Tobacco use contributes to the development of at least 20 different types of cancer and is the cause of some 2.4 million cancer-related deaths globally every year. These premature deaths are largely preventable if effective measures are implemented to prevent tobacco use and encourage and support people in ending their consumption of tobacco.
Interventions to reduce the demand for and supply of tobacco are provided by the World Health Organization’s Framework Convention for Tobacco Control (WHO FCTC). WHO has developed a policy package known as MPOWER to assist countries in implementing the requirements and guidelines of the WHO FCTC.
These proven measures include support to quit, warning about the dangers of tobacco, banning tobacco advertising and particularly raising taxes on tobacco products. Certain measures can be implemented regardless of a country’s income level, such as effective smoke-free legislation that bans smoking in public places, including indoor workplaces.
Since 2005, when the WHO FCTC came into force, governments have acted to improve tobacco control in their countries. Today, 65% of the world population is covered comprehensively by at least one recommended measure compared with 15% in 2007.
However, 80% of tobacco consumption remains concentrated in low and middle-income countries (LMICs), where a substantial increase in global funding for tobacco control is urgently needed in order to support further progress implementing the FCTC. According to rough estimates, the global funding gap for tobacco control amounts to just over USD 27bn per year, but only 0.16% of Development Assistance for Health going to tobacco control in 2019.
The Framework Convention Alliance (FCA) is an alliance of nearly 300 civil society organisations in 100 countries that works to strengthen the WHO FCTC and support its full and accelerated implementation worldwide. “We have very detailed policy guidance on exactly what to do to end the tobacco epidemic, but it is not being implemented quickly or comprehensively enough,” said Ryan Forrest, Associate Director, Policy and Advocacy, FCA, in an interview with UICC.
Even though tobacco tax revenues worldwide amount to USD 250bn annually, only about one billion is spent globally on tobacco control, according to the WHO 2017 report on the global tobacco epidemic – the vast majority in high-income countries.
Currently, only 2 US cents is spent per person per year in LMICs on tobacco control. Half is spent by national governments, the other half comes from international funding. The fill the funding gap, 11 US cents per person per year is required.
Ms Forrest explained that to address the funding gap, the FCA is looking at two core aspects: develop sustainable domestic funding in countries where it is needed and increase global investment in tobacco control.
“We need to work on multiple fronts. Domestic resource mobilisation is key but we know that spending on tobacco control is often not prioritised. In budgeting processes, it’s easy to pass over long-term, population-level preventive measures in favour of what are more urgent priorities. With tobacco control, the payoff is not always immediately visible.”
– Ryan Forrest, Associate Director, Policy and Advocacy, FCA and co-author of “It is time to become serious about closing the global resource gap for FCTC implementation” in Tobacco Induced Diseases
The process of developing and implementing effective tobacco control policies is often hindered by interference and influence by the tobacco industry. “Part of that is by spreading misinformation and incorrect data; for instance, saying that tobacco taxes will result in more illicit trade and reductions in revenue for governments,” said Ms Forrest. This argument has proven to be false.
Yet increasing taxes on tobacco products remains one of the more effective policies to curb tobacco use, a win-win measure for governments as “it raises revenue, including for health spending, while reducing consumption”, said Ms Forrest. “There is still a lot of work to be done in terms of raising tax rates, there’s a lot more revenue can be collected. But there is also the fact that sometimes none of the money from tobacco taxation is being spent on control.”
Industry interference is not the only hurdle to implementation in LMICs. National budgets are often very stretched and effective tobacco tax administration requires funding and technical expertise to get set up and operate until enough revenue is generated. In this sense, international funding can play a catalytic role in helping to get progress going on tobacco control.
Ms Forrest said that one of the FCA’s main objectives now is raising awareness about the funding gap and the need for greater investment in tobacco control – conducting research, putting out briefs, speaking at events and also building relationships with development communities at the national and global level to encourage more funding.
The FCA also supports budget advocacy projects in Africa. Together with Cancer Research UK and the American Cancer Society, FCA offers technical support to coalitions in Uganda and Senegal to see tobacco control prioritized in national budgets. They also work with the Norwegian Cancer Society to integrate tobacco control in national development plans in Nigeria, Chad, Ghana, Senegal and Uganda as another way to unlock domestic funding.
“Investing in tobacco control is smart. It saves money down the line and is one of the most effective ways of reducing the number of lives lost prematurely to cancer and other diseases.”
– Ryan Forrest, Associate Director, Policy and Advocacy, FCA
 Monitor tobacco use and prevention policies. Protect people from tobacco smoke. Offer help to quit tobacco use. Warn about the dangers of tobacco. Enforce bans on tobacco advertising, promotion and sponsorship. Raise taxes on tobacco.