarettes should be increased by 10%.”

“However, there have been always obstacles in its implementation. For example, in 2010 the figure decreased to 5% due to ‘manipulative tactics’ by the powerful tobacco lobby. Tobacco producers said that high taxes on cigarettes would lead to an increase in cigarette smuggling, and thus managed to reduce the tax.”

However, in January this year, lawmakers passed cigarette and tobacco tax slabs to be implemented under the sixth five-year economic development plan (2017-22).

Based on the new law, the tax slab on locally-produced tobacco and cigarettes is 10%; for local brands jointly produced by domestic and foreign manufacturers, it is 20%; for domestically produced cigarettes with foreign brand names the slab is 25%; and for imported cigarettes and tobacco, it is 40%.

Lawmakers also mandated the Ministry of Industries, Mining and Trade to announce the retail prices of cigarettes and all tobacco products to the relevant authorities for taxation purposes and for printing the tax rates on cigarette packs.

“Since the beginning of the past fiscal year (ended in March) the taxes collected on tobacco products are paid to the Health Ministry (50%), Education Ministry (25%) and Ministry of Sports and Youth Affairs (25%). The Education Ministry is required to spend the money on increasing students’ awareness of harms associated with tobacco smoking,” Madani said.

Earlier, the tax money was given to the ministries of health and sports and youth affairs.

Facts About Tobacco

There are more than 7 million deaths from tobacco use every year, a figure that is predicted to cross 8 million by 2030 without effective and intensified action. Tobacco consumption is a threat to any person, regardless of gender, age, race, cultural or educational background. It brings suffering, disease, and death, impoverishing families and national economies.

Tobacco use costs national economies enormously through increased healthcare costs and decreased productivity. Some 80% of premature deaths from tobacco occur in low- or middle-income countries, which face increased challenges to achieving their development goals, the WHO website reports.

Tobacco growing requires large amounts of pesticides and fertilizers, which can be toxic and pollute water supplies. Each year, tobacco growing uses 4.3 million hectares of land, resulting in global deforestation between 2% and 4%. Tobacco manufacturing also produces over 2 million tons of solid waste.

By increasing cigarette taxes worldwide by $1, an extra $190 billion could be raised for development. High tobacco taxes contribute to revenue generation for governments, reduce demand for tobacco, and offer an important revenue stream to finance development activities.

Big Tobacco is losing the fight to stop plain packaging of cigarettes

May 23rd, 2017
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Dr Enrico Bonadio, a Senior Lecturer in the City Law School, says the tobacco industry’s bid to avoid plain packaging by relying on legal arguments around trade and intellectual property rights, is being systematically dismissed by courts around the world.

https://www.city.ac.uk/news/2017/may/big-tobacco-is-losing-the-fight-to-stop-plain-packaging-of-cigarettes

You may already have seen the tobacco packs currently sold in the UK: a dark, murky green colour with large graphic health-warning images and scary messages aimed at informing current and potential smokers about the devastating consequences of tobacco consumption. They have no colourful logos, with the brand name just displayed in small characters in a standard font.

These packs are now required by new regulations which entered into force in May 2016. There has been a one-year transitional period for the sell-through of old stock – and from May 20 2017 all tobacco products on sale in the UK must comply with the new rules.

The legislative move has been recommended to all countries by the World Health Organisation to reduce the attractiveness of smoking and eventually reduce consumption. Australia was the first country to introduce such strict packaging requirements in December 2012. France and, of course, the UK have since followed suit.

It follows significant research that shows these new standardised cigarette packs are much less appealing to consumers – and young people especially.
The industry’s legal defeats

No wonder tobacco companies have challenged the measure in the courts. They have argued that it is useless, too harsh – and is an infringement of their fundamental and intellectual property rights, especially trademarks. Yet, their claims are based on weak arguments and have been rejected by both the High Court of England and Wales and the Court of Appeal.

The tobacco industry has faced numerous courtroom defeats of late. Last year Uruguay won a landmark case against the Swiss giant Philip Morris International. The company had sued the Latin American state after it introduced two measures affecting tobacco packaging and trademarks. These were mandatory graphic health warnings covering 80% of cigarette packets (a measure very close to plain packaging) and the obligation for tobacco companies to adopt a single presentation for their brands, dropping for example the “gold” and “blue” descriptors, that could lead smokers to believe one variant was safer than another.

