Tobacco is a leading risk factor for many cancers and reducing use can lead to a decrease in cancer incidence and mortality. Yet while efficient regulatory tools exist that promote prevention and cessation, their implementation faces a number of challenges, including political will and funding.
The first UICC Virtual Dialogue in a series on tobacco control was held on Wednesday 12th May. Panellists explored how the cancer, non-communicable disease (NCD) and tobacco control communities can best coordinate their efforts to overcome these challenges and accelerate the implementation of the WHO Framework Convention on Tobacco Control.
The panel consisted of Prof. Anil D’Cruz, President of UICC and Director of Oncology at Apollo Hospitals, India; Dr Adriana Blanco Marquizo, Head of the Secretariat of the WHO Framework Convention on Tobacco Control (WHO FCTC); and Dr Nour Obeidat, Director, Cancer Control Office at King Hussein Cancer Center. It was moderated by Leslie Rae Ferat, Executive Director of the Framework Convention Alliance (FCA).
“This is a very important topic. I say this as President of UICC and as a clinician who has spent 33 years treating head and neck cancers, which represent one-third of all cancers in India, and are primarily caused by tobacco.”
– Prof. Anil D’Cruz, President of UICC and Director of Oncology at Apollo Hospitals, India
Tobacco is responsible for a third or a half of all cancer-related deaths, depending on the region, or some 2,4 million deaths globally every year. Second-hand smoke presents certain health risks for all populations and children are particularly vulnerable, with more than half of the children worldwide under the age of 15 estimated to be exposed to second-hand smoke. This leads to increases in the risk of sudden death syndrome, severe asthma and ear and respiratory infections.
“We know these figures are stagging and increase every year,” says Prof. D’Cruz. While highlighting efforts and progress made in developed nations, he reminded participants that 80% of tobacco use is concentrated in low- and middle-income countries. “We need to take our voice now to new areas to prevent the sheer morbidity and mortality – the ill-health – caused by tobacco.”
In this respect, the panellists agreed that the need to coordinate efforts between the cancer and tobacco communities was self evident.
“It is not that we are not working together but we need to work even more together. Power is in the numbers. We have different constituencies, different tools, different opportunities. The tobacco community offers legal tools, which can help the cancer community achieve its aims of moving countries in the right direction, while the cancer community is closer to clinical settings, which can help better inform us and build records on cancers caused by tobacco.”
– Dr Adriana Blanco Marquizo, Head of the Secretariat of the WHO Framework Convention on Tobacco Control (WHO FCTC)
Speaking from the unique position of working in a cancer centre with a small tobacco-control hub, Dr Obeidat said that one community cannot work without the support of the other. In her centre, she particularly emphasised the need to raise awareness and share information and evidence on the issue of continued tobacco use during cancer treatment.
She also illustrated why collaboration and synergy between NGOs are essential, particularly in lower resourced regions. Single-party efforts to collate evidence on the harms of tobacco and advocate for policy changes and greater control are never enough, she says. Not only are combined resources necessary for increased leverage, but also funding opportunities – necessary to an NGO’s survival – often require partnerships between organisations. “These partnerships need to be in place before the funding opportunity arises, to demonstrate that collaboration is possible and necessary.”
In a pulse survey taken among participants, lack of political will and tobacco industry interference were cited as the top reasons why effective measures to curb the use of tobacco are so difficult to see implemented.
Prof. D’Cruz qualified this result by pointing out that policymakers have made many positive changes in the past decade. He cited the 2019 WHO report on the global tobacco epidemic, which shows that about 65% of the world’s population is covered by at least one comprehensive tobacco control measure, compared to 15% in 2007.
These measures include: monitoring tobacco consumption and the effectiveness of preventive measures; protecting people from tobacco smoke; offering help to quit tobacco use; warning about the dangers of tobacco; enforcing bans on tobacco advertising, promotion and sponsorship; and raising taxes on tobacco.
Prof. D’Cruz underscored the particular effectiveness of the last measures, taxation. “Why do people keep using tobacco? Ease of access, availability and prices. Raises taxes, consumption will drop. It took the US three decades to accomplish what France did in 10 years.”
For Dr Obeidat, lack of action in a country like Jordan, with limited resources, can be traced back to lobbying by the tobacco industry, either directly or indirectly. The tobacco industry is a key source of profit for an under-resourced government and the fact that they rely on these profits is what drains political will, she says. It is essential that their influence be curtailed and the long-term benefit of investing in prevention emphasised.
“Prevention pays off in years, returns on investment come after decades. On the other hand, dollars are coming in on a daily basis from tobacco. It all goes back to that.”
– Dr Nour Obeidat, Director, Cancer Control Office at King Hussein Cancer Center
Dr Marquizo picked up on a comment by a participant to draw attention to the possibility of lack of political will connected to lack of awareness. Many people have passed in the main seats of government, she said, and consistent efforts must be made to raise awareness on the risks of tobacco use and the tools that are available and effective in fighting industry influence – linking the importance of reducing tobacco use to other factors such as COVID-19 recovery or the achievement of the Sustainable Development Agenda.
The Global Strategy to Accelerate Tobacco Control and the Framework Convention on Tobacco Control (FCTC) outline measures that should be a top priority for policymakers as they have a proven track record to reduce the supply of and demand for tobacco.
The FCTC is a tool available to everyone and, said Dr Marquizo, “opens the door” for civil society organisations (CSOs) to collaborate by providing them with legal arguments in advocating for legislative action. Furthermore, she said, CSOs can make politicians aware that inaction on tobacco will have a human cost in terms of poorer health and lives – and can have a political cost also.
In second pulse survey taken with participants, four collaborative actions that the cancer and tobacco communities could take were cited as having substantial impact but would also require effort to enact: advocate for increased taxation, build capacity for policy change, raise public awareness and counter tobacco industry misinformation and lobbying.
Sharing mutual experiences, knowledge and best practices was also seen as an action more easily carried out with a potential for maximum impact. Also, Dr Obeidat pointed out, great collaboration and idea sharing accelerates awareness raising and capacity building.
In final statements, all panellists again agreed on the need to consistently drive home the message that cancers can be prevented; and that higher tobacco taxes is one of the more effective means to reduce consumption. “Together, we are stronger,” emphasised Dr Marquizo, while Dr Obeidat reiterated the need to know who the NGOs are – and mobilise them.
“Thinking about ways to build these synergies between communities and collaborate is more important than ever as we emerge from the COVID-19 pandemic, to ensure that tobacco control is positioned as key issue that we all need to be talking about.”
– Leslie Rae Ferat, Executive Director of the Framework Convention Alliance