The recent High Court judgement in Australia upholding legislation to enforce plain packaging for tobacco products provides a good opportunity to look at the impacts of tobacco in low and middle income countries, and what’s needed to stem the tide of poverty and mortality they cause.

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It’s increasingly recognised that non communicable diseases (NCDs) are among the greatest threats to global public health. According to the WHO, in 2008 NCDs (consisting of cardio-vascular diseases, chronic respiratory diseases , cancers, and diabetes) were responsible for 63% of all deaths worldwide. The key source for statistics on the burden of NCDs – the WHO’s Global Status Report on NCDs 2010 – presents clear evidence that NCDs primarily affect low and middle income countries. In 2008, 80% of all NCDs deaths occurred in low and middle income countries – an increase from 40% in 1990.

Tobacco use is a major driver of the NCD epidemic, and is one of the single biggest public health threats the world has ever seen. Tobacco causes around 6 million deaths each year, and ultimately kills around half of its users. 10% of people killed by tobacco aren’t even smokers – but instead are killed by exposure to second hand smoke. Importantly, 80% of all smokers are in low and middle income countries. Tobacco use isn’t only a health problem, but is actually a development issue. Tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development. Money spent on tobacco would obviously be better spent on healthy food and education.

Over recent years there has been increased momentum in global tobacco control. In February 2005, the WHO Framework Convention on Tobacco Control came into force, and since then it has become one of the most widely embraced treaties in the United Nations’ history, with more than 170 Parties covering 87% of the world’s population. The WHO Framework Convention is an important contribution to global public health – it reaffirms the right of people to the highest standard of health, provides legal foundations for international health cooperation and sets high benchmarks for compliance.

Much more, however, is needed if we are to stall and reverse the growth in tobacco use and NCDs more broadly. One of the key elements of the tobacco threat, as countries like Australia recognise and address this problem, is that tobacco companies are adopting increasingly aggressive strategies to increase their infiltration of developing countries. In countries like China, India and Indonesia, overall rises in economic development have led to an increase in tobacco use. A good example of this is the Tobacco Asia Conference, which is scheduled to be held in Indonesia on 19 September 2012.  A coalition of civil society groups came out strongly against this conference, noting that ‘The conference committee deems Indonesia a tobacco-friendly market with no smoking bans or other restrictions or regulations compared to other ASEAN countries. That is an insult to our nation because it means we are supporting death, and we are urging the government to ban this conference.’ Such protest and awareness raising has a vital role to play in ensuring that the tobacco industry and governments are held accountable and that the damage to low and middle income countries is halted.

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It’s also vital that the tobacco control lessons that have been learnt in the developed world are shared with low and middle income countries. In July 2012, the Australia India Institute Taskforce on Tobacco Control launched a report outlining steps that could be taken in India to reduce the use and impacts of tobacco products. Drawing upon achievements in Australia, the report outlines how legislative change, public education, enhanced Government accountability, plain packaging and pictorial warnings will help reduce the roughly 1 million Indians who die from tobacco use each year.

It’s also important that tobacco control is seen as a core element of efforts to improve global public and eliminate poverty. One way this can be achieved is through elements of tobacco control being funded through the aid programs of developed countries like Australia, the United States and the United Kingdom. AusAID has started funding tobacco control in the Pacific, including through activities like surveys on youth smoking, promotion of the Framework Convention on Tobacco Control, and interventions including enforcement training. AusAID is also providing funding to address the disease outcomes of tobacco use, including cancer. This funding is currently focused on the Pacific, and it’s important that Australia’s commitment broadens to include other countries with major tobacco and NCD problems in Southeast Asia and beyond.

Finally, it’s vitally important that international development agencies embrace the need to tackle tobacco use. At present, programs to reduce tobacco use and control NCDs are largely limited to agencies that have a specific focus on these issues. The World Health Assembly’s decision in May 2012 to adopt a new global target of a 25% reduction in premature mortality from NCDs by 2025 was a step in the right direction; as was the inclusion of NCDs in the Rio + 20 Earth Summit’s outcomes document The Future We Want. What’s needed now is for tobacco control and NCDs to be placed at the centre of the international development discourse. The Oxfams and World Visions of the world need recognise and respond to the problem, and the post 2015 MDGs need to have a clear commitment to this crucial public health and development issue.

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Sam Byfield

Sam Byfield is the Non Communicable Diseases Coordinator at the Nossal Institute for Global Health in Melbourne, Australia. He previously worked at Vision 2020 Australia, where he contributed to cementing blindness prevention as a priority in Australia’s Aid Program; at the Yunnan Health and Development Research Organisation, where he worked on advocacy and programs to address environmental health problems in Southwest China; and at the Australian Parliament, where he undertook research and analysis across a range of foreign policy issues. His other interests include disability inclusive development (for three years he was a member of the Executive Committee of the Australian Disability and Development Consortium) and China’s emergence as an aid donor.

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