Research for International Tobacco Control (RITC)

Tobacco as a Development Issue

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Why is Tobacco Unique as a Policy Issue?

Tobacco use sustained through addictive properties, low prices, social norms, vigorous marketing by powerful multinational corporations

Perceived by many to contribute to social and psychological well-being

Tobacco epidemic exacerbated by complex factors with cross border effects, including trade liberalization, foreign direct investment, global marketing; transnational advertising, promotion and sponsorship; international movement of contraband and counterfeit cigarettes.

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Global Tobacco Consumption

Approximately 1.3 billion people smoke cigarettes (1 in 5 of the world’s population; 1 in 3 of those over 15)

Global prevalence (2000) = 29% (47% men: 10% women)

One in two long-term smokers will die from a tobacco related disease - many before 65

Tobacco expected to be the leading global cause of death before age 65 by 2020

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Global Tobacco Consumption

Smoking (particularly amongst men) culturally accepted in many countries

GYTS shows many smokers in developing countries begin in their teens

Quitting rates low in low- and middle-income countries compared to developed countries

Advertising is ubiquitous and aggressive

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Advertising

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Advertising

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Advertising

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Advertising

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Stages of the Tobacco Epidemic

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Past and Future Annual Deaths due to Tobacco Use

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1.52.12.1

4.2

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01234567

89

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1950 1975 2000 2025-2030

Developed

Developing

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Source: Who (2002) The Tobacco Atlas, p.36.

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Tobacco and Developing Countries

70 % of tobacco grown in developing countries

70 % of tobacco consumed in developing countries

In 2000 half of 5 million tobacco-related deaths occurred in developing countries

By 2030 70 % of tobacco–related deaths will occur in developing countries

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Global Burden of Non Communicable Diseases (NCDs)

Tobacco use linked causally to cancers, cardiovascular disease, respiratory diseases, tuberculosis, and diabetes

Population aging and changes in risk factors have accelerated the epidemic of NCDs in many developing countries

Burden of NCDs is increasing, accounting for nearly half of the global burden of disease (all ages)

Many developing countries now face a “double burden”

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Tobacco and Development

More than a health issue: economic, agricultural, environmental, socio-cultural, trade and marketing

Tobacco linked to poverty (up to 10% of household expenditures in poorest families)

Women and youth at particularly high risk

Tobacco kills people in their productive middle years

High economic costs – estimated $2.2 B direct medical costs; $5.4 B lost productivity in Canada (1992 USD)

Tobacco and Poverty

“Each tobacco user represents one of more people – whether the smoker or his or her spouse or child – who is needlessly going hungry”

(Efroymson et al, Tobacco Control 2001

 

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Tobacco and Poverty

Tobacco linked to poverty as household income is spent on tobacco rather than food or basic need

India/Bangladesh/Egypt: 2% - 4.5% of household expenditures on tobacco products

Bulgaria 10.4% of total income on tobacco products

China 17% of household income on tobacco

Even small amounts represent very high opportunity costs

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Tobacco and Poverty

Evidence in some countries that tobacco use is growing fastest amongst the poorest groups:

Indonesia:1981 – lowest income groups spent 9% of

their total expenditure on tobacco1996 – lowest income groups spent 15%

of their total expenditure on tobacco

In Bangladesh- smoking twice as high in the lowest income group as in the highest

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Tobacco and Poverty

Smoking exacerbates poverty in other ways:Poor families are vulnerable to illness

particularly the loss of a breadwinner Paying for treatment further impoverishes

families

Study of 20,000 poor men and women in 23 countries found that sickness or injury in a family is by far the most frequent trigger into (worse) poverty

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Poverty and Policies Urban and rural Bangladesh per capita

spending on tobacco higher than on milk

Spending by average smoker on cigarettes would buy 3000 calories of rice

Often men control the income and have first access to food. Women and children are most likely to go hungry.

