Burden of Disease and Best Practices

High-level Roundtable on Tobacco Control and Development Policy

Brussels, Belgium
3 February 2003

Commissioner Nielson, Commissioner Byrne, Ambassador Correa, Dr Dixon, Mr Pendleton, Ladies and Gentlemen,

It is a great pleasure to participate in this roundtable which brings together tobacco control and development - two issues close to my heart and central to our work. I would like to congratulate Commissioners Nielsen and Byrne in taking this initiative to look at tobacco control from the perspective of development policies and priorities.

To a large extent, thanks to Commissioner Byrne's determined persuasion and hard work, the EU will soon put in force some of the toughest tobacco control measures in the world. The European Commission has also played a strong supportive role in the efforts WHO has made on tobacco control over the past few years.

While the EU and other OECD countries are in the forefront on tobacco control in their own countries, tobacco control does not so far play an important role in the development assistance programmes of the European Union. The reason we are here today is to discuss how we can close this gap between national vigilance and international inaction.

We know that healthy populations are critical for poverty reduction, economic growth and long-term development.

In addition to the traditional burden of communicable diseases, developing countries today are faced with a huge increase in noncommunicable diseases. Tobacco is a major contributor to these diseases, which now account for more than half the disease burden in all WHO regions except sub-Saharan Africa. This alarming increase threatens to undermine their economic and social development.

Together with HIV/AIDS, tobacco use is the fastest growing cause of death in the world. It is set to become the leading cause of premature death in the 2020s. Last year, tobacco killed 4.9 million people. The figure will be higher this year. Without further action, it is predicted that in the early 2020s the number of deaths from tobacco each year will have doubled. Seventy per cent of these deaths will occur in developing countries.

The past few decades have seen dramatic increases in smoking in developing countries, especially among males. In contrast, in many industrialized countries, tobacco use has shown a steady but slow decrease, mostly among males.

Smoking rates are on the rise in some low and middle income countries, especially among young people and women, and they remain relatively high in most of the former socialist economies.

With these trends, tobacco will predominantly be a developing country problem in the coming decades. Recent epidemiological studies illustrate this. In China, for example, if current smoking patterns persist, approximately one-third of the 300 million Chinese males now between 0-29 will die as a result of tobacco use. That is 100 million people !

Tobacco’s adverse effects are not limited to cigarette-smoking. In India, bidi smoking and tobacco quid chewing were shown to play a significant role in the development of fatal diseases.

Smoking also harms others. There are definite health risks from passive smoking and smoking during pregnancy adversely affects foetal development. Studies have found substantially higher levels of lung cancer among people working in restaurants, bars and other smoke-filled environments.

As with most other health issues, the poor are harder hit than the rich. Poor people tend to use tobacco products more. Similar patterns exist with respect to education levels and socio-economic status. For example, in China, individuals with no schooling were nearly seven times more likely to smoke than individuals with a college degree, while uneducated adults in Brazil were five times more likely to smoke than adults who had received at least secondary education.

In fact, differences in tobacco use can explain a significant portion of the mortality gap between rich and poor. Research shows that in Canada, England and Wales, Poland, and the United States, the middle-age mortality gap between rich and poor would be reduced by between one-half and two-thirds if smoking could be eliminated.

The indirect effects of smoking on health are many. One such example is that tobacco use contributes to malnutrition when money is spent on tobacco instead of on food. In Bangladesh, it has been estimated that, if poor people did not smoke, 10.5 million fewer people would be malnourished.

Last year's World Health Report: "Reducing Risks, Promoting Healthy Life" listed tobacco among its 10 top risks to health. But at the top of the list was underweight, causing 3.7 million deaths each year. Remember - even here, tobacco plays a role!

While the damage done by tobacco is well documented, what do we know about effective action for tobacco control ?

First of all, we know that, as with the battle against HIV/AIDS, effective tobacco control can only happen when there are high profile champions and sustained political support for action.

The time has now come to fully involve the highest levels of Government and the highest levels of opinion leaders in our efforts to build on the present momentum and secure commitment. Only then can we reap the significant health and economic benefits of a reduction in tobacco use.

In most countries some form of government action, including taxes and legislation, has been introduced to control tobacco consumption. Countries that have adopted comprehensive tobacco control policies including a ban on advertising, strong warnings on packages, controls on the use of tobacco indoors, high taxes on tobacco products, and health education and smoking cessation programmes have had considerable success.

But for the moment, such actions are beyond the capacities of many developing countries. These countries struggle with imperfect revenue collection structures, weak ability to restrict smuggling and little capacity to build information campaigns, fight economic and political opposition to advertising bans and incentive campaigns for cessation. Besides, such measures have been shown to be most effective in regions with a high prevalence of tobacco use, especially those in the second or third stage of the tobacco epidemic.

Yet, we also know that in all countries, control measures do have effect. The most applied intervention is taxation. It has proven to have the greatest impact on population health. It is also the most cost-effective option. Taxation actually raises revenue for governments, even when it causes tobacco consumption to decrease substantially. Moreover, it is the most effective in reducing tobacco use among the young and the poor which are the most vulnerable of all groups of smokers.

Many countries have chosen to allocate a portion of revenues from tobacco taxes to the health sector to promote health and discourage smoking behaviours. This, in turn, can help make other types of tobacco control efforts both more effective and self-financing. This is particularly important to developing countries where money to finance new public health initiatives is often scarce.

As you have discussed yesterday, tobacco policies should be seen as an integral part of development policies for health, and play a role whether in the context of PRSPs or other processes of the broader poverty reduction strategies.

Studies we have done show that the combination of taxation, comprehensive bans on advertising, and information activities is affordable and cost-effective in most countries. Adding smoking restrictions in public places increases the costs, but results in even greater improvements in health.

In less than two weeks, the negotiations will begin in Geneva on the final text of a Framework Convention on Tobacco Control. Ambassador Correa has done an admirable job in crafting a text which forms an excellent basis for an effective treaty. With this text, we can expect a Framework Convention with a maximum number of signatory countries. With a broad acceptance, it will have a major impact on public health in the years to come.

The Framework Convention will be particularly important for developing countries, as they begin their efforts to build a legal and regulatory protection against the marketing efforts of the large tobacco companies. To do so and to build effective enforcement capacity against smuggling and launch effective information campaigns against tobacco, these countries would need substantial assistance; both financial and competency-building. Many financial mechanisms already exist for this purpose.

Once adopted by the World Health Assembly and ratified by countries, the Framework Convention will also be an excellent basis from which to structure development assistance policies on tobacco control.

I am very pleased to see the European Commission take a lead in the work to integrate tobacco control into development assistance policies. Such efforts have the potential to reap enormous gains in terms of lives lost and in accelerated development. I look forward to the discussion here today, but even more, to the actions that will follow from this initiative.

Thank you.