The fact that the courts sided with Uruguay would have been encouraging to other countries aiming to introduce controls on tobacco packaging. And even greater encouragement came recently from a World Trade Organisation ruling which deemed that the plain packaging requirements introduced by Australia as compliant with international trade and intellectual property rules – and are therefore a legitimate public health measure.

The decision has not been officially announced, but a confidential draft of the interim ruling was leaked to the media and the final decision is expected later this year. The Australian measure had been challenged at the WTO tribunal by Cuba, Dominican Republic, Indonesia and Honduras, countries whose economies strongly rely on the tobacco industry.

A domino effect

This is a blow to the industry. The short-term consequences of the WTO ruling – Imperial Tobacco’s shares fell more than 2% after the decision was leaked – reflects the longer-term danger that this ruling poses. It will likely convince other states to introduce plain packaging legislation without fear of violating international trade and intellectual property laws. It basically gives them a green light by removing the regulatory chilling effect that such legal action has produced on countries that wanted to follow Australia’s example.

After all, more and more countries seem interested in adopting standardised packaging. As well as France and the UK, Ireland and Norway will introduce packaging restrictions later in 2017, and Hungary in 2018. Many other states are debating similar measures, including New Zealand, Canada, Belgium, Slovenia, Belgium, Singapore and Thailand.

So, a legislative trend has started which aims to restrict the ability of tobacco manufacturers to make their products appealing to consumers by using eye-catching words, logos or ornamental features on the pack. And attempts by Big Tobacco to stop it by relying on legal arguments around trade and intellectual property rights are being systematically dismissed by courts around the world.

Ultimately, the industry needs to accept the fact that its ability to use fancy brands, especially on packaging, may be reduced by governments for public health reasons. Also that a company’s property rights are not absolute or untouchable. Not only does it not have enough legal basis – as has now been confirmed by several courts and tribunals – but it also disregards legitimate policies adopted by democratically elected governments.

Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma

May 22nd, 2017
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https://academic.oup.com/jnci/article-abstract/109/12/djx075/3836090/Cigarette-Filter-Ventilation-and-its-Relationship?redirectedFrom=fulltext

The 2014 Surgeon General’s Report on smoking and health concluded that changing cigarette designs have caused an increase in lung adenocarcinomas, implicating cigarette filter ventilation that lowers smoking machine tar yields. The Food and Drug Administration (FDA) now has the authority to regulate cigarette design if doing so would improve public health. To support a potential regulatory action, two weight-of-evidence reviews were applied for causally relating filter ventilation to lung adenocarcinoma. Published scientific literature (3284 citations) and internal tobacco company documents contributed to causation analysis evidence blocks and the identification of research gaps. Filter ventilation was adopted in the mid-1960s and was initially equated with making a cigarette safer. Since then, lung adenocarcinoma rates paradoxically increased relative to other lung cancer subtypes. Filter ventilation 1) alters tobacco combustion, increasing smoke toxicants; 2) allows for elasticity of use so that smokers inhale more smoke to maintain their nicotine intake; and 3) causes a false perception of lower health risk from “lighter” smoke. Seemingly not supportive of a causal relationship is that human exposure biomarker studies indicate no reduction in exposure, but these do not measure exposure in the lung or utilize known biomarkers of harm. Altered puffing and inhalation may make smoke available to lung cells prone to adenocarcinomas. The analysis strongly suggests that filter ventilation has contributed to the rise in lung adenocarcinomas among smokers. Thus, the FDA should consider regulating its use, up to and including a ban. Herein, we propose a research agenda to support such an effort.

What’s keeping Indonesia, China addicted to smoking?

May 13th, 2017
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A World Trade Organisation ruling backing Australia’s hard line on cigarette packaging highlights a gulf between Asia and much of the rest of the world

http://www.scmp.com/week-asia/society/article/2094162/whats-keeping-indonesia-china-addicted-smoking

It was during a trip to Egypt in 1995 when Edison Siahaan first felt that something wasn’t quite right with his throat. Four decades had gone by since he started smoking at the age of 15. His voice had been raspy for years. Maybe this was just the dry air tickling the back of his throat.