Vietnam – annual household expenditure on tobacco 1.7 times expenditure on education

Advertising and low taxes encourage purchase of tobacco

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Cigarette prices and consumptionSouth Africa

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Cigarette excise taxes and government revenue – South Africa

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WHO Commission on Macroeconomics and Health (CMH)

CMH emphasized the interconnectedness of health and sustainable development

Where national disease burden is high, national wealth and productivity are likely to be low

Two way relationship between economic development and health:Poverty increases vulnerability to diseasePeople who are sick cannot work – affecting their

income

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WHO Commission on Macroeconomics and Health (CMH)

CMH emphasized tobacco as a link between poverty and illness

CMH highlights tobacco consumption as one of the serious deleterious consequences of globalization

Significant changes can be achieved through modest investments in tax increases; ad bans; strong health warnings on cigarette packages; and use of primary health care services for advice and assistance to smokers

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Millennium Development Goals (MDGS)

Overlap between the MDGs and CMH:Both seek to reduce the impact of health-

related problems as an element of economic development

Both focus on alleviation of poverty as a key determinant of future economic development

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Tobacco Cultivation

Given the growth in world population, the tobacco industry will not decline rapidly enough to cause workers to lose their jobs

Trans-national companies are increasingly replacing less efficient local operations. Manufacture of foreign cigarettes is highly mechanized

Most job losses result from increasing mechanization.

Farm families reap little profit from tobacco cultivation

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Tobacco Cultivation

Tobacco farmers in cycle of debt to repay farm input loans

Farm income vulnerable in case of bad crop year or low tobacco prices

Harm to farm families and the environment through heavy use of pesticides.

Labour intensive crop often involving women and children

Curing process harmful to health and involves extensive deforestation

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Tobacco Manufacturing and Marketing

Those working in tobacco factories or selling tobacco on the streets earn starvation wages.

Beedi workers in India among the most exploited in India

Young children often involved in the production of beedis

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The Framework Convention on Tobacco Control (FCTC)

A Global Treaty for a Global Problem

First global treaty to focus on a health issue

Negotiated under the auspices of the WHO

Came into force in Feb. 2005 following ratification by 40 countries

Includes demand and supply reduction strategies

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The FCTC:includes a variety of policy measures:

Advertising, promotion and sponsorship

Price and tax measures

Passive smoking and smoke-free environments

Packaging and labelling

Product regulation

Tobacco sales to and by young people

Treatment of tobacco dependence

Education, communication and public awareness

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Research for International Tobacco Control (RITC)

IDRC a pioneer in responding to this issue via RITC in1995 (with Health Canada & Sida)

Limited support from CIDA and Rockefeller Foundation

IDRC has recently renewed and expanded its funding to RITC

Continued funding from Health Canada; a new partnership with DFID

Focus on research, dissemination, capacity building and networking

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New Directions for RITC

Continued focus on research, capacity building, dissemination and networking

“Responsive” funding will respond to local needs and emerging topics globally

“Focused” funding will focus on Tobacco and Development issues

Allocated funding for fellowships to promote new researchers

Focus on priority countries and regions

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RITC Focused ResearchPriority Topics

Poverty and Tobacco

Tobacco Farming: Health, Livelihoods, Economics and the Environment

Health Systems Interventions

Globalization, Trade and Tobacco

Alternate Forms of Tobacco Use

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Research for Action on the FCTC

Public health issues cannot be contained within national borders; require greater collaboration and coordination

FCTC responds to:The tobacco epidemic in developing countries;Globalization;Trade liberalization

Highlights the need for: Multi-sectoral action and Trans-national cooperation

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Research for Action on the FCTC

This meeting focuses on transcending national borders, working toward greater collaboration, and building networks.

Purpose of the meeting:To capture lessons learned from the research;To discuss the policy implications of the

research;To strengthen research capacity through

interaction with peers and through specific workshops;

To provide an opportunity to network and for the development of networks

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Moving Forward

While tobacco use contributes to the entrenchment of individuals and nations in poverty, economic growth in the world’s poorest nations is likely to fuel, if unchecked, an increase in tobacco use.

Tobacco use is not a personal choice, freely made. Tobacco control should be a part of initiatives designed to improve health and reduce poverty.

Lack of statistical information results in poor evidence for the individual and national health and economic impacts of tobacco use.

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Moving Forward

Tobacco industry greatly overstates its contribution to national economies and understates the costs tobacco imposes.

Price and tax measures in coordination with measures to reduce smuggling will increase government revenues (and reduce poverty) and decrease tobacco use.

Action to reduce exposure to ETS will beneficial for health and the environment

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Moving Forward

4.    Tobacco industry greatly overstates its contribution to national economies and understates the costs tobacco imposes.

 5. Price and tax measures in coordination with measures to reduce smuggling will increase government revenues (and reduce poverty) and decrease tobacco use.

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Moving Forward

Controls on labelling and packaging, limits on advertising and sales to minors, education and public information will increase awareness of the dangers of smoking.

Support for alternative crops and the environment will limit the negative effects of tobacco cultivation and may alleviate poverty.

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Thank You

Linda Waverley

http://www.idrc.ca/ritc