Tobacco, economics and matters of the heart

My heart sank when I heard news of the recent Ebola outbreak in DR Congo. I was in Sierra Leone in 2015 and it was tough working alongside colleagues who lost family and friends to the epidemic. While I was there, I also had a Sierra Leonean friend, who was fighting cancer with very little support from the Government or from international donors or NGOs. There were no screening or radiotherapy services, so my friend had to find the money to fly to Ghana for care. She managed but this is clearly not an option for the average Sierra Leonean.

Cancer rates are rising across Sub-Saharan Africa, and pose a serious threat to already fragile health systems. With an estimated half a million cancer deaths recorded each year1, the human and economic costs are difficult to ignore. Why then is it so difficult to drum up attention (and financial resources) from the global community to address this particular health crisis?

I suppose, unlike Ebola, it’s difficult to argue that cancer is an urgent global security threat. But surely we should start to recognise it as a global health and development threat? Frustratingly, despite the inclusion of a target in the 2030 Agenda for Sustainable Development, non-communicable diseases (NCDs) like cancer are still not part of the mainstream international development narrative.

The programme I manage at Cancer Research UK is focused on preventing cancer in low and middle- income countries. The leading preventable cause of death globally is tobacco. Tobacco, as many have argued before me, is also an epidemic which will account for a predicted 8 million deaths a year2 by 2030. Tobacco is a commercial epidemic, created and spread by the Tobacco Industry.

Today is World No Tobacco day. In the Africa region, smoking rates are on the rise.  If we turn back to Sierra Leone, 28.6% of men and 8.2% for women smoke3, compared with an average 17% prevalence in the UK, and smoking among young people is on the increase, with 20.4% of boys and an even higher percentage (24.1%) of girls using tobacco4. These trends are set to worsen unless concerted action is taken.

Unfortunately, like many low and middle-income countries, Sierra Leone is performing poorly on the implementation of tobacco control policy: there are no bans on smoking in public places, nor are there any cessation programmes; health warnings on cigarette packs are not compulsory; and there are no bans on tobacco advertising. Tobacco taxation levels, which we know are an effective measure to drive down demand, are also low: tax makes up just 13.2% of the retail price5.

The tobacco epidemic can’t be rolled back by a vaccine. It needs urgent government action and much, much more international support. Cancer Research UK’s programme is designed to accelerate implementation of the Framework Convention on Tobacco Control (FCTC). The FCTC is a global treaty that identifies key interventions for tobacco control and is a huge asset in the fight against tobacco and diseases like cancer. But implementation of its different articles has been under-funded and the results are uneven.

To help address this, we are supporting local academics and think tanks to carry out much needed independent research to inform tobacco control policymaking. From late summer onwards, Cancer Research UK will be funding research in 24 low and middle-income countries; research that makes clear the economic arguments for tobacco control. And there are many – the recent WHO report ‘Saving lives, spending less’ notes that $1 invested in tobacco control brings a return of $7.43 to society. I hope that these numbers start to cut through the noise and that international donors see the economic rationale for investing more in the prevention of NCDs. Not least because failing to make this investment also has a heart-breaking human cost.