Beat tobacco to save lives and reduce poverty

Globally, more than seven million people die from diseases caused by tobacco use every year, including hundreds of thousands from secondhand smoke exposure. This is seven million too many, and yet still the number is rising. Every single death from tobacco is a preventable tragedy.

In Bangladesh, tobacco shapes the ill-health of many people. More than 22 million Bangladeshis smoke, most being men. While very few Bangladeshi women smoke, 18.7 million women use smokeless tobacco and are at risk of cancer.

The deaths and the suffering from diseases that tobacco causes have wide-reaching impacts on the health and wellbeing of individuals and their families, the prosperity of communities, and equality within our societies. As in every country, tobacco acts as a bottleneck to escaping poverty, trapping households in cycles of spending that limit their ability to fund essentials. Studies have found that tobacco use in Bangladesh accounts for a significant proportion of household expenditures, resulting in lower expenditures for food and education in low-income households. In households that used tobacco, it has been found that approximately 5.5 percent of expenditures were for tobacco-attributable illness. Use of tobacco can impoverish families through high medical expenditures associated with tobacco-related diseases and lost household income due to illness and death. Consequently, the economic burden of tobacco use falls disproportionately on the poor as they tend to be the least able to afford needed medical care.

Tobacco's public health and economic burden is increasingly carried by low- and middle-income countries (LMICs) rather than the prosperous ones. In LMICs, in particular, and especially those with similar economic profiles to Bangladesh, the burden from tobacco is only rising. Already, over 80 percent of global deaths from cancer, diabetes, heart and lung disease, all of which using tobacco increases the risk of, occur in LMICs. Coping with tobacco-related disease limits capacity to address other priority health areas, build sustainable health systems, and provide basic health services. In Bangladesh, diseases and deaths from smoking are estimated to be responsible for 7 percent of total health costs or close to Tk 2,200 crores (Tk 22 billion) in avoidable health care expenditures per annum. The total economic loss from smoking is Tk 16,000 crores (Tk 160 billion) per year, equivalent to about 1.4 percent of annual gross domestic product (GDP).

Fundamentally, tobacco curbs the development of nations. This is why the World Health Organization and partners have focused on the links between tobacco and development for this year's World No Tobacco Day, on May 31.

Despite the gloomy numbers and forecasts on the huge financial burden on health systems and economies, opportunities can be found in the economics of tobacco control. Revenue potential from tobacco taxation, for example, is substantial, as are the gains in reducing tobacco use prevalence. Revising Bangladesh's current tax structure for cigarettes could create a 3-4 percent decline in cigarette smoking prevalence over two to three years and generate up to Tk 3,900 crore (Tk 39 billion) extra in tax revenue in the 2017-2018 fiscal year. This could be an important revenue stream to finance universal health coverage in Bangladesh and priority health prevention and promotion programmes of the government.

The economic and health gains of tobacco control in Bangladesh can be amplified further with stronger enforcement of the Smoking and Tobacco Products Usage (Control) Act, and implementation of article 5.3 of the World Health Organization Framework Convention on Tobacco Control, which calls for protection of tobacco control policies from commercial and other vested interests of the tobacco industry.

The economics of tobacco control is not only the concern of tobacco users, nor is it only the concern of those who set policy. It is unavoidably a multisectoral issue that must be tackled beyond the health sector, covering issues as broad as reducing poverty, building sustainable agricultural systems, environmental protection, international trade agreements, tackling the illicit flow of tobacco products and tax avoidance.

Bangladesh must prioritise and accelerate tobacco control efforts as part of the response to the 2030 Agenda for Sustainable Development, for tobacco control is more than a health issue; it is a matter that should be taken seriously for the development, future and prosperity of Bangladesh.

N. Paranietharan is World Health Organization (WHO) Representative to Bangladesh, and Kelly Henning is Director, Bloomberg Philanthropies Public Health programmes.