But it wasn’t dry air and it wasn’t a tickle. It was cancer. Doctors excised a portion of his trachea leaving a hole the size of a nickel at the base of the throat. He lost his bank job because for a year following the surgery he couldn’t speak. Even now, what passes for speech makes him sound like the emperor from Star Wars only with more hissing. Now 79, Siahaan, a kindly old gent with a full head of hair, is tough to look at. “I see kids smoking all the time here,” he says, gesturing back and forth along the length of the street from his front room. “It makes me sick to think they are going to ruin their life. I point at this hole in my throat and say to them: do you want to look like this?”

Asian men already account for the lion’s share of the world’s tobacco related illnesses, yet a World Trade Organisation ruling this week that upheld tough anti-smoking rules introduced in Australia in 2012, showed that if anything, the gap in attitudes between Asia and the rest of the world may be widening.

“Tobacco in China is absolutely devastating,” says Dr Angela Pratt who helps handle external relations at the World Health Organisation’s office for the Western Pacific in Manila.

In China, roughly 300 million people smoke, according to the WHO. Most of these are men. More than half of Chinese adults are smokers and two-thirds of young Chinese men start smoking. While smoking rates are steady, the absolute number of smokers is rising in line with population growth. Chinese smokers account for 44 per cent of all the cigarettes puffed in the world. At current rates 200 million Chinese will die this century from tobacco-related illnesses, Pratt says. “That’s a huge burden. The people afflicted are often the sole income earners,” she says.

This week, the WTO ruled that Australia’s plain packaging rules, which ban branding and distinctive colouring from packs of cigarettes, were a legitimate public health measure. The ruling knocked back a complaint from Indonesia, Cuba, Honduras and the Dominican Republic, who said the rule amounted to an illegal trade barrier. As the former chief of staff to the Australian health minister who introduced the plain packaging measures, Nicola Roxon, Pratt helped develop the policy, bulletproofing it from court challenges from tobacco companies and governments.

“We were proud to be taking on plain packaging,” Pratt recalls. “But we wanted to be sure to be able to defend it.”

Together with graphic warnings and taxes that will push cigarettes up to A$40 (HK$230) per pack by 2020, the measure is credited with accelerating the fall in Australia’s smoking rate. The most recent figures show about 13 per cent of Australian adults smoke and less than five per cent of school children. A dozen countries, from Canada to Chile and Britain to Uruguay are either introducing similar rules or seriously considering them.

At the other extreme is Indonesia. The most recent figures, which date back to 2013, show 240,000 Indonesians die every year from tobacco related illnesses. Two-thirds of Indonesian men and boys, over the age of 15, smoke, according to the Ministry of Health.

Most troubling are the numbers of new young smokers throughout the archipelago, says Dr Widyastuti Soerojo, chair of the tobacco control unit at the Indonesian Public Health Association. She says some 16 million Indonesian youngsters between the ages of 10 and 19 experiment with smoking every year – a rate of about 44,000 every day.

Indonesia is among the few countries that are not signatories to the United Nation’s Framework Convention on Tobacco Control, which among other things aims to curb the appeal of smoking for children.

Indonesia television and billboards feature handsome intrepid men jumping out of planes or into business meetings. Roadside kiosks individually sell clove cigarettes, known as kretek, for as little as 10 US cents each.

Governments in Jakarta and local governments in vote-rich provinces, such as Central Java and East Java, fend off calls for more curbs on smoking saying they provide badly needed jobs to rural families.

But mechanisation and growing taste for machine-made cancer sticks rather than hand-rolled types, belie that argument. Tobacco accounts for about half of one per cent of all jobs in Indonesia, according to the Southeast Asia Tobacco Control Alliance. Campaigners are quick to point out the country’s richest families have tobacco to thank.

The Hartonos, Indonesia’s richest family and worth US$17 billion, own kretek maker Djarum.

