Some reflections on World No Tobacco Day

Image courtesy of www.askideas.com

This post was written by Deborah Arnott, Chief Executive of ASH.

Today is the WHO’s World No Tobacco Day, a day set aside as a tribute to the seven million people killed each year by tobacco and a call to action to governments to halt this deadly epidemic.[1] An epidemic two of Britain’s largest companies, Imperial Tobacco and British American Tobacco, are busily trying to export around the world.[2] [3] [4] While the twentieth century tobacco epidemic was concentrated in high income countries like the UK and the US that is no longer the case, nearly 80% of smokers now live in low and middle income countries (known as LMICs). In the twentieth century 100 million people died from smoking, in the twenty first, on current trends, 1 billion will die, the majority in their most productive years and disproportionately concentrated in poorer countries.[5]

This year’s theme is “Tobacco — a threat to development”. [6] The UK government has already responded to this call to action by committing £15 million (around US$18 million) into supporting implementation of the WHO’s tobacco treaty (FCTC) in poorer countries between now and 2021. As the UK said in its statement launching the project, “tobacco use negatively impacts on health and development.” From civil society Cancer Research UK has invested £5 million (around $6 million) [7] to support treaty implementation focusing on helping build the evidence base in poorer countries. The UK government’s funding comes from the aid budget (the UK is the only G7 country to have met the UN’s target to spend 0.7 per cent of gross national income on overseas aid). The initiative is being delivered by the WHO FCTC Secretariat to directly support a number of Parties as well as supporting initiatives to promote implementation of the treaty in all low- and middle income countries. [8]

For this alone the UK would merit the WHO WNTD medal this year, if our public health minister had not already been awarded the WHO Director-General’s special award last year for implementing plain standardised packaging.[9] The UK has come top of the European tobacco control country listings since 2007 [10] and in 2015 was awarded the prestigious American Cancer Society’s Luther L Terry medal for exemplary leadership by a government ministry.[11] These awards are due to the global leadership the UK has shown in implementing the WHO FCTC to the highest standards. The UK has everything from smoking cessation support free at the point of delivery to a complete ban on advertising promotion and sponsorship; from high taxes consistently rising above inflation year on year to comprehensive smokefree laws; from a ground breaking and highly effective anti-smuggling strategy to, most recently, being the second country in the world to pass legislation requiring standardised “plain” packaging of tobacco products.

But more remains to be done. The Prime Minister’s commitment to ‘fighting against the burning injustice that if you’re born poor, you will die on average nine years earlier than others’[12] is welcome and achievable. As her Government has acknowledged [13], half this difference in life expectancy is due to the higher rates of smoking amongst the least affluent, so major improvements can be achieved by driving down smoking rates amongst the most disadvantaged in society. [14]

The UK’s achievements to date are due to the strong political consensus we have in support of tobacco control. At the time plain packaging legislation was passed, with cross party support, the Health Minister shared a tweet with his opposite number saying, “Let’s hope both our children can grow up in a smokefree generation”.[15] But the evidence, at home and abroad, is that we cannot achieve a smokefree future without a comprehensive and sustained government strategy, with tough new targets to drive down smoking prevalence. Many measures, such as the advertising ban, taxation and standardised packaging, are self-sustaining. However to succeed in reducing inequality, the Government also needs to ensure adequate funding for the recurring costs of measures that are known to be effective — mass media campaigns, smoking cessation services and tackling tobacco smuggling. [16] [17]

The Tobacco Control Plan for England expired at the end of 2015 and to date there is no sign of its successor. It was promised in summer 2016 and even more recently we were told at the end of last year that it was due “shortly”. We’re only a week away from a general election — the incoming government must commit to publishing a new and challenging tobacco control plan. Since the last Tobacco Control Plan expired hundreds of children have started smoking every day[18]. Many, if not all, of these children will go on to become lifelong smokers, half of whom will die on average 10 years prematurely after suffering from painful and unpleasant diseases such as cancer, cardiovascular disease or COPD caused by their smoking. On 1 July 2017 it will be the 10th anniversary of the implementation of smokefree legislation in England. A worthy date for publication of the next Tobacco Control Plan, with a commitment to delivering a smokefree future for our children.

References

[1] WHO press release for World No Tobacco Day 2017
[2]Tobacco Tactics — BritishAmerican Tobacco in Afica: A Past and Present of Double Standards
[3] BAT’s African Footprint. ASH. 2008
[4]UK cigarette firm criticised over Laos tobacco tax deal — The Observer, 5 October 2014
[5] Tobacco Atlas — Smoking’s Death Toll 
[6] WHO World No Tobacco Day 2017 page 
[7] Cancer Research UK policy on international tobacco legislation
[8] WHO — Parties to FCTC 2030 announcement 
[9] World No Tobacco Day Awards 2016
[10] The Tobacco Control Scale 
[11] American Cancer Society Luther Terry Award winners 2015 
[12] Statement from the new Prime Minister Theresa May. 13 July 2016. Accessed online 8th December 2016.
[13] Hansard. Smoking: Written question — HL1194. 26 July 2016.
[14] Marmot M. Fair Society Healthy Lives (The Marmot Review), 2010.

Reference 15: Twitter exchange between Andy Burnham and Jeremy Hunt

[16] ASH. Smoking Still Kills. London 2015.
[17] RCP. Nicotine without smoke: Tobacco Harm reduction. A report by the Tobacco Advisory Group of the Royal College of Physicians. London. RCP. 2016.
[18] Source: Estimate by CRUK based on data from the national survey on Smoking, drinking and drug use among young people in England in 2014. The NHS Information Centre for Health and Social Care.