Why Governments Must Prioritise Sustained Tobacco Control Investment in Low- & Middle-Income Nations

Credit: WHO/2017

By Ryan Forrest, Sara Rose Taylor
OTTAWA, Sep 2 2019 – Trends in global consumption of cigarettes haven’t improved since the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) came into force, according to a study published in the British Medical Journal (BMJ) earlier this summer.

Perhaps this is because the FCTC on its own is not a magic bullet. Governments have paid the issue of tobacco-use a lot of lip service but they have invested very little to match the global burden of the epidemic.

Simply agreeing on what needs to be done (i.e. negotiating and ratifying the FCTC) will not on its own lead to reductions in tobacco use. What’s important is whether countries are adopting, implementing and enforcing tobacco control laws and policies in line with their obligations under the treaty.

Tobacco control policies work when implemented, and one of the key lessons to take from the study in the BMJ is that countries urgently need support to do so.

Framing the debate on FCTC impact

Among the most quickly and most universally ratified treaties in existence, FCTC has long been hailed as a breakthrough in efforts to protect the world’s citizens and economies from the harmful effects of tobacco use, which remains a leading global cause of preventable death.

Credit: BMJ 2019;365:l2287

The FCTC has also been looked to as a testing ground for new approaches to global health governance; a potentially replicable model that could be applied to address other health and development issues.

The value and importance of the FCTC and the usefulness of the efforts of the large global tobacco control community that has worked for many years to negotiate the treaty and later to support its ratification and implementation around the world are widely acknowledged.

Much less is known, however, about the impact of the FCTC on smoking patterns.

But what is most needed is a nuanced understanding of how the FCTC impacts cigarette smoking patterns in different regions of the world and the contribution of the treaty to tobacco control policy development and implementation.

We know, indisputably, that tobacco control policies work when implemented, but we also know from experience that implementation and enforcement of these policies is a major challenge in many low- and middle-income countries (LMICs).

These countries often lack the data, organisational structures, human resources, and funds necessary to develop sustainable national tobacco control programmes.

Oiling the wheels of progress

Funding is perhaps the biggest challenge in most LMICs. A 2011 report by the World Health Organization notes that public spending on tobacco control in LMICs ranged from just US$0.0048 to US$0.01 per capita – far short of the estimated per capita cost of US$0.11 required to implement effective tobacco control programs in most LMICs.

There has also been a shocking lack of international investment in tobacco control – amounting to just US$70 million in Development Assistance for Health (DAH) in 2017 according to the Institute of Health Metrics and Evaluation’s most recent report. That’s just 8.5% of all DAH allocated for non-communicable diseases, and an even tinier fraction of all DAH.

WHO criteria for the highest level of achievement of key tobacco control demand-reduction measures. Credit: The Lancet Public Health Volume 2, ISSUE 4, Pe166-e174, April 01, 2017

The new analysis in the BMJ of the FCTC’s impact since its adoption should serve as an urgent call to action for the international community. Tobacco use causes more than 8 million deaths compared to approximately 3 million deaths for malaria, HIV/AIDS and tuberculosis combined.

Progress on reducing global tobacco use requires a concentrated effort on strengthening FCTC implementation in LMICs. Despite the growing evidence that accelerating FCTC implementation contributes to progress in decreasing tobacco use, too many countries are still lagging behind and failing to invest in tobacco control.

Understanding the priorities and accelerating progress

The newly adopted Global Strategy to Accelerate Tobacco Control identifies specific areas where governments can focus action to create the most impact. Immediate priorities include strengthening national tobacco control plans and adopting stronger price and tax measures.

Raising tobacco taxes to increase tobacco product price and decrease affordability is a particularly compelling policy proposal. A 10% increase in price yields a 4% decrease in consumption in high-income countries and a 5% decrease elsewhere, and the best way for governments to influence prices is to substantially increase taxes.

This is the case in the European Union (EU), where new evidence published in the Tobacco Control journal suggests that high cigarette prices are extremely effective in decreasing cigarette consumption and contributing to public health.

