The funding crises forced upon by the US government on
several low- and middle-income countries is an opportunity
in disguise to improve programme efficiency and outcome and
invest optimally in health and development responses from
domestic coffers.
Evidence shows that tobacco alone
costs an economic loss of US$ 1.4 trillion every year. One
can imagine the huge economic benefit if governments
accelerate progress towards ending tobacco, and reducing
burden of tobacco-caused diseases and untimely deaths, and
averting this mountainous economic loss to global
economy.
All governments can generate more domestic
resources by following the science. “One of the scientific
evidence-based tobacco control measures is to raise tobacco
taxes. Taxation is one of the most effective ways of
reducing tobacco use. Higher tobacco taxes raise tobacco
prices, leading to reductions in tobacco consumption.
Increasing the price of tobacco reduces tobacco use by
discouraging initiation among potential users, encouraging
current users to quit and helping to prevent relapse in
those who have stopped,” said Dr Tara Singh Bam, Asia
Pacific Director (Tobacco Control), Vital Strategies, and
honorary Board Director of Asia Pacific Cities Alliance for
Health and Development (APCAT).
Dr Bam was delivering
a public health guest lecture in the Faculty of Medicine,
Udayana University, Indonesia, on the topic: “Integrative
approaches to end the double burden of tuberculosis and
tobacco Use.” It was organised by Udayana University and its
Udayana CENTRAL (Centre for NCDs, Tobacco Control and Lung
Health). This lecture was chaired by Dr Ketut Suarjana, Head
of Department of Public Health and Preventive Medicine,
Udayana University, Indonesia.
Follow the science and
raise tobacco taxes
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Raising tobacco taxes is one of
the six cost-effective and high impact measures to reduce
demand for tobacco recommended by the World Health
Organization (WHO) as part of its MPOWER package since 2008
onwards. All these six measures are in line with the legally
binding global tobacco treaty (formally called the World
Health Organization Framework Convention on Tobacco Control
or WHO FCTC) which is ratified by 182 countries and the
European Union. “Indonesia should also ratify it as it is
the only country in Asia Pacific which has not done so,”
said Dr Bam.
“Governments can also levy similar
taxes on alcohol, sweetened sugary drinks, or junk fast food
– all of which is a major pushback for public health, as
it increases the risk of preventable deadly diseases,”
rightly said Dr Bam.
By raising taxes on products that
are proven to increase the risk of deadly diseases,
governments can get more financial resources to invest into
public health. More importantly, raising such taxes would
deter users to consume harmful products and dissuade those
who are not yet consumers of unhealthy diets and
drinks.
For every US$ 1 invested in TB control,
return on investment is US$ 46
An important 2023
study shows that for every US$ 1 invested in science- and
evidence-based TB control, the return on investment is US$
46.
When hit with funding crises at several levels,
does it not make a lot of sense to invest domestic resources
in fully funding the domestic fight to end TB? If
governments find ALL people with TB with best of screening
and diagnostic tools, put them on the latest treatment
regimens, then they would prevent TB too, reduce human
suffering and untimely deaths. TB preventive therapy as well
as addressing risk factors for TB is equally
important.
“Stronger implementation of
evidence-based tobacco control measures also has a positive
impact on TB response as well as other health programmes,
such as those addressing cardiovascular diseases, diabetes
and other non-communicable diseases,” said Dr
Bam.
Double trouble: tobacco and TB
Dr Putu
Ayu Swandewi Astuti, Coordinator of Undergraduate Public
Health Study Programme, Udayana University, said that
tobacco use is the biggest risk factor for TB, as per the
latest WHO Global TB Report 2024. Tobacco use was the risk
factor for almost 150,000 people with TB disease in 2023 in
Indonesia (one-fifth of the total number of TB patients
notified in the same year in Indonesia). Undernutrition
ranked 2ndbiggest TB risk factor in Indonesia with 84,000
people with TB disease notified in 2023. Diabetes, HIV and
alcohol were the next three big risk factors for TB in the
country.
“10.8 million people fell ill with active
TB disease in 2023 worldwide as per the latest WHO Global TB
Report. Out of these, 1.25 million died due to TB in the
same year globally. However, if we look at tobacco use,
there were at least 1.133 billion tobacco users aged 15
years or above. Over 8 million tobacco users lost their
lives in a year,” said Dr Bam. “At least 0.73 million
people get TB disease in a year due to tobacco use, and 16%
of them die due to the dual pandemic of TB and
tobacco.”
Dr Bam shared that a WHO and The Union
monograph on TB and tobacco control shows how tobacco
smoking amplifies the risk of TB infection, mortality,
treatment relapse, heightened clinical severity, and delays
in both diagnosis and treatment.
Another study done by
Dr Tara Singh Bam, Dr Donald Enarson (legendary lung health
expert), Dr Dirgh Singh Bam (former Health Secretary of
Government of Nepal) and others, showed that there were
worryingly long delays in TB diagnosis and initiation of
treatment. Current tobacco smokers in Nepal had an average
of 133 days of delay and ex-smokers had 103 days of average
delay, compared to those who had never smoked but faced an
average delay of 80 days. These delays in TB diagnosis and
treatment result in mounting up catastrophic costs for many
people in low- and middle-income countries.
Better TB
treatment outcomes in those who quit tobacco
A study
published in 2022 in the reputed journal Thorax showed that
TB treatment outcomes were significantly better among those
patients who had quit tobacco use during the TB treatment in
Pakistan and Bangladesh. More than 91% of TB patients who
had quit tobacco use during TB treatment were successful in
completing the therapy (compared to 80% who did not quit
tobacco use).
TB relapse rates were also higher among
those who did not quit tobacco use during TB treatment- 6%
among those who had quit tobacco use and 14% among those who
had not quit tobacco use during the treatment reported TB
relapse.
Leadership and accountability
Rights
come with responsibilities. Dr Bam encouraged everyone to
take individual responsibility to have a health seeking
behaviour, help protect others from infection and access
healthcare services promptly when needed. Current tobacco
users also have a responsibility to quit tobacco use and
stay away from deadly tobacco.
We also need to unite
and hold governments to account to deliver on the promises
made for saving our lives from both: TB and tobacco – along
with all other sustainable development goals and
targets.
Bobby Ramakant – CNS (Citizen News
Service)
(Bobby Ramakant is a World Health
Organization (WHO) Director General WNTD Awardee 2008 and
Health Editor at CNS (Citizen News Service). He is also on
the executive boards of Global Antimicrobial Resistance
Media Alliance (GAMA) and Asia Pacific Media Alliance for
Health and Development (APCAT Media). Follow him on
Twitter/X: @BobbyRamakant)
– Shared under
Creative Commons
(CC)