Indonesian cigarette sales totaled US$16 billion in 2015. Sampoerna, which is more than 90 per cent owned by Philip Morris, is Indonesia’s most valuable company.

“The government treats tobacco like it’s a normal industry but really this is neocolonialism by tobacco companies,” Dr Soerojo says.

In China, the culprit for health advocates is the China National Tobacco Corporation, which controls more than 98 per cent of the local market. Implementation of the UN tobacco convention falls to the Ministry of Industry, which is also home to the body that owns China Tobacco. “A parallel would be, back when I was with the health ministry, meetings were chaired by a representative of Philip Morris,” Pratt said. “There’s plenty of room for conflict of interest.”

Still, there’s progress. Beijing, Shanghai and Shenzhen, with a combined population of more than 60 million, have banned smoking in public areas. China hiked taxes on cigarettes in 2015. The move resulted in a 20 per cent jump in the retail prices of the cheapest brands. Owing to its massive market, that move alone resulted in a more than 2 per cent drop in world tobacco consumption in 2016.

In Indonesia, smoking is banned in most public spaces but enforcement peters out the further one travels from the centre of Jakarta. Indonesia introduced graphic warnings on packaging in 2012 and hiked excise taxes on cigarettes by 15 per cent in 2016. Even so, additional hikes for this year were scotched. Glimmers of light are on the horizon, says WHO’s Pratt, but plain packaging is still “a long way off”.

For Siahaan, his government’s halting go-slow approach is proof that cigarettes are insidious, and for him, more ruinous than narcotics. “At least with drugs you can get help,” he gasps. “For cigarettes, you see them everywhere.”

Anti-smoking group seeks to raise legal smoking age to 20

May 10th, 2017
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Around one billion people will die from tobacco-related causes by the end of the 21st century if current smoking patterns continue…

http://www.taiwannews.com.tw/en/news/3159764

Taiwan’s anti-smoking group held a press conference on Wednesday calling for higher legal smoking age and completely smoke-free workplaces and indoor public places.

The group has called on the Legislature to revise the nation’s Tobacco Hazards Prevention Act comprehensively to correspond to the requirements of the WHO’s Framework Convention on Tobacco Control (WHO FCTC).

WHO FCTC is the first treaty negotiated under the auspices of the World Health Organization that was developed in response to the globalization of the tobacco epidemic.

Democratic Progressive Party (DPP) legislator Chen Man-Li (陳曼麗) and Kuomintang (KMT) legislator Ko Chih-En (柯志恩) both showed up to the press conference today in support of the group.

Taiwan Heart Foundation’s Chairman Lue Hung-chi (呂鴻基) said today that around one billion people will die from tobacco-related causes by the end of the 21st century if current smoking patterns continue.

Major changes that the group has called for include bans on smoking in all workplaces and indoor public places, increase the size of warnings on tobacco packs to 85% of the surface area and with mandatory plain packaging, bans on sponsorship from tobacco companies, bans on the sale of flavored cigarettes, extend all the smoking-related bans to include e-cigarettes, and raise the legal age for smoking from 18 to 20.

Tobacco Control Program

May 5th, 2017
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Context

Tobacco use, and its negative health, social and economic impacts, is a significant global health challenge.

http://www.worldbank.org/en/topic/health/brief/tobacco

According to the 2015 World Health Organization (WHO) Report on the Global Tobacco Epidemic, in 2013, 21% of adults globally were current smokers – 950 million men and 177 million women. Despite increasing global population between 2007 and 2013, smoking prevalence has actually declined worldwide from 23% in 2007, preventing an increase in the number of smokers in the world. The total remains at 1.1 billion smokers globally in 2013.

Tobacco use is a leading global disease risk factor and underlying cause of ill health, preventable death, and disability. It is estimated to kill more than 5 million people each year across the globe. If current trends persist, tobacco will kill more than 8 million people worldwide each year by 2030, with 80% of these premature deaths taking place in the developing world.

In 2015, the “Addis Ababa Action Agenda” adopted at the Third International Conference on Financing for Development held in Addis Ababa, Ethiopia — and later endorsed by the United Nations as part of the Sustainable Development Goals (SDGs) — recognized that public policies and mobilization, and effective use of domestic resources, underscored by the principle of national ownership, are central to the common pursuit of sustainable development, including achieving the SDGs.

