Will countries 'walk the talk' to end the tobacco epidemic?

Bobby Ramakant *

World No Tobacco Day 2015

Despite unprecedented pressure from tobacco industry to delay, dilute or thwart progress on a range of tobacco control measures globally, considerable achievements have been made by governments over the past years to protect public health. The global tobacco treaty, which was the first corporate-accountability and public health internationally binding treaty of the World Health Organization (WHO), is one major leap forward to move the world towards ending game of tobacco.

On this World No Tobacco Day 2015, it is important to acknowledge that despite advancements in tobacco control, formidable challenges remain. It is no surprise that tobacco-related diseases, disabilities and deaths are alarmingly on the rise despite progress in tobacco control. With over 6 million tobacco-related deaths globally (over a million deaths in India alone), there is no doubt that urgent public health priority is to accelerate progress towards ending game of tobacco, and preventing any further tobacco-related disease, disability or death globally.

"Daily average number of patients of cardiovascular diseases (CVDs) who come to Out-Patients-Department (OPD) is rising by 25-30% every year. More alarming is the fact that average age of significant number of patients has dropped down to less than 40 years. Most of these young patients usually have no conventional risk factor associated with CVDs such as diabetes or hypertension but tobacco use is often prevalent" said Professor (Dr) Rishi Sethi of Cardiology Department of King George's Medical University (KGMU).

New cases of all types of cancers rising - regardless of income!

Cancer is second only to CVDs as lead cause of death around the world. A new study "The Global Burden of Cancer 2013" Published in JAMA Oncology on 28 May 2015 confirms the worst fears: new cases of virtually all types of cancers are rising in countries globally - regardless of income!

The study conducted by an international consortium of researchers led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington sends a strong message to governments globally: "Cancer remains a major threat to people's health around the world,” said oncologist Dr Christina Fitzmaurice, lead author of this study. "Cancer prevention, screening, and treatment programs are costly, and it is very important for countries to know which cancers cause the highest disease burden in order to allocate scarce resources appropriately."

Prevention is better than cure - with tobacco established as a common big risk factor for cancers and CVDs among other life-threatening diseases, governments have no excuse to let corporations laugh their way to the bank at the cost of spreading illness, misery and deaths in communities.

People before profits: easier said than done!

Tobacco industry interference in public health policy is not new rather age-old tactic of industry to increase its markets and cast 'doubts' on evidences emerging against tobacco! Recognizing this, the global tobacco treaty (formally called WHO Framework Convention on Tobacco Control - FCTC) has a strong Article 5.3 one of the guiding principles states that there is a direct and irreconcilable conflict of interest between tobacco industry and public health. Due to this WHO FCTC Article 5.3, global tobacco treaty intergovernmental negotiations have been considerably firewalled from tobacco industry interference.

But governments in countries are dealing with often alarming levels of industry interference when they attempt to do good on tobacco control. That is why, official conference declaration of 16th World Conference on Tobacco Health (WCTOH) held in March 2015 had a major recommendation: "All Parties (governments that have ratified the global tobacco treaty) establish and finance a multisectoral national coordinating mechanism of the WHO FCTC fully firewalled from the tobacco industry (Articles 5.2 and 5.3) and adopt comprehensive measures to prevent tobacco industry interference in public health policies in line with Article 5.3 guidelines."

Recognizing how countries that were implementing strong tobacco control measures, were also confronted with stiff opposition from tobacco industry, this official WCTOH conference declaration also said "The delegates at WCTOH affirm their support to all countries that have passed or are considering adopting plain packaging or graphic health warnings covering more than 85 percent including India, Pakistan and Nepal and ask them to stand firm against tobacco industry pressure."

Pictorial health warnings - a controversial flashpoint

"Tobacco packaging designs have become a controversial flashpoint in the ongoing struggle between the tobacco industry and countries seeking to support public health simply because package design is so effective at influencing consumers' decisions to, buy or not buy, tobacco products. In 2012 the tobacco industry spent $9.17 billion on advertising cigarettes in the USA alone – so it’s clearly an investment that pays dividends," said Dr Ehsan Latif, Director of the Department of Tobacco Control at the International Union Against Tuberculosis and Lung Disease (The Union).

"As bans on overt marketing of tobacco products spread across the globe, tobacco packaging is one of the only platforms left for the industry to promote their deadly products. That’s why the industry is fighting so hard against the excellent new laws that commandeer this space for public health."

Evidence shows that effective health warnings – including large and shocking pictures and strong clear language – motivate smokers to quit and discourage non-smokers from starting. "The graphic element vastly increases a warning’s impact and is vital for communicating with young people and in areas with low literacy rates," says Dr Latif. "These warnings work. In Brazil, two-thirds of smokers said they made them want to quit, and, in Singapore, 71 percent said they now knew more about the health effects of smoking."

Dr Tara Singh Bam, The Union's Technical Advisor on Tobacco Control, said to Citizen News Service (CNS): "During the past year, India, Pakistan and Nepal have introduced laws that require graphic health warnings to cover 85 percent of the surface area of tobacco packaging. Nepal’s law requires 90 percent coverage. These countries now face increasing pressure from the tobacco industry to delay and water down this legislation, which are slated to be the strongest in the world."

Countries should adapt plain-packaging now!

Now that so-called standardised or plain packaging -- packs without branding, a standardised unappealing colour, and large warnings in both picture and text -- have been proven to work in Australia, several new countries have committed to introduce similar legislation. Two years after Australia’s 2012 introduction of plain packs, cigarette consumption was found to have dropped by 12.8 percent.

"Australia has been taken to court repeatedly by the tobacco industry since plain packs were introduced. Now the UK and Ireland, who have just passed similar laws, are being taken to court too," said Dr Latif. "Just as in India, Nepal and Pakistan, Big Tobacco is taking action against governments that are exercising their sovereign right to protect the health of their people. Countries around the world must unite and coordinate efforts to swiftly end the tobacco industry’s tactics to delay this vital work."

Ending game of tobacco is social justice imperative!

Despite overwhelming evidence that tobacco is the common risk factor of major life-threatening non-communicable diseases (NCDs) such as CVDs, cancers, etc, governments around the world have not been able to act as fast as they should have to end the tobacco epidemic. It is a social justice imperative as well as major priority for public health to not let anyone suffer anymore tobacco related disease, disability or death" rightly said Professor (Dr) Rama Kant, WHO Director-General's Awardee.