Bettcher_edited.qxp 4/9/08 2:26 pm Page 23
The Challenge of Eliminating Tobacco-induced Cancers in the Developing World
least occasionally. However, it requires that healthcare workers,
Figure 2: Tobacco Taxes Reduce Consumption
particularly physicians, be motivated to provide advice. Cessation
counselling is most effective when it includes clear, strong and
2,500
45
Consumption (left scale)
personalised advice to quit from healthcare practitioners as part of
40
Excise tax rate (as a % of retail price)
Excise tax rate (right scale)
general medical care. Physician advice can be especially powerful
2,000 35
when it is related to issues of specific interest to the patient (e.g.
30
consultation for heart or lung symptoms).
1,500
25
20
Millions of packs
1,000
MPOWER Policy 4 – Warning About the 15
Dangers of Tobacco
10
500
Despite overwhelming evidence of the dangers of tobacco, relatively
5
few tobacco users worldwide fully understand the risks to their health,
0 0
especially in developing countries. Most people know generally that
1980 1985 1990 1995 2000 2005
tobacco use is harmful but are unaware of the wide spectrum of
Year
specific illnesses caused by tobacco, the likelihood of disability and
Figure 3: Global Tobacco Control Is Underfunded
death from long-term tobacco use, the speed or degree of addiction
250
to nicotine or the harmfulness of second-hand smoke.
US$205
Graphic warnings on tobacco product packaging deter tobacco use,
200
yet only 15 countries, representing 6% of the world’s population,
mandate pictorial warnings that cover at least 30% of the principal
surface area.
150
More than 40% of the world’s population lives in countries that do
not prevent the use of misleading and deceptive packaging terms such
US$ per capita
100
as ‘light’ and ‘low-tar’ – none of which actually signifies any reduction
in health risk. 50
US$28
MPOWER Policy 5 – Enforcing Bans on Tobacco US$7
US$1
0
US$0.001 US$0.005
Advertising, Promotion and Sponsorship
Low-income countries Middle-income countries High-income countries
The tobacco industry spends tens of billions of dollars worldwide each
year on advertising, promotion and sponsorship. Partial bans on Per-capita public spending Per-capita tobacco tax revenue
on tobacco control
tobacco advertising, promotion and sponsorship do not work, because
the industry merely redirects its resources to other non-regulated
Based on 70 countries that provided information on both tobacco tax revenues and
marketing channels. Only a total ban can reduce tobacco consumption
expenditure on tobacco control.
and protect people, particularly youth, from industry marketing
tactics. Only 5% of the world’s population currently lives in countries than four of five high-income countries tax tobacco at 51–75% of
with comprehensive bans on tobacco advertising, promotion and retail price, fewer than one-quarter of low- and middle-income
sponsorship. About half the children of the world live in countries that countries tax tobacco at this rate.
do not ban free distribution of tobacco products. National-level studies
before and after advertising bans have found a decline in tobacco Higher taxes can also provide countries with funding to implement and
consumption of up to 16% following prohibitions. enforce tobacco control policies and can pay for cancer prevention
and other public health and social programmes. In countries with
MPOWER Policy 6 – Raising Taxes on Tobacco Products available information, tobacco tax revenues are more than 500 times
Raising taxes, and therefore prices, is the most effective way to higher than spending on tobacco control. In low- and middle-income
reduce tobacco use, and especially to discourage young people from countries for which information is available, tobacco tax revenue is
using tobacco. It also helps to convince tobacco users to quit. Increasing 5,000 times higher than spending on tobacco control (see Figure 3).
tobacco taxes by 10% generally decreases tobacco consumption by 4%
in high-income countries and by about 8% in low- and middle-income The tobacco epidemic is man-made and entirely preventable. People,
countries. In South Africa, for example, cigarette consumption fell by acting through their governments and civil society, can reverse the
5–7% for every 10% increase in the price of cigarettes, resulting in a epidemic. However, strong, ongoing commitment is needed to see this
sharp decline in consumption, with the largest smoking decreases through. Currently, only 5% of the world’s population lives in a
among the young and the underprivileged (see Figure 2). A 70% country that fully protects its population with any one of the key policy
increase in the price of tobacco would prevent up to one-quarter of all interventions that have significantly reduced tobacco use in the
tobacco-related deaths among today’s smokers. countries that have implemented them. Countries need to act
immediately, because reversing this entirely preventable epidemic is a
Only four countries, representing 2% of the world’s population, have top priority for public health and for political leaders in the world. The
tax rates greater than 75% of retail price. In addition, although more MPOWER package can not only provide a clear road-map for countries
EUROPEAN ONCOLOGY 23
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