Clause 32 of the Addis Ababa Action Agenda states that price and tax measures on tobacco are viewed as an effective and important means to reduce tobacco consumption and health care costs, and represent a revenue stream for financing for development in many countries.

The Action Agenda also stresses that the tobacco tax agenda is fully consistent with obligations acquired by 180 countries that are parties to the WHO Framework Convention on Tobacco Control (FCTC) (an additional seven countries have signed the FCTC but have not ratified it, and only nine countries are neither signatories or parties to the FCTC).

World Bank Group Tobacco Control Program

The World Bank Group’s Global Tobacco Control Program assists countries in fostering and implementing tobacco tax reforms to achieve public health goals by reducing tobacco affordability and consumption, and for mobilizing domestic resources to expand the fiscal space to fund priority programs and investments that benefit the entire population, and controlling illicit trade on tobacco by strengthening customs systems. Work has been carried out over 2013-2016 in Philippines, Bostwana, Ghana, Namibia, Vietnam, Georgia, Indonesia, and Peru; more recently, for the support of tobacco tax reforms adopted in 2017 in Armenia, Colombia, Moldova, and Ukraine, and assessments done over 2016-2017 in Nigeria, Ethiopia, Lesotho, Belarus, Turkey, Chile, and on the European Union tax harmonization process. Work is currently underway or being initiated in the Indonesia, Sierra Leone, China, and Montenegro. In addition, the program supports knowledge exchange, including peer-to-peer advice and support, among selected countries on the economics of tobacco control (for example, through the Joint Learning Network, which includes more than 30 countries).

The preparation of a Tobacco Taxation Module as part of WBG/IMF Tax Policy Assessment Framework (TPAF) is underway as part of a new WBG/IMF initiative launched ahead of the Financing for Development Conference in Addis Ababa, held in July 2015, to help member countries strengthen their tax systems. One of the pillars of the initiative includes the development of “improved diagnostic tools to help member countries evaluate and strengthen their tax policies.” Building on their collective expertise, the Bretton Woods Institutions (BWIs) aim to play a fuller role in enabling all of their member countries to assess tax policy performance in order to identify priority tax policy reforms, and design the requisite support for their implementation. The TPAF is a diagnostic framework to provide systematic and structured assessment of a country’s tax policy system, and to develop options for improving such system given a set of policy objectives.

More specifically, the program assists government agencies in developing capacity to assess the health and social costs of tobacco use, and design, enact, administer and monitor tobacco taxation policies. Enhanced capacity will enable countries to increase prices and reduce tobacco use, taking into account the macro-economic and fiscal situation of each country, tax laws, and existing tax administration structure and processes. This process includes assessments and discussions related to fiscal revenues and allocation; smoking patterns and taxes at country level; and socio-economic and health impacts of increasing tobacco tax rates, under different tax policy scenarios, and including impacts on employment, smuggling and other likely impacts of tobacco tax reforms.

The Bank team engaged in this program is multi-sectoral, and includes experts in health, governance, and macro-economics and financial management. Initial discussions are being held to mobilize knowledge and expertise from the International Monetary Fund’s Fiscal Affairs team. The Bank team is also working closely with other international partners, such as the World Health Organization and the Campaign for Tobacco-Free Kids.

The Bank’s Tobacco Control Program is implemented through a multi-donor trust fund financed by the Bill & Melinda Gates Foundation and the Bloomberg Philanthropies. These donors take part in governance of the trust fund and participate in the selection of priority countries included for support under the program.

Joint Learning Network Module: The Joint Learning Network (JLN), connects practitioners and policymakers across countries, facilitating peer-to-peer learning and sharing of knowledge and experience. As part of the Bank’s program, the network is currently developing a Tobacco Tax and Illicit Trade on Tobacco Module targeting member countries in Asia, Africa, Latin American and the Caribbean, and Europe, as well as a diverse group of international, regional, and local partners. The module is expected to focus on tobacco taxation, tax administration, and illicit trade control measures.

