The Index of Tobacco Control Sustainability (ITCS) is a new tool to assess and guide national tobacco control programmes and systems to become sustainable. It was developed to work for countries across the economic spectrum, using 31 indicators to identify whether the vital structures, policies and resources for sustainable national tobacco control programmes are present or absent. Through the ITCS’ comprehensive and holistic assessment, countries can draw out the information needed to strengthen and sustain their tobacco control systems. Importantly, the ITCS identifies infrastructural gaps as well as areas of strength.
After the ITCS was published in British Medical Journal Tobacco Control, it was piloted in 24 countries with the highest burden of tobacco use —an ITCS assessment was completed in each. The greater the number of indicators a country has in place, the greater its ITCS score. The higher a country’s total score the more likely it is to have a sustainable tobacco control programme. The greatest possible score is 130. Because MPOWER encompasses the key evidencebased strategies needed to reduce tobacco use, it is the most important factor for sustainable tobacco control.
Without at least four MPOWER policies in place a country cannot be sustainable, regardless of its score.
One possible limitation of the ITCS is that it identifies the presence or absence of key components for sustainable tobacco control —it does not assess quality. The rationale for this binary rating system: present or absent, is strong. It places emphasis on ensuring that the foundations for critical components are in place, and clearly identifies infrastructural gaps.
It also enables assessment across vastly varied countries.
If a component is pending at the moment of assessment, it is designated as absent. So an ITCS assessment should be viewed as a ‘snapshot in time’, capturing a moment in an evolving situation.
An ITCS assessment is only the start of the process; it sets a baseline from which the critical work can begin —to address the system gaps identified. Multiple assessments conducted over a number of years can track development.
FINDINGS OF THE 24 COUNTRY ASSESSMENTS:
Two countries achieved the ‘threshold’ of sustainability, and Vietnam is very close to this level.
All three are low0- and middleincome economies. This illustrates that financial resources may not be the sole, or even the primary factor, for sustainable tobacco control.
Several areas stand out as requiring action by many countries:
Critical measures for preventing tobacco industry interference were absent in many cases: no country has a WHO FCTC Article 5.3 policy covering all government departments and few ban tobacco industry corporate social responsibility programmes. These gaps should be addressed as a priority, to ensure investments in tobacco control are not undermined.
Many countries had one of the two tax indicators, but few had both.
One is a good foundation, but with both tax policies in place, this most effective measure for reducing tobacco consumption will have assured long-term impact.
Other factors requiring action include: earmarking a national tobacco control budget; developing health promotion funds or similar; official involvement of civil society within national tobacco control committees; and prioritising capacity-building.
The ITCS was developed at the start of The Union’s second decade working in international tobacco control. As a partner in the Bloomberg Initiative to Reduce Tobacco Use we work with governments and civil society in low and middle income countries to help introduce and implement policies proven to reduce tobacco use. The ITCS is the work of Dr Angela Jackson-Morris and Dr Ehsan Latif of The Union’s Department of Tobacco Control.
Access the ITCS & 24 Country Assessments at www.tobaccofreeunion.org
Contact Dr Jackson-Morris ajackson-morris@theunion.org for more information on completing an assessment.