Curbing the Tobacco Epidemic in the Americas

By Carissa F. Etienne

Though the devastating health effects of tobacco use are well known, tobacco’s negative repercussions extend well beyond the obvious health outcomes.

Tobacco consumption creates a significant economic burden on societies because of both the high costs of health care and the associated lost productivity. In addition, tobacco use contributes to health inequalities and exacerbates poverty within and between countries through the diversion of resources away from food and other essential needs as well as through foregone income.

These and other adverse consequences of the tobacco epidemic disproportionately affect low- and middle-income countries, where more than 80% of the world’s smokers now live, including 127 million, in the Region of the Americas. Considering its tremendous health and economic costs, the tobacco epidemic has the potential to undermine both social and economic development.

The global response to tobacco is the WHO Framework Convention on Tobacco Control (FCTC), which has been ratified by 180 countries worldwide and 30 countries in the Americas. The FCTC provides a blueprint for governments to effectively curb the tobacco epidemic by implementing specific evidence-based interventions to reduce consumption. These include: adopting tax and price measures to reduce tobacco consumption; banning tobacco advertising, promotion and sponsorship; creating smoke-free work and public spaces; requiring prominent health warnings on tobacco packages; and combating illicit trade in tobacco products. These interventions have been identified as “best buys” in the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases, which calls for a 30% relative reduction in the prevalence of tobacco use by 2025. Of note, raising taxes has proven to be the single most potent and cost-effective strategy for reducing tobacco use.

There is now clear evidence that appropriately structured tax policies can provide the dual benefit of reducing tobacco consumption as well as generating additional tax revenues. A recent global study found that increases in tobacco taxation in low- and middle-income countries could prevent millions of deaths while also creating new fiscal space for financing development.

Despite the clear path forward set forth by the FCTC and abundant evidence on the effectiveness of increasing taxes to reduce tobacco consumption, taxation remains the least widely implemented FCTC measure. This is largely due to industry tactics to block, delay, and weaken tobacco control policies. In the specific case of fiscal policies, governments often abstain from taking action because of claims propagated by the tobacco industry that higher taxes harm economies by increasing levels of illicit trade and by decreasing tax revenues. Published data refute these claims. However, the relative paucity of country- and region-specific evidence on the economic aspects of tobacco control limits the ability of health authorities to effectively advocate for comprehensive implementation of the FCTC.

A special issue of the PAHO’s Pan American Journal of Public Health published in November 2016 addresses this gap by presenting systematic regional evidence on the effectiveness of tobacco taxes that is consistent with global findings.

The dissemination of regional evidence is a first step in challenging the tobacco industry’s unfounded claims about the detrimental economic effects of tobacco control and informing evidence-based policies to reduce national tobacco consumption and the associated burden of disease. It is our hope that health authorities will use the evidence presented in the magazine to advocate for effective implementation of the FCTC, in particular its mandates aimed at making tobacco less affordable through increased taxes.

Carissa F. Etienne is a public health expert from Dominica. She serves as the Director of the Pan American Health Organization.