Hiilamo and Glanz (2018) conducted a global comparison on the limited implementation of FCTC 2003 tax provision. Their study shows that tax increases are an effective measure for lowering tobacco consumption in both high income and low-income countries. The same tax increase is expected to determine different outcomes in countries adopting this measure depending on their overall economic status, as an increase of 10% in tobacco taxes is estimated to result in a 4% reduction in tobacco use in low income countries, and a 5% reduction in low or medium income countries. However, although article 6 of the FCTC establishes that signing countries should implement tax and price policies on tobacco products for achieving health benefits for their population, the guidelines for implementing these policies do not establish specific tax or price targets (Hiilamo and Glanz, 2018). This makes it possible for the tobacco industry to use this to their advantage. Companies in the industry fight tax increases by financing research suggesting that there are economic benefits to be gained from tobacco, they finance lobby campaigns directed at ministries of finance who, owing to insufficient knowledge regarding public health and FCTC requirements, often embrace the argument that increasing taxes for tobacco products can only result in increasing illicit trade and will therefore harm the most vulnerable groups. The lack of specific targets for tax and price increases also helps the tobacco industry to profit by raising prices for their premium brands and lowering prices for very low-price brands, which eventually results in increasing their profits (Hiilamo and Glanz, 2018). The differences between countries may therefore be explained as a consequence of poor knowledge of decision makers regarding public health aspects and FCTC requirements, coupled with the tactics of the tobacco industry for fighting tax increases, and for using the drawbacks of implementation guidelines to their advantage.
According to WHO (2017), average smoking rates among adults declined from 24% in 2007 to 21% in 2015. Gender-wise, smoking prevalence is still higher among men. On average, men’s overall smoking decreased from 39% in 2007 to 35% in 2015. It is important to note that smoking prevalence is still higher among the population in lower income countries, whereas smoking reduction occurs at a more significant rate in high-income countries. The rate of smoking men in high-income countries decreased from 34% in 2007 to 19% in 2015. This contrasts significantly with the situation of low and middle-income countries, in the case of which only approximately a third have recorded statistically significant decreases. For women, global smoking rates have decreased from 8% in 2007 to 6% in 2015 (WHO, 2017).
Levy et al. (2018) evaluated the effect of the six MPOWER measures released by the WHO to assist countries with the implementation of the FCTC. The researchers identified 88 countries which adopted at least one of the MPOWER measures. They estimated the effect of the policy implementation by using validated SimSmoke models with the number of smokers in each of the 88 countries. This helped establish the decrease in the number of smokers since the policy was adopted. Relying on research indicating that 50% of smokers were victims of smoking-attributable deaths (SAD), Levy et al. (2018) were able to establish that 22 million projected deaths were averted since policy implementation.
Food plays an important part in global patterns of health inequality. According to FAO et al. (2018), by 2017 the level of undernourished people had risen to 821 million, representing approximately one in nine people in the world. Wasting affects over 50 million children under five and more than 38 million children in the same age segment are overweight. 672 million adults are obese and UNICEF reports that in many countries, obesity and under-nutrition coexist. Food insecurity, high costs of nutritious foods (and low costs of low nutritional foods), as well as physiological adaptations to food restrictions, are considered to be the main causes of these imbalances. Nutrition is impacted upon by climate change, but also by water and sanitation, by changes in maternal care and childcare as well as by breastfeeding (FAO et al., 2018). It may be argued that similar to access to health care, access to nutritious foods is also impacted upon by a broader range of social factors which go beyond the sector of food. Therefore, correcting the obvious imbalances entails cross-sectorial partnerships at both national and global levels. Additionally, food industry stakeholders may contribute to encouraging poor choices at population level with the purpose of meeting their interests. Marketing campaigns, and funding of research arguing for the quality or low risks associated with their products, may be seen as similar to the tactics employed by tobacco companies, and, coupled with low process, may achieve similar outcomes in encouraging consumption amongst the most vulnerable segments of the population.
Although it may be believed that only those in areas suffering from famine and malnutrition are exposed to the risks posed by poor nutrition, Lang and Heasman (2004) point out that this is not the case. The methods of production, distribution and consumption of food developed by Western societies carry a significant impact on the quality of food consumed even by the most developed populations of the world. Moreover, even in high income countries there is an unequal distribution of financial resources, resulting in segments of population depending on low incomes and experiencing deprivation. The multitude of food products available are also a consequence of a production mechanism which relies on reducing the quality of the products and their nutritional value (e.g. minerals, vitamins etc.) for the purpose of maximising quantity and profit. The high global rates of overweight and malnourished people, which are not only representative of developing countries (e.g. obesity has become a chronic problem in the USA, one of the wealthiest countries in the world), indicate that wealth is not implicitly followed by health (Lang and Heasman, 2004). Better developed and implemented food policies, which would encompass the contributions of global stakeholders, might arguably contribute to mitigating the risks associated with poor nutrition worldwide.
FAO, IFAD, UNICEF, WFP and WHO. (2018). The State of Food Security and Nutrition in the World 2018. Building climate resilience for food security and nutrition. Rome, FAO.
Hiilamo, H. and Glantz, S. (2018). Limited implementation of the framework convention on tobacco control’s tobacco tax provision: global comparison. BMJ Open, 8(10), p.e021340.
Lang, T. and Heasman, M. (2004). Food Wars: The Global Battle for Mouths, Minds and Markets. 2nd edition. London/New York: Routledge.
Levy, D.T., Yuan, Z,, Luo. Y. et al. (2018). Seven years of progress in tobacco control: an evaluation of the effect of nations meeting the highest level MPOWER measures between 2007 and 2014. Tob Control 2018;27:50–7.
WHO. (2017). WHO REPORT ON THE GLOBAL TOBACCO EPIDEMIC, 2017. Monitoring tobacco use and prevention policies. [Online] Available at: https://www.world-heart-federation.org/wp-content/uploads/2017/07/WHO-Report-on-the-global-tobacco-epidemic-2017-EMBARGOED.pdf [Accessed 15 December 2018]