What Uganda can do to ensure healthy lives, wellbeing

By Taddeo Rusoke

The Framework Convention Alliance (2015) notes that implementation of the World Health Organisation Framework Convention on Tobacco Control (FCTC) is included in the Sustainable Development Goals (SDGs) that world leaders adopted in September 2015 at the UN General Assembly.

In fact, it is recognised as one of the "means of implementation" to reach the overall health goal (SDG 3) and a target on non-communicable diseases (NCDs).

Strengthening tobacco control is a proven, effective approach, with built-in revenue. The world has a new blueprint for development. On September 25, 2015, the United Nations member states agreed that the SDGs will replace the Millennium Development Goals (MDGs) as the guide to improving the lives of the world's people and the earth itself until 2030.

Now the hard work of translating the words into action and ultimately progress, begins. A first step will be for governments to establish priorities. The SDGs contain 169 commitments, so it is impossible for every government to give equal weight to each of them. Thus the Government must invest in fighting NCDs, which include the devastating, frightening killers such as diabetes, cardiovascular disease, cancers and chronic lung disease.

It was long thought that NCDs were ‘lifestyle' diseases of people living in high-income countries. NCDs account for 60% 35 million of global deaths, but the largest burden falls on low- and middle-income countries, making NCDs a major cause of poverty and an urgent development issue.

Globally, the impact of NCDs will increase 17% in the next 10 years, 27% in Africa. Low-income countries, many of which are still grappling with heavy burdens of infectious disease, risk being overwhelmed by this wave of largely preventable NCDs.

NCDs and tobacco use

The major risk factor to NCDs is tobacco use; Tobacco use kills more than six million people every year, the majority of them in their most productive years (aged 30-69). In the 20 century, 100 million people were victims of tobacco use: in this century it will kill one billion people, unless trends change. Fortunately, we know what steps to take to fight the tobacco epidemic and to prove that dire forecast wrong.

They are contained in the World Health Organisation Framework Convention on Tobacco Control (FCTC). The FCTC was adopted in 2005 and today has 180 parties, which represent almost 90% of the world's population. Uganda became a signatory of the FCTC on June 20, 2007.

WHO has described FCTC measures as a ‘best buy' in fighting NCDs. The former WHO director-general, Margaret Chan, told the NCD summit in 2011 that fully implementing the FCTC "would bring the single biggest blow to heart disease, cancer, diabetes and respiratory disease".

That message was heard. FCTC implementation is included in the SDGs. SDG 3 (the ‘health goal') is: Ensure healthy lives and promote well-being for all at all ages. Target 3.4 of SDG 3 is: by 2030, reduce by one-third premature mortality from NCDs through prevention, treatment and promotion of mental health and well-being. And target 3.a is: strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate.

The current WHO director-general, Dr Tedros Adhanom Ghebreyesus, has established the WHO Independent Global High-level Commission on NCDs. This will go a long way to mitigate NCDs especially those associated with tobacco use.

The need to increase taxes on tobacco products

Most importantly, raising tobacco taxes is known to be one of the most effective ways to cut tobacco consumption. In South Africa, total taxes on cigarettes rose from 32% to 52% of the retail price between 1993 and 2009.

This contributed to halving tobacco consumption from about four cigarettes per adult per day to two cigarettes per day over a decade and generated a nine-fold increase in government tobacco tax revenues.

Higher tobacco prices also discourage young people from starting to smoke and were strongly endorsed by former entrepreneur and philanthropist Bill Gates: "Among the revenue proposals, tobacco taxes are especially attractive because they encourage smokers to quit and discourage people from starting to smoke, as well as generate significant revenues. It's a win-win for global health." 

The world's governments endorsed tobacco taxation as a potential revenue source to finance development activities, at the Financing for Development conference in Addis Ababa from July 13-16, 2015.

The WHO FCTC developed guidelines on how governments can both raise taxes and make them more effective. Not only would comprehensive tobacco control programmes help Uganda to achieve SDG 3, fighting tobacco and tobacco use would advance progress on many other goals, including end poverty in all its forms everywhere, end hunger, promote sustainable agriculture, promote economic growth, and combat climate change.  So what are we waiting for? 

NCDs a barrier to sustainable development

NCDs are a huge barrier to development in Uganda, one that threatens to overwhelm government resources. The leaders of the WHO and the UN Development Programme have instructed their in-country representatives to work together to support governments that want to make the fight against NCDs a national priority.

World leaders have now signalled that taking action is essential to attaining sustainable development by 2030. It is, therefore, important for Uganda to seize this opportunity to invest in one of the ‘best buys' - strengthened tobacco control. It will pay dividends in the health of Ugandan citizens and in accelerating development overall. The onus is you and me to control tobacco use.  

The writer is a tobacco control research fellow at Nkumba University