Smoking surge has moved from rich to poor countries

Some estimates suggest one billion people could die from tobacco use across the 21st century. Picture: AFP

During the course of the 20th century, tobacco smoking killed about 100 million people, most of whom lived in today’s rich countries. However, that picture is changing and the health burdens of smoking are moving from high-income to low and middle-income countries. Some estimates even suggest one billion people could die from tobacco use across the 21st century.

Until now, investment in targeting health threats such as tobacco, alcohol and salt have largely been the preserve of wealthy countries. In Australia, more than 150,000 people die each year from chronic diseases.

In poorer countries, a much bigger focus has been on eradicating infectious disease. However, as people live longer, non-communicable diseases are claiming more lives everywhere in the world while receiving only a fraction of health funding.

In poor countries we should keep fighting illnesses such as malaria, tuberculosis and HIV-AIDS, but we also urgently need to increase our focus on chronic disease risks such as tobacco, alcohol and salt intake.

We have promised to tackle chronic diseases by 2030 along with many other promises in the so-called Sustainable Development Goals. Unfortunately, we’re failing. On current trends, the world will be a half-century late delivering across all its promises.

The reason is clear: politicians decided to make an impossible 169 promises. Having 169 priorities is indistinguishable from having none.

This year, the world will be at halftime for its 2030 promises, yet it will be nowhere near halfway. It is time to identify and prioritise the most crucial goals. My think tank, the Copenhagen Consensus, is doing exactly that. Together with several Nobel laureates and more than 100 leading economists, we have been working for years to identify where each dollar can do the most good.

A new, peer-reviewed study shows that tax and regulation policies to fight chronic diseases can deliver outstanding social benefits for relatively small investments, something most countries support in principle.

There are two effective ways to reduce the death toll from smoking. One is through a simple tobacco tax. The other is tobacco regulation, which can include bans on advertising and on smoking in public places.

Tobacco taxes make smoking costlier, which means more young people will never start, more smokers will stop or reduce their consumption, and there will be fewer second-hand smoking deaths. Taxes also raise large and reliable funds for the government, something many governments in the global south struggle to secure. We know from many real-world examples that higher taxes reduce tobacco consumption.

The direct cost of changing legislation is quite small. Raising the tobacco tax across low and lower-middle-income countries to four times the sales cost is estimated to cost $US45m ($67m). Of course, it also will confer a relatively large loss to present-day smokers, worth almost $500m. In total, the cost up to 2030 would be a sizeable $US462m. However, this policy also would significantly reduce smoking and thereby save more than 1.5 million lives. In monetary terms, every dollar in cost would achieve a phenomenal social benefit worth $101. Similarly, tobacco regulations have small administrative costs and larger smoker losses, but because they will likely save more than 300,000 lives they deliver a spectacular benefit-cost ratio of 92.

Alcohol regulations are also a sound investment. Alcohol kills 300,000 people annually in low-income countries and 1.6 million in lower-middle-income countries. It contributes to numerous diseases and causes an additional 700,000 accidental deaths globally, as well as immense social damage. Tightening alcohol regulations can reduce harmful consumption and avert 150,000 deaths across the rest of the decade. Each dollar spent will deliver $US76 of social benefits. Alternatively, an alcohol tax can generate large, if slightly lower, benefits at $US53 back on the dollar.

Lowering unhealthy salt intake – as Britain, Finland and Poland have done – through regulations that gradually reduce the salt content in processed foods is another sound investment. According to the World Health Organisation, we should consume a little less than one teaspoon of salt each day, but almost everywhere in the world people consume much more. This leads to high blood pressure, heart disease and strokes. It causes almost two million deaths each year.

For poorer countries, enforcing salt regulations will be more expensive at over $US400m, but this approach could avoid almost 500,000 deaths, delivering $US36 of social benefits for each dollar spent.

We will not deliver on all the global promises for 2030 – that much was clear even when they were originally written. However, the data now shows we will likely not deliver on any of the main goals because we have promised everything to everyone. It is time to focus our remaining efforts on the best investments. Here, our research shows some of the best investments lie in the regulation for tobacco, alcohol and salt, which can deliver outstanding benefits at low cost.

Bjorn Lomborg is president of the Copenhagen Consensus and a visiting fellow at Stanford University’s Hoover Institution. His new book, Best Things First, is available for pre-order.