PAHO warns of tobacco epidemic in the Caribbean

WASHINGTON, United States (CMC) — The director of the Pan American Health Organisation (PAHO), Dr Carissa Etienne, has warned about what she described as the tobacco epidemic in the Americas, including the Caribbean, saying that 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,” said the Dominican-born Etienne, writing in the Pan American Journal of Public Health.

“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,” she added.

Etienne said these and other adverse consequences of the tobacco epidemic disproportionately affect low-and middle-income countries, where more than 80 per cent 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,” she said.

Etienne noted that the global response to tobacco is the World Health Organisation (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, Etienne said.

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, she said.

These interventions, Etienne said, have been identified as “best buys” in the WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases, which calls for a 30 per cent 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,” she said, adding that 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.”

The PAHO head pointed to a recent global study that 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.

But Etienne said, 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.

She said 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,” Dr. Etienne said.

But she said 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 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, Dr. Etienne said.

She said 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,” Etienne said.

A new landmark global report from WHO and the National Cancer Institute of the United States of America said that policies to control tobacco use, including tobacco tax and price increases, can generate significant government revenues for health and development work.

The report said that such measures can also greatly reduce tobacco use and protect people’s health from the world’s leading killers, such as cancers and heart disease.

But left unchecked, the report warned that the tobacco industry and “the deadly impact of its products cost the world’s economies more than one million US dollars annually in healthcare expenditures and lost productivity.”

According to findings, published in The Economics of tobacco and Tobacco Control, said that, currently, about six million people die annually as a result of tobacco use, with most living in developing countries, such as those in the Caribbean.

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