The Challenge of Non-Communicable Diseases and Road Traffic ...

An Overview 39
Tobacco
There is strong evidence, including from LMIC, to
show that tobacco excise taxes are an effective tool in
reducing tobacco use, particularly amongst the young
and the poor, as well as a reliable source of government
revenues. Multiple-country examples and technical
guidance to assist implementation exist [236].
Increasing tobacco taxes by 10 percent will reduce
tobacco use by up to 8 percent in LMIC as well as an
increase revenues by 7 percent [237]: in South Africa,
for example, each 10 percent increase in price
reduces consumption by 6 percent. A focus on excise
taxes is recommended, relying more on specific than
ad valorem tax, especially where tax administration
is challenging. All tobacco products should be taxed
as relative increases in the prices of cigarettes may
lead to substitution by lower-price products – particularly
important given that smokeless tobacco
(snuff or chewing) is more common amongst youth
and women. Arguments that higher taxes will have
harmful economic effects, for example by encouraging
smuggling or reducing employment, are false
or overstated [238]: in South Africa the tobacco industry
claims that illicit trade is 20 percent whereas
research indicates it is only 10 percent, underlining
the importance of scrutinizing data sources for misinformation
or tobacco industry involvement [94].
Although the Framework Convention on Tobacco
Control (FCTC) has entered into force in most SSA
nations (40 by December 2012 8 ; see Box 3)[239], only
modest progress has been made in its implementation.
While many countries have legislation or policies
on protection from exposure to tobacco smoke,
only a handful meet required standards in implementation.
Little progress has been made on packaging
and labeling of tobacco products and while
slightly better progress has been made in banning
tobacco advertising, promotion, and sponsorship,
again this is not to required standards [240]. Lessons
from a review of African countries are that an active
tobacco control civil society movement, political
will, and active research support are significant
contributors to success [241-242]: in the countries
8 At the time of publication, in SSA, Mozambique and Ethiopia have
signed but not ratified or entered it into force, and Eritrea, Malawi,
Somalia, South Sudan, and Zimbabwe have not signed, ratified, or
entered it into force.
with the most successful tobacco control programs
(South Africa, Mauritius, and Kenya) partnership
between CSOs and government institutions is a key
feature, and NGOs in 15 African countries have produced
‘shadow reports’ monitoring compliance of
their country with FCTC obligations [243].
BOX 3: Regional Response to Tobacco
In 2011, the global tobacco epidemic killed almost six
million people; nearly 80 percent of these deaths occurred
in LMIC. Cigarette consumption in Western Europe
dropped by 26 percent between 1990 and 2009,
but increased in Africa and the Middle East by 57 percent
during the same period. African countries are experiencing
the highest increase in the rate of tobacco use
amongst developing countries: the number of smokers
in SSA is projected to increase 148 percent by 2030, to
208 million smokers or one-fifth of the total population.
Africa is at a crossroads in its response to tobacco control.
On the one hand, countries in this region have become
an increasingly attractive market as tougher regulations,
high taxes, and greater consumer awareness
in developed countries are ‘closing the door’ to tobacco
imports and leading to reductions in use. On the other
hand, cigarettes are becoming more affordable as incomes
rise in many African countries.
Significantly, Africa is fighting back. In Africa, 42 percent
of countries have already signed the 2003 WHO FCTC,
which binds them to a number of anti-tobacco measures.
Additionally, on June 3-5, 2012, the World Bank, in partnership
with the Southern Africa Development Community
(SADC), the Ministry of Finance of Botswana, the
Bloomberg and Bill and Melinda Gates Foundations, and
WHO, convened a high level forum on The Economics of
Tobacco Control: Taxation and Illicit Trade. With the participation
of delegations from the Ministries of Finance,
Trade, and Health of 14 SADC member countries, the aim
of the forum was to promote dialogue on best practices
in effective design and administration of excise taxes
on tobacco as an instrument to promote public health,
and to share knowledge on the dimensions, causes, and
extent of illicit trade in tobacco products and strategies
to control it. The involvement of high-level officials from
different sectors in the forum underscored the potential
for multisectoral collaboration and action to prevent
and control tobacco addiction that contributes to ill
health, disability, and premature mortality in Africa.