Credit: Universal Health Coverage (UHC) Movement for the UN High-Level Meeting on UHC Key Ask 5: Invest More, Invest Better – Sustain public financing and harmonise health investments

A conclusion that is in line with the new FCTC impact analysis in the BMJ, which points out that some of the difference in consumption trends between high- and low-income countries may be due to the effects of “EU accession rules requiring stringent tobacco control measures among new members”.

Taking a whole- of-government approach

Tobacco use is one of the most challenging health issues that modern societies face. Trying to understand what this challenge means for low- and middle-income countries is crucial. Equally important is to understand that the full and immediate implementation of the FCTC reduces tobacco use.

In just a few weeks, developed and developing countries will meet in New York to review progress on the Sustainable Development Goals (SDGs). Countries cannot afford to overlook the tobacco epidemic and how tobacco control efforts captured under SDG 3.a – though critically under-resourced – are contributing to decreasing tobacco use.

In LMICs, in addition to civil society stakeholders, various government sectors (not only health) must have equal responsibility for ensuring full and effective FCTC implementation. In fact, Article 5 of the treaty addresses tobacco control governance considerations with a view to encouraging robust multi-sectoral mechanisms and protection of tobacco control policies from the commercial and other vested interests of the tobacco industry.

Making the public health case for FCTC implementation is not enough. An economic case can also be made, for instance. The total global economic cost of smoking was estimated to have been US$1.4 trillion in 2012.

This economic burden is particularly damaging for LMICs, who already lack economic resources for development; in 2012, LMICs shouldered 40% of the total economic cost. A multi-faceted approach is vital for LMICs because country delegations to international negotiations such as the upcoming SDG Summit typically comprise representatives of Departments of finance, trade, agriculture and other sectors.

For sustainable development, there is much to be done. There will be little progress if there is no urgent action to reduce tobacco use in LMICs. It’s time for the international community to match the scale of the tobacco use problem with the resources and financing needed to enable progress.

Is the UN’s High Seas Treaty Heading Towards Troubled Waters?

Scientific expeditions in recent years have revealed that the high seas, 200 nautical miles from coastal shores, harbor an incredible array of species that provide essential services for life on Earth. Credit: The Pew Charitable Trusts

By Thalif Deen
UNITED NATIONS, Sep 2 2019 – The world’s high seas, which extend beyond 200 nautical miles, are deemed “international waters” to be shared globally– but they remain largely ungoverned.

“It’s a jungle out there”, remarks one diplomat, describing a virtually lawless wide-open ocean which has steadily undergone environmental destruction, including illegal fishing and overfishing, plastics pollutions, indiscriminate sea bed mining and degradation of marine eco systems.

The Food and Agriculture Organisation (FAO) has warned that the world’s fisheries have continued to decline, with 33 percent of fish stocks “overfished,” resulting in devastating economic consequences for coastal nations and small island developing states (SIDS).

Still, a two-week long meeting, described as the third in a series of four substantive sessions of an intergovernmental conference of 190 member states, concluded August 30, without “a serious commitment” to a longstanding proposed high seas treaty.

A final negotiating session is scheduled to take place in the first half of 2020.

Asked about the roadblocks during recent negotiations, Liz Karan, Project Director for Protecting Ocean Life on the High Seas at Pew Charitable Trusts, told IPS: “The challenging issues in the negotiations have not changed.”

She said countries still need to find solutions for sharing benefits derived from marine genetic resources, and how a new treaty body will coordinate with existing regional fisheries management organizations, and sectoral organizations such as the International Maritime Organization (IMO) and the International Seabed Authority (ISA).

The current draft treaty text, she pointed out, still retains the ambitious options to create a comprehensive Marine Protected Area (MPA) network aimed at preserving high seas marine life.

Credit: FAO

Dr. Sandra Schoettner of Greenpeace’s Protect the Oceans campaign, said: “It is very disappointing to see that the pace and ambition in this meeting don’t match the level of urgency required to save our oceans and protect our planet against the climate emergency and massive biodiversity loss we are facing.”

She said the lack of political will for a progressive outcome of these negotiations is alarming as some countries clearly still favor exploitation over protection. Keeping things as they are is not going to save our oceans or, ultimately, humankind.

“That’s why it’s so frustrating to see UN members like the European Union proposing insufficient solutions that don’t represent a real change for our oceans,” she noted.

“In addition, we expect more ambition from China, the host of the CBD CoP15, to be at the forefront of biodiversity protection. We also expect a maritime nation like Norway to take leadership in this process and are disappointed to see them push for a treaty that manages our global oceans in the same way which has brought them to the brink of collapse,” Dr Schoettner declared.

According to the High Seas Alliance, the ocean’s key role in mitigating climate change, which includes absorbing 90% of the extra heat and 26% of the excess carbon dioxide created by human sources, has had a devastating effect on the ocean itself.

Managing the multitude of other anthropogenic stressors exerted on it will increase its resilience to climate change and ocean acidification and protect unique marine ecosystems, many of which are still unexplored and undiscovered. Because these are international waters, the conservation measures needed can only be put into place via a global treaty, the Alliance said.

Credit: Greenpeace

Peggy Kalas, coordinator of High Seas Alliance told IPS each of the primary elements has difficult issues but, likely, the Marine Genetic Resources (MGR) discussion and questions surrounding access and benefit sharing are one of the most difficult.

Asked if the proposed treaty will ensure a comprehensive MPA network to protect the rich biodiversity in the world’s oceans, she said: “Certainly, one of our key ambitions for this agreement, is to provide a framework for the establishment of well-managed and representative network of MPAs.”

On small island developing states (SIDS), most of whom are threatened by sea-level rise triggered by climate change, Kalas said: “A global approach and decision-making body will help smaller states with less capacity, if acting alone, to protect areas beyond national jurisdiction (ABNJ).”

She said the proposed moratorium on deep sea mining is a separate process than the discussion taking place with respect to deep seabed mining (DSM). That discussion will continue within the confines of the International Seabed Authority (ISA).

Dr Palitha Kohona, who co-chaired (along with Dr Elizabeth Linzaard of the Netherlands) the UN Adhoc Group on Biological Diversity Beyond National Jurisdiction, told IPS that during past negotiations in that Group, a historic compromise was struck between the EU and the Group of 77 (G77) developing nations plus China.

Both groups agreed to support the EU’s pursuit of marine protected areas (MPA) while the G77 demand for benefit-sharing– relating to products developed by industry using marine genetic resources beyond national jurisdiction, mainly by the pharmaceutical industry– would be accommodated by the EU.

While this combination of forces between the G77 and the EU enabled the Working Group to finalise its recommendations by consensus, a group of countries whose common motive remained obscure, continued to express reservations, said Dr Kohona, a former Chief of the UN Treaty Section.

Nevertheless, these states, which included Norway, Russia, the US and South Korea, did not block consensus during negotiations back in February 2015.

He said the concerns of developing countries need as much attention as the call of the EU for MPAs, if the proposed Global Oceans Treaty is to be successfully finalized. But much work will need to be done inter-sessionally.

Admittedly, while the global oceans are under enormous stress with dead areas continuing to expand, and need urgent attention, the call of the developing world not to be excluded from the next development in industry, the revolution of the pharmaceutical industry based on marine genetic resources, must not be ignored.

“Precedents and compromises from within the Law of the Sea framework will need further exploration,” he declared.

Dr Schoettner of Greenpeace said the stakes are even higher now for the final stage of the negotiations.

In 2020, world leaders need to deliver a Global Ocean Treaty that allows the creation of fully protected ocean sanctuaries in international waters.

In order to seize this historic opportunity to safeguard our oceans for future generations, Greenpeace urges heads of states and ministers to commit to a strong Global Ocean Treaty – so that delegates in the negotiating room have a clear mandate to advocate progress instead of just managing defeat, she noted.

“The solution is right in front of us, now all we are missing is the political will to give a chance to our oceans and to the people who rely on it to survive.”

The writer can be contacted at thalifdeen@aol.com