Tobacco's cost to our country

By Paul Ebusu

In recent years, we have seen the burden of cancer increase across Uganda.

According to WHO figures, in 2012 alone, more than 29,000 people were newly diagnosed with cancer in Uganda and many tens of thousands more are cancer survivors or living with this disease.

There is an obvious human cost: the suffering of the cancer patient and the emotional and financial impact on their loved ones. Many cancer sufferers are still economically active when they become ill and have to stop working, negatively impacting their dependents, employers and the wider economy. And our healthcare system must manage the burden of cancer alongside many other priorities. For the sake of Uganda's people and our country's social and economic development, we must do all we can to control cancer.

While we cannot prevent all cancers, we have a responsibility to reduce the needless suffering and cost of cancers that are preventable. There is one clear way to make an impact: tobacco use is a risk factor for a number of different types of cancer among men and women. Reduce smoking and we can reduce tobacco-related cancers. Alarmingly, we could be facing further increases instead, as more youth take up the habit. While the Global Adult Tobacco Survey (2013) found that 7.9% of Ugandans aged 15 years and older use tobacco, this figure has the potential to rise quickly, as 17.3% of youths aged 13-15 reported using tobacco (Global Youth Tobacco Survey, 2011). Most lifetime tobacco users start before the age of 21, so we need to deter youth from starting to use tobacco and persuade current users to quit.

That is why Uganda Cancer Society (UCS), which is committed to preventing cancer, has become more active in supporting tobacco control and monitoring the tobacco industry's tactics, which aim to encouraging people, especially youth, to start using tobacco. We are consistent in our message to Ugandans: tobacco harms. We support those who already have tobacco-related cancer and because we see the terrible suffering tobacco inflicts on our fellow citizens, we advocate for policy change that makes a difference.

The single most effective way of reducing tobacco use is to make this deadly product less affordable by increasing taxes and prices to a level where people reduce or halt their consumption. Unfortunately, this most effective of tobacco control measures was not included in the Ugandan Tobacco Control Act, 2015.

Even as we make the case for health, the tobacco industry claims that increasing tobacco taxes is harmful to the economy. The facts just do not support that argument. A health cost study by the Centre for Tobacco Control in Africa (CTCA) and partners found that for every one Shilling the Ugandan Government currently receives in the form of tobacco taxes, it spends four Shillings on treatment and related costs for tobacco-related disease, including cancer. In a recent court case brought by tobacco giant British American Tobacco (BAT) to try block implementation of the 2015 Tobacco Control Act, the health ministry stated that the government spends over sh1.8b each year treating tobacco related diseases, and the cost of treating a patient with tobacco related cancer is at least sh6m. That is harmful to our health system and our economy.

Now that BAT has been defeated in its appeal to the courts, we encourage government to fully implement and enforce the 2015 Tobacco Control Act. There is clear evidence that the tobacco industry still targets children and youth in Uganda, in spite of the fact that there is a ban on tobacco advertising and promotion, a ban on tobacco sales near schools, and a ban on tobacco sales to people under the age of 21. High tobacco taxes and prices should be used to reinforce the impact of the Act, encouraging current smokers to quit and discouraging youth from starting to use tobacco.

We feel strongly about this issue and believe that tobacco industry interference in tobacco control must be effectively countered if the country is to make meaningful progress. As such, UCS is building global and regional partnerships. We have joined a global coalition of cancer organizations - Prevent20 (wecanprevent20.org) - working to increase tobacco taxes and prevent tobacco-related cancers. We also can overcome the tobacco industry's falsehoods; UCS strongly supports and partners with regional efforts such as Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM - www.atim.co.za). We strongly believe that the East African region needs to build a strong coalition to monitor and counter Tobacco Industry's tactics and lies therein. Governments of the region need to adopt and enforce strong codes of conducts for public officials intending to work with the Tobacco Industry to sabotage public health.

Ugandans need to hear the truth about tobacco's physical and economic dangers. And the Addis Ababa Accord, agreed by governments from around the world, recommends using high tobacco taxes as a source of domestic funding for development priorities, including healthcare. That's an important message for our government, as it aims to balance the budget and seeks to find financing for health.

For example, in the recent tax amendments, the tax on medicines was increased. This poses a threat to the fight against ill health in general, but cancer treatment in particular. Cancer medicines are super specialised and generally expensive. Due to regular drug stock outs at Uganda Cancer Institute, patients have had to buy drugs from private clinics. Some patients have been left unable to maintain their treatment plans, resulting in poorer treatment outcomes and low survival rates. In terms of tobacco-related cancers, the tax on medicines is a tax on tobacco-related suffering, when we should be increasing taxes on the cause - tobacco - to a level that encourages people to cut down and quit, so they avoid tobacco-related disease.

For many years, we have had only minor tobacco tax increases, if any. Continued increases in tobacco taxes are always to be welcomed, but this year, once again, the rate of increase was not high enough to deliver real term reductions in affordability - especially for the lowest-cost, local brands likely to be used by the most vulnerable. Different rates of tax for different products also undermine the public health goal of reducing smoking, by encouraging tobacco users to switch to cheaper brands rather than quit. So tobacco prices remain low, especially when compared with household necessities like bread. How can that be? Bread sustains. Tobacco kills.

It is time for change.

WHO recommends that tobacco taxes should be high enough to deliver a public health impact. In the latest budget, Uganda has not met that recommendation. We urge policymakers to reduce preventable illness and death from tobacco-related cancer, protect the health of current and future generations of Ugandans, and raise revenues to support our country's development priorities, including healthcare services, by increasing tobacco taxes to WHO-recommended levels in the next budget.

The writer is the Executive Director of the Uganda Cancer Society