In 1991 the World Bank adopted a mandatory operational policy not to lend, invest in, or guarantee investments or loans for tobacco production, processing, or marketing. The Bank’s activities in the health sector discourage the use of tobacco products.

Why the emphasis on tobacco taxation?

Raising taxes on tobacco products is one of the most cost-effective measures to reduce consumption of products that increase mortality , while also generating substantial domestic revenue for health and other essential programs—investments that benefit the entire population. Given this, the World Bank Group Tobacco Control Program gives priority attention to tobacco taxation.

Findings in the 2015 WHO Report on the Global Tobacco Epidemic show that while only 33 countries impose taxes that constitute more than 75% of the retail price of a pack of cigarettes—the taxation level recommended to have an impact on consumption —most countries that do tax tobacco products have extremely low tax rates. And some countries do not have a special tax on tobacco products at all.

Given this situation, the World Bank Group’s program supports governments to look at accumulated country evidence and use tax measures to increase the retail price of tobacco products as one of the best available public health policy measures.

Some important lessons from international experience about how to effectively implement tobacco taxation policy to achieve public health objectives can be adopted and adapted in policy dialogue and operational support to countries. Such lessons include:

  • While nearly all countries tax tobacco products, an excise tax is the most important type of tobacco tax, since it applies uniquely to tobacco products and raises prices relative to prices for other goods and services.
  • Simpler tobacco tax structures are more effective than complex ones, since tiered tax structures are difficult to administer and can undermine the health and revenue impacts of tobacco excise taxes.
  • Use of specific excise taxes enhances the impact of tobacco taxation on public health by reducing price gaps between premium and lower-priced alternatives, which limits opportunities for users to switch to less-expensive brands in response to tax increases. Taxing all tobacco products comparably reduces incentives for substitution.
  • Ad valorem taxes are difficult to implement and weaken tax policy impact. Since they are levied as a percentage of price, companies have greater opportunities to avoid higher taxes and preserve or grow the size of their market by manufacturing and selling lower-priced brands. This also makes government tax revenues more dependent on industry pricing strategies and increases the uncertainty of the tobacco tax revenue stream.
  • Specific excise taxes need to be adjusted for inflation to remain effective.
  • Tax increases should reduce the affordability of tobacco products. In many countries, where incomes and purchasing power are growing rapidly, large price increases are required to offset growth in real incomes.
  • Strong tax administration is critical to minimize tax avoidance and tax evasion, to ensure that tobacco tax increases lead to higher tobacco product prices and tax revenues, as well as reductions in tobacco use and its negative health consequences.
  • Regional agreements on tobacco taxation can be effective in reducing cross-border tax and price differentials and in minimizing opportunities for individual tax avoidance and larger scale illicit trade.

For more information, please contact:

Patricio V. Marquez

Lead Public Health Specialist

World Bank Group Health, Population and Nutrition Global Practice

Email address: pmarquez@worldbank.org

Blanca Moreno-Dodson

Lead Economist

World Bank Group Macro Economics and Fiscal Management Global Practice

bmorenododson@worldbank.org

Big Tobacco Attacks Sensible F.D.A. Rules on Vaping

Apr 19th, 2017
by Editor.
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As smokers turned to electronic cigarettes to reduce the health risks of smoking, big tobacco companies started buying e-cigarette makers and producing and selling their own. Now those companies are lobbying Congress to prevent the Food and Drug Administration from regulating electronic cigarettes and cigars, as it does conventional cigarettes. If they succeed, they will be able to sell and market addictive nicotine products to young people with few restrictions.

https://www.nytimes.com/2017/04/19/opinion/big-tobacco-attacks-sensible-fda-rules-on-vaping.html?_r=1

While promoters of e-cigarettes and e-cigars, which provide nicotine in vapor form, say they can help people quit conventional tobacco products containing harmful tar, there is not a lot of evidence for that claim. In addition, the devices are dangerous to young people because the nicotine they provide “can cause addiction and can harm the developing adolescent brain,” according to a 2016 report by the surgeon general, Vivek Murthy. Health experts also say that the vapor those devices produce can contain carcinogens and metal particles.

