Is tobacco a development issue? Report from an email discussion

Taxation
Participants cited numerous studies in both developed and developing countries which have shown that price increases reduce cigarette consumption. The poor are generally more responsive to price changes than the rich. One contributor suggested that rapidly increasing excise tax is a win-win option for governments. A 10 percent increase in the retail price of cigarettes reduces per capita consumption by between four and eight percent. At the same time government revenue increases. Evidence suggests that rapid increases in the excise tax in South Africa since 1993 have contributed to a 30 percent decrease in cigarette consumption.

However, governments must ensure that tax increases do not stimulate smuggling to the extent that the tax collection system is undermined. There is also a need to monitor the effects of raised cigarette taxes on the consumption of traditional tobacco products if authorities are to reduce the incidence of all tobacco-related diseases.

Tobacco companies
The debate also took in the role of tobacco companies. Participants observed that tobacco companies operate double standards around the world, often getting away with practices in developing countries that would be completely unacceptable in wealthier regions with stricter legislation. Their influence is very strong in Russia, linked to weak tobacco control legislation. The FCTC has the potential to make a massive impact in Russia and the CIS.

One contribution highlighted a powerful and under-utilised channel through which to effect change. The overriding aim of tobacco companies is to maximise their share price. Many people unknowingly and indirectly own shares in tobacco companies through mutual funds and pension schemes and could use their influence as shareholders to change the behaviour of tobacco companies.

Policy lessons
Discussion participants highlighted several factors as essential to the success of tobacco control policy:

• a strong, binding FCTC
• the involvement of other UN agencies such as the WTO, FAO and ILO
• incorporation of a tobacco control agenda by environmental, human rights, gender and corporate accountability movements
• informing women from all socio-economic strata about tobacco and involving them in the policy-making process.

Researchers and health professionals have particularly important roles to play. Dialogue between researchers and policy-makers is crucial to establish priority areas for research and fast-track approaches to implementation. Researchers can influence policy by providing information at the appropriate time in an understandable format and by exploiting policy windows such as a change of government. Policy-makers need to know what interventions work and at what social and economic cost. Public opinion is also important. Researchers may benefit from working with NGOs in communicating research to the public and to policy-makers, as with the powerful coalition formed in South Africa in the late 1980s.

It is also important to ensure that sound tobacco control laws are implemented. Experience from South Africa suggests that it is not easy to enforce bans on smoking in public places. Health professionals can play an important role in implementation. Many local healthcare managers are not aware of the evidence on the social cost of tobacco consumption. Involving health professionals in the policy-making process and building their technical capacity to interpret research results will change their role from implementers to advocates and will increase the likelihood of research results reaching policy-makers.

It is also important to bear in mind that external influences such as severe economic depression or war could push tobacco control completely off the agenda.

Future research
Research is needed to support the development of appropriate policy options for tobacco control in developing countries, which may be very different to those tried and tested in the North. However, a shortage of applications for research funding in this area suggests that research capacity is sorely lacking.

The discussion highlighted the need for research on:

• how tobacco farmers, national governments and multinational tobacco companies benefit from the tobacco industry
• the effects of tobacco control on government revenues
• policy solutions to phase out economic dependency on tobacco
• smoking trends related to socio-economic status in different countries
• the influence of tobacco as a symbol of affluence on demand for cigarettes in developing countries
• the extent to which corruption threatens tobacco control
• the impact of tobacco control on other risk-taking behaviours, such as illegal drug use or unsafe sex
• medicinal uses for tobacco, possibly through genetic modification
• intervention strategies that will encourage the involvement of local health managers in tobacco control research efforts and policy processes.

Conclusions
From the contributions made to the discussion, it appears that participants felt strongly that tobacco is a development issue, posing far-reaching threats to countries' development efforts if not controlled. A number of concrete policy measures that could head off these negative effects were suggested. However, the clear message to emerge from this email discussion is that current gaps in evidence and knowledge, if not addressed by researchers and policymakers alike, could well hamper the effective control of tobacco.