OPINION - World No Tobacco Day
01 Jun 2015
By Professor Stephen Leeder
Execution or lengthy imprisonment is at one end of the spectrum of political response to drugs. Indifference or encouragement to produce them is at the other. Our ability to manifest these two responses simultaneously is truly impressive.
World NO Tobacco Day reminds us of the enormity of the health problems associated with the use of tobacco and our ambivalence towards it. Current estimates are that one billion people will die from tobacco-related diseases this century. Indonesia, deeply concerned about heroin and ice, nevertheless tolerates and promotes tobacco production and use. About 70% of Indonesian men smoke.
As Derek Yach, a South African physician who worked with WHO in the early 2000s to achieve an international treaty on tobacco control observed, “state monopolies led from China, Indonesia and India are poised to soon be the dominant manufacturers by volume of traditional tobacco products.”
According to the FAO from 1970 to 2000, world tobacco consumption, production and trade increased steadily, slowing since, more so in developed countries, “while tobacco production and use is still increasing in the majority of developing countries.” According to Tobacco Facts, about 6% of the workforce, or 300,000 people, are employed in the tobacco production industry in Indonesia. There were 684 000 tobacco farmers in 2005 or 1.6% of total agriculture labour force. Tobacco generates about 6% of the Inodnesian government’s annual revenue. There are no restrictions on advertising or on where you can smoke. About 200 billion cigarettes of different sorts are produced annually and WHO claims that about 200,000 Indonesians die from tobacco each year. After oil tobacco is Indonesia’s second biggest export.
In considering what to do about the global epidemic of tobacco use, three responses stand out as worthy of our support.
First, the transaction in 2005 of the World Health Organization’s first international treaty is the most successful international response to date to the global epidemic of tobacco-related diseases. Born of about 50 years of policy work in relation to tobacco, the Framework Convention for Tobacco Control (FCTC) commenced with 168 signatory countries. It was supported by agencies including the IMF, World Bank, UNICEF, several pharmaceutical companies and international health NGOs. It is a complex legal agreement that seeks through the enactment of protocols to reduce both supply and demand for tobacco. Australia signed up early and has strongly supported the treaty. Indonesia is not yet a signatory. When relations with Indonesia settle, we should discuss this.
Second, we can support aid and development agencies such as the World Bank. World Bank modelling has shown that wherever tobacco is taxed, consumption falls, government revenue increases and tobacco farming can give way to subsidised food production. The World Bank model applies whatever the national income; raising taxes has worked in low- and middle-income countries such as South Africa, Egypt and Turkey. This can be used as a strong card in the game of encouraging countries to grow economically at the same times as improving their health.
Third, vigilance is needed even in Australia where tobacco control has achieved so much. Smoking has fallen from 72% in men in 1945 to 15% now. Education about the risks of smoking must continue among young and old, together with information about the value of quitting. Unfortunately, the latent effects of smoking years ago, and those consequences suffered by current smokers mean that we have about 15 000 tobacco-associated deaths a year. Plain packaging is working, and most critically, social attitudes and the definition of what is normal have changed. E-cigarettes should be viewed sceptically. Water-pipe smoking has become popular in Australia and its health effects are well known. Support for smokers who wish to quit may not need to be extensive to be effective.
World NO Tobacco Day reminds us of what is possible. It may be an unattainable goal but the pathway there is plain. Advocacy from public health professionals that has achieved so much in Australia can harnesses legal, economic, political and legal tactics for global application. As a result we could see that one billion potential deaths tobacco deaths halved by the end of this century.