Another government report found that 16 percent of high-school students said they had used e-cigarettes in 2015, up from just 1.5 percent in 2011. The industry sells these products in a broad array of flavors, like gummy bear and cotton candy, designed to appeal to young people when they are more susceptible to becoming dependent or addicted to nicotine.

After years of deliberation, the F.D.A. said last May that it would begin regulating the manufacturing, sale, packaging and advertising of e-cigarettes, and all tobacco products, under a 2009 federal law that authorized it to do so. Specifically, the agency said it would begin reviewing the health risks of e-cigarettes introduced since early 2007, and potentially ban specific flavors and products that it deemed harmful. The tobacco lobby wants Republicans to amend a vital appropriations bill to exempt products that were introduced before May 2016 from F.D.A. review.

The push to undermine the F.D.A.’s authority began even before the agency had finished its rule. One Republican lawmaker, Representative Tom Cole of Oklahoma, introduced a bill in 2015 that was identical to a draft circulated by the Altria Group, the country’s biggest tobacco company and a marketer of vaping products. In addition to its legislative effort, the industry has also filed several lawsuits in federal courts challenging the rule.

Tobacco companies complain that the F.D.A.’s rule amounts to “retroactive” regulation because many of the e-cigarettes and e-cigars it will regulate have been on the market for years. But the industry has known for years that government officials were developing this rule. Large bipartisan majorities in Congress voted in 2009 to hand the agency the authority to evaluate and approve new tobacco products introduced on or after Feb. 15, 2007. The F.D.A. is simply doing its job by protecting public health.

Smoking costs China $57 billion in 2014: WHO calls for national ban

Apr 16th, 2017
by Editor.
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The economic dividends from China’s tobacco industry are a false economy, which is at odds with government’s vision for China’s future, the World Health Organization (WHO) claimed on Friday.

http://www.ecns.cn/2017/04-16/253586.shtml

“The total economic cost of tobacco use in China in 2014 amounted to a staggering 350 billion yuan ($57 billion), a tenfold increase since 2000,” Bernhard Schwartlander, the WHO representative in China, told a press conference in Beijing.

The increase is a result of more people diagnosed with tobacco-related illness and increasing healthcare expenditure, according to a report jointly released by the WHO and the United Nations Development Program (UNDP) at the conference.

“The direct cost of treating tobacco-related diseases in China was about 53 billion yuan and the indirect cost was expected to be 297 billion yuan,” in which the productivity loss from premature deaths was a major concern, according to the report.

Meanwhile, the report said that tobacco represents an economy of the past as China’s tobacco companies do not fit the vision of an innovative, value-added future economy.

“Projected increases in these costs will lead to negative spillovers effects across many sectors, placing increasing challenges to Chinese economy and businesses, in addition to the social welfare and health system,” it said.

Wu Yiqun, deputy director of the Beijing-based Research Center for Health Development, a think tank, told the Global Times earlier that China has huge public support for a nationwide smoking ban, but the timetable to adopt a law has been on the back burner.

“The proposed law has been mainly stymied by tobacco industry officials due to the huge economic interests involved,” Wu said.

The sector handed over 1.1 trillion yuan ($170 billion) to the State in 2015, up 20.2 percent from the previous year, the State Tobacco Monopoly Administration said in 2016.

The revenue from the tobacco industry derives from corporations whose business model is to create dependence on a lethal substance.

China in 2016 adopted the “Healthy China 2030″ blueprint, which says China aims to reduce smoking rates among adults from 28 percent to 20 percent by 2030.

More than 1 million people die of tobacco-related diseases every year in China, and the number is expected to reach 3 million by 2050 if no action to reduce smoking rates is taken. About 44 percent of the world’s cigarettes were consumed in China in 2014, nearly 26 percent higher than that in India, the report said.

China’s Ministry of Finance announced in May 2015 to raise cigarette taxation from the previous 5 percent to 11 percent, which “led to a reduction in cigarette sales for the first time in 20 years,” according to the report.

However, “cigarettes are increasingly affordable as the increase in cigarette prices has been much lower than the average increase in salaries.”

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