This week the United Nations is convening a high-level meeting of member nations to discuss the prevention and control of non-communicable diseases. With 35 million deaths annually caused by these diseases – 28 million in low- and middle-income countries (LMIC) alone - a global public health crisis is looming that will put further stress on already vulnerable healthcare systems and economies.
Of the four most prevalent types of non-communicable diseases - cardiovascular disease, cancer, chronic respiratory diseases and diabetes - there is one risk factor that cuts across all of them: tobacco use.
Almost six million people die every year because of tobacco use. When you do the math, that means unless urgent action is taken now, tobacco will kill one billion people this century.
These deaths, however, are preventable if leaders of countries large and small, wealthy and poor, have the political will to use the proven, affordable, tested tools available to them.
As detailed in the World Health Organization’s (WHO) landmark Framework Convention on Tobacco Control – the world’s first treaty on a public health issue – raising the price of tobacco products through higher excise taxes is the most effective. Other effectivepolicies recommended by the WHO include prohibiting smoking in all public places; placing large, graphic health warnings on all tobacco packages; implementing hard-hitting mass media campaigns to warn people about the dangers of usingtobacco; and banning all tobacco advertising, promotion and sponsorship.
When all of these measures are implemented the results are clear: people use less tobacco and live longer,healthier lives.
The cost of implementing these initiatives is a tiny fraction of the amount of revenue collected from tobacco taxes. In 2009, for instance, tobacco tax revenues, in 31 low- and middle-income countries totaled US $29 billion. That’s nearly 50 times the US $600 million that WHO estimates is needed to implement strong tobacco control interventions in all low- and middle-income countries. Put another way, the projected price-tag of 11 cents a person required for effective tobacco control policies is not beyond any country’s reach. Tobacco control is cost-effective, feasible, and – especially with tobacco tax increases – it can generate revenue to pay for health care and other needs.
New York City is a perfect example of how successful tobacco control efforts can be. Over the past decade, we have prohibited smoking in virtually all indoor workplaces, including bars and restaurants; raised excise taxes; and launched a number of hard-hitting anti-tobacco media campaigns to significantly raise public awareness.
The results? Prior to 2002, the prevalence of smoking among adults had remained steady at about 22% for a decade. But between 2002 and 2010, that number dropped to 14%, resulting in more than 400, 000 fewer adult smokers in New York City. Furthermore, between 2001 and 2009, smoking prevalence among students aged 14-18 years dropped from 18% to 8%.
Contrary to the doomsayers’ predictions about the economic calamity that would come with strong tobacco policies, New York City’s economy has been unaffected. The restaurant and bar industry hired more people and saw increased revenues within one year of the smoke-free workplace law going into effect. And since 2002, we have generated over $4.4 billion in revenue from the excise taxes on cigarettes sold in New York City, which have helped fund not only our public health programs, but all areas of city government, from public safety to parks and recreation.
New York City is not alone in its success. Cities, states and countries all around the world have shown that success is achievable by implementing these initiatives. At Bloomberg Philanthropies we have been working with our partners around the world to ensure countries and their leaders have the ability to access and implement these critical tools. And the progress we’ve seen is encouraging.
Notable success stories include the state of Sao Paulo, Brazil which implemented 100% smoke-free public places in August 2009, after which six additional Brazilian states followed (covering over 75 million people); Egypt has raised taxes on cigarettes twice since July 2010; and Uruguay mandated graphic pack warnings that cover most of the tobacco package in 2009. And the momentum is building; already in 2011, Nepal, Lebanon, Argentina and Ecuador have passed comprehensive national tobacco control legislation.
Despite this remarkable progress, much work remains: only 17% of the world’s population is benefitting from two or more of the WHO’s recommended tobacco control measures. The UN meeting can help change that. Certainly there is no single solution to tackling all non-communicable diseases, but a concentrated focus on proven tobacco control measures by governments around the world will begin to address the 1 billion people at risk, and to ease the economic burden of health care costs and lost productivity.
The 174 nations that have joined the tobacco control treaty represent a significant commitment to action – and our best hope yet of saving hundreds of